本文選題：擴(kuò)散加權(quán)成像　切入點(diǎn)：高級(jí)別膠質(zhì)瘤　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討ADC直方圖及其相關(guān)參數(shù)在鑒別高級(jí)別膠質(zhì)瘤與腦轉(zhuǎn)移瘤中的應(yīng)用價(jià)值。材料與方法對(duì)未經(jīng)過手術(shù)、化療、放療及其他抗腫瘤治療的13例高級(jí)別膠質(zhì)瘤和20例腦轉(zhuǎn)移瘤行常規(guī)MR平掃、增強(qiáng)及DWI掃描(b=0,1000),將DWI掃描所重建出的ADC圖,參照T2WI圖像逐層勾畫出腫瘤的邊界,通過第三方軟件生成整個(gè)瘤體的ADC直方圖,并計(jì)算出直方圖的平均值(ADCmean)、最大值(ADCmax)、最小值(ADCmin)、中位數(shù)(ADCmedian)、峰度、偏度、方差、極差和5th~95th百分位點(diǎn)之間每隔5個(gè)百分位點(diǎn)所測(cè)得的ADC值。比較高級(jí)別膠質(zhì)瘤和腦轉(zhuǎn)移瘤ADC直方圖的各相關(guān)參數(shù)值之間的差異,P0.05的參數(shù)認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義,并通過ROC曲線評(píng)價(jià)各參數(shù)的診斷效能。結(jié)果高級(jí)別膠質(zhì)瘤與腦轉(zhuǎn)移瘤的ADC直方圖均為頻數(shù)分布不對(duì)稱的偏態(tài)分布。高級(jí)別膠質(zhì)瘤多為正偏態(tài)分布,高峰更為陡峭,通常呈“高狹峰”,右側(cè)的尾部多延伸較長,明顯長于左側(cè),ADC值大部分分布于左側(cè);腦轉(zhuǎn)移瘤呈負(fù)偏態(tài)分布或正偏態(tài)分布,偏度一般小于高級(jí)別膠質(zhì)瘤,呈“低闊峰”,左側(cè)尾部多稍長于右側(cè),ADC值大多分布在右側(cè),且ADC值的分布較高級(jí)別膠質(zhì)瘤集中。從統(tǒng)計(jì)結(jié)果看,高級(jí)別膠質(zhì)瘤的峰度、偏度、ADCmax和極差分別為4.40±2.08、0.87±0.72、2.63±0.44×10-3mm2/s、2.14±0.52×10-3mm2/s,轉(zhuǎn)移瘤的峰度、偏度、ADCmax和極差分別為3.12±1.44、0.41±0.55、2.17±0.65×10-3mm2/s、1.55±0.69×10-3mm2/s,轉(zhuǎn)移瘤的以上四個(gè)參數(shù)值均低于高級(jí)別膠質(zhì)瘤相應(yīng)參數(shù)值,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。峰度系數(shù)的ROC曲線下面積為0.71,敏感度76.92%,特異度60%,其最佳閾值為2.87;偏度系數(shù)的ROC曲線下面積為0.72,敏感度53.85%,特異度90.00%,其最佳閾值為1.11;極差的ROC曲線下面積為0.76,敏感度84.62%,特異度65.00%,其最佳閾值為1.70×10-3mm2/s;ADCmax的ROC曲線下面積為0.70×10-3mm2/s,敏感度76.92%,特異度60.00%,最佳閾值為2.20×10-3mm2/s。極差的AUC和敏感度最好,偏度系數(shù)的特異度最好,兩者聯(lián)合特異度為58.50%,聯(lián)合敏感度為92.90%,其聯(lián)合敏感度高于單一參數(shù)的敏感度。結(jié)論ADC直方圖在對(duì)高級(jí)別膠質(zhì)瘤與腦轉(zhuǎn)移瘤的鑒別中相對(duì)于常規(guī)ADC值測(cè)定具有一定的優(yōu)勢(shì),可能成為有價(jià)值的新方法。
[Abstract]:Objective to evaluate the value of ADC histogram and its related parameters in differentiating high grade gliomas from brain metastases.Materials and methods 13 cases of high grade gliomas and 20 cases of brain metastases without operation, chemotherapy, radiotherapy and other antitumor therapy were examined by conventional Mr scan, enhanced Mr scan and DWI scan. ADC images were reconstructed by DWI scan.The ADC values measured at every five percentile points between the range and the 5th~95th percentile.Comparing the differences of ADC histogram parameters between high-grade gliomas and brain metastases, the difference was statistically significant, and the diagnostic efficacy of each parameter was evaluated by ROC curve.Results the ADC histograms of high grade gliomas and brain metastases were skewed with asymmetric frequency distribution.The high grade gliomas are mostly positive skew distribution, the peak is steeper, usually "high narrow peak", the right tail extension is longer, obviously longer than the left side ADC value distribution most of the left side, brain metastases show negative skew distribution or positive skew distribution.The degree of deviation is generally smaller than that of high grade gliomas, showing a "low broad peak". The value of ADC in the left tail is longer than that in the right, and the ADC value is concentrated in the higher grade gliomas.浠庣粺璁＄粨鏋滅湅,楂樼駭鍒兌璐ㄧ槫鐨勫嘲搴，

本文編號(hào)：1706645