本文選題：乳腺病變 + 磁共振動(dòng)態(tài)增強(qiáng)��； 參考：《川北醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:1.探討擴(kuò)散峰度成像(Diffusion Kurtorsis Imaging,DKI)參數(shù)平均擴(kuò)散峰度(Mean kurtorsis,MK)及其衍生參數(shù)平均擴(kuò)散系數(shù)(Mean Diffusion,MD)對(duì)乳腺良惡性病變的診斷價(jià)值。2.探討動(dòng)態(tài)增強(qiáng)磁共振掃描(Dynamic Contrast-enhanced Magnetic Resonance Imaging,DCE-MRI)聯(lián)合DKI對(duì)乳腺良惡性病變的診斷價(jià)值。材料與方法:按納入標(biāo)準(zhǔn)隨機(jī)收集2016年6月至2017年1月因乳腺病變?cè)诖ū贬t(yī)學(xué)院附屬醫(yī)院行MRI平掃、DCE-MRI及DKI掃描患者45例,年齡為21~69歲,平均年齡為44.3±5.9歲,均為女性患者,經(jīng)術(shù)后病理證實(shí)的共50個(gè)病灶,其中良性病灶21個(gè),惡性病灶29個(gè)。從前述45例研究對(duì)象中隨機(jī)選取15例健側(cè)正常乳腺纖維腺體組織作為對(duì)照組。分別由兩位放射科醫(yī)生采用盲法獨(dú)立測(cè)量對(duì)照組、良性病變組、惡性病變組MD值、MK值,對(duì)所得結(jié)果進(jìn)行正態(tài)分布及方差齊性檢驗(yàn),采用Kruskal-Wallis檢驗(yàn)、單因素方差分析比較MK值、MD值在各組間的統(tǒng)計(jì)學(xué)差異。分別由兩位放射科醫(yī)生采用盲法按DCE-MRI、DCE-MRI結(jié)合DKI兩種方法對(duì)45例乳腺病變進(jìn)行分類,組內(nèi)及組間的比較采用?2檢驗(yàn)。繪制ROC曲線,比較兩參數(shù)、兩種方法間的診斷效能。結(jié)果:(1)MD值、MK值分別在對(duì)照組、良性病變組、惡性病變組間差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。惡性病變組MK值0.90±0.19(10-3mm2/s)高于良性病變組0.54±0.13(10-3 mm2/s)與對(duì)照組0.48±0.13(10-3mm2/s),惡性病變組MD值1.41±0.32(10-3 mm2/s)低于良性病變組1.98±0.38(10-3 mm2/s)與對(duì)照組2.25±0.26(10-3 mm2/s)。根據(jù)ROC曲線顯示,分別以1.61(10-3 mm2/s)/0.73(10-3 mm2/s)作為MD/MK值診斷乳腺良惡性病變的臨界值時(shí),其診斷乳腺惡性病變的靈敏度與特異性分別為77.6%/81.0%、80.0%/93.5%,MD值、MK值曲線下的面積(AUC)分別是0.88、0.95。(2)根據(jù)DCE-MRI對(duì)乳腺良惡性病變進(jìn)行分類,其診斷乳腺惡性病變的靈敏度、特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確性分別為93.1%、71.4%、81.8%、88.2%、84.0%;根據(jù)DCE-MRI聯(lián)合DKI對(duì)乳腺良惡性病變進(jìn)行分類,其診斷乳腺惡性病變的靈敏度、特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確性分別為93.1%、85.7%、90.0%、90.0%、90.0%。兩種方法AUC分別為0.86、0.92。結(jié)論:(1)DKI參數(shù)MK值及其衍生參數(shù)MD值對(duì)于乳腺良惡性病變的判斷具有較高的診斷價(jià)值,且MK值診斷效能優(yōu)于MD值。(2)DKI聯(lián)合DCE-MRI的使用可以進(jìn)一步提高DCE-MRI對(duì)乳腺惡性病變的診斷效能。
[Abstract]:Purpose 1.To investigate the diagnostic value of mean diffusion kurtosis (mean diffusion kurtosis) of diffusion kurtosis imaging (DKI) and its derived parameter mean diffusion coefficient (mean diffusion coefficient) in the diagnosis of benign and malignant breast lesions.To evaluate the diagnostic value of dynamic Contrast-enhanced Magnetic Resonance imaging DCE-MRI combined with DKI in benign and malignant breast lesions.Materials and methods: from June 2016 to January 2017, 45 patients with breast lesions underwent MRI plain scan DCE-MRI and DKI scan in affiliated hospital of North Sichuan Medical College. The age was 21 ~ 69 years, the average age was 44.3 鹵5.9 years.There were 50 lesions confirmed by postoperative pathology, including 21 benign lesions and 29 malignant lesions.Fifteen healthy normal breast fibrous glands were randomly selected from the 45 subjects as control group.The MK values of the control group, benign lesion group and malignant lesion group were measured by two radiologists, respectively. The results were tested by normal distribution and homogeneity of variance, and Kruskal-Wallis test was used.Single factor analysis of variance (ANOVA) was used to compare the statistical difference of MK and MD in each group.45 cases of breast lesions were classified by two radiologists according to the methods of DCE-MRIMr and DKI respectively.Draw the ROC curve, compare the diagnostic efficiency between the two parameters and the two methods.Results there were significant differences in MK and MK between control group, benign lesion group and malignant lesion group (P 0.05).According to the ROC curve, when using 1.61g 10-3 mm2/s)/0.73(10-3 mm 2 / s as the critical value of MD/MK for the diagnosis of benign and malignant breast lesions,The AUC of the two methods was 0.86 ~ 0.92, respectively.Conclusion the MK value of DKI and its derived parameter MD are valuable in the diagnosis of benign and malignant breast lesions, and the diagnostic efficacy of MK value is better than that of MD value. DKI combined with DCE-MRI can further improve the diagnostic efficacy of DCE-MRI in the diagnosis of breast malignant lesions.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R655.8;R737.9

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