基于磁共振扩散加权成像技术正常子宫肌层的应用研究

发布时间：2018-05-04 22:22

本文选题：子宫 + 磁共振扩散加权成像　；参考：《重庆医科大学》2015年硕士论文

【摘要】：第一部分子宫扩散加权成像磁化率伪影与肠道准备之间的相关性研究目的：探讨肠道准备对子宫扩散加权成像磁化率伪影的影响。方法：将60名健康女性受检者(23-45岁)随机分为两组(无肠道准备组和肠道准备组),每组30名受检者,然后对每一位受检者进行T2轴位和失状位、DWI扫描,然后由两名医师分别对其图像进行双盲法评价。结果：两名医师评价无肠道准备组肠道以气体为主的出现率平均为65.00%,以液体为主的出现率平均为35.00%；肠道准备组肠道以气体为主的出现率平均为23.33%,肠道以液体为主的出现率平均为76.67%,两名医师评价的两组结果均具有统计学差异(PI=0.001,P2=0.002)。肠道以气体为主时子宫DWI磁化率伪影阳性率平均为82.91%,肠道以液体为主时子宫DWI磁化率伪影阳性率平均为13.46%,两名医师评价磁化率伪影结果均具有统计学差异(P1=0.OOO,P2=0.000)。结论：子宫DWI检查前进行肠道准备有助于减少子宫DWI磁化率伪影的产生,从而提高子宫DWI的图像质量,这更有利于我们进行子宫组织学的研究、子宫疾病的诊断、监测以及治疗后的疗效评价。第二部分正常子宫肌层扩散加权成像ADC值在时间与空间上的对比研究目的：探讨健康女性子宫肌层ADC值在绝经期与育龄期子宫体、子宫颈的差异。方法：90名健康女性(绝经期、增殖期、分泌期各30名)均接受MR扫描,分别测量子宫体和子宫颈肌层ADC值,然后进行对比分析。结果：绝经期、分泌期、增殖期宫体肌层ADC值分别为(1.23±0.31)×10-3mm2/s、(1.86±0.13)×10-3mm2/s、(1.72±0.18)×10-3mm2/s,差异有统计学意义(F=67.30,P0.001);子宫颈肌层ADC值分别为(1.19±0.37)×10-3mm2/s、(1.82±0.18)×10-3mm2/s、(1.68 ±0.16)×10-3mm2/s,差异有统计学意义(F=47.89,P0.001)。绝经期、增殖期、分泌期的宫体和宫颈肌层ADC值均差异无统计学差异(P均0.05)。绝经期肌层ADC值明显低于增殖期、分泌期肌层ADC值(P0.05),增殖期肌层ADC值低于分泌期(P0.05)。结论：不同生理周期及不同子宫区域肌层ADC值的改变对影像学诊断子宫病变、鉴别子宫肌层的生理改变与病理改变、确立恶性肿瘤的侵犯范围及疾病治疗前后的随访具有重要的参考价值。第三部分不同月经周期正常子宫肌层ADC值的可重复性研究目的：探讨正常子宫肌层ADC值测量者内、测量者间的一致性以及不同月经周期正常子宫肌层ADC值的可重复性。方法：采用3.0 T磁共振对34例健康女性(增殖期18名,分泌期16名)进行2次盆腔MR扫描,前后两次扫描间隔一个月经周期。由两名放射科医师独立进行子宫肌层ADC值的测量,每一次扫描同一名医师间隔一周进行两次测量,分析比较各自前后两次测量的一致性(即测量者内的一致性),再取每一次扫描每一名医师两次测量的子宫肌层ADC值的平均值进行同一次扫描两名医师之间的一致性检验(即测量者间的一致性)以及两次扫描不同月经周期正常子宫肌层ADC值可重复性检验。结果：两次MR扫描两名医师测量者内一致性均较好,其ICC分别0.95,0.82,0.85,0.89；两次MR扫描测量者间的一致性均较好,其ICC分别为0.92,0.88。两名医师测量的子宫肌层ADC值在分泌期均大于增殖期,且差异具有统计学意义(P0.05)。增殖期和分泌期在两次检查中的差异均不具有统计学意义(P均0.05)。Bland-Altman分析发现两名医师测量得到的子宫肌层ADC值在增殖期95%的置信区间分别为：-14.3%-13.6%和-11.5%-12.8%；在分泌期95%的置信区间分别为：-7.6%-7.0%和-7.7%-7.8%。分泌期相对于增殖期较好。结论：正常子宫肌层ADC值的测量者内、测量者间的一致性较好,为正常子宫肌层ADC值的广泛运用于临床提供了证据,但正常子宫肌层ADC值可重复性在分泌期较增殖期好。
[Abstract]:The study of the correlation between magnetic susceptibility artifacts and intestinal preparation in the first part of the uterine diffusion-weighted imaging objective: To explore the effect of intestinal preparation on the susceptibility artifacts of diffusion-weighted imaging of the uterus. Methods: 60 healthy female subjects (23-45 years old) were randomly divided into two groups (no intestinal preparative group and intestinal preparation group), 30 subjects in each group. The T2 axis and DWI scan were performed on each patient, and the images were evaluated by two doctors respectively. Results: the average rate of gas based in the intestinal intestinal preparation group was 65%, the average rate of liquid dominated by two doctors was 65%, and the intestinal bowel preparation group was dominated by gas in the intestinal preparation group. The average rate of occurrence was 23.33%, the average rate of liquid dominated intestinal tract was 76.67%, and the two groups evaluated by two doctors were statistically different (PI=0.001, P2=0.002). The average susceptibility rate of DWI susceptibility in the intestines was 82.91%, while the DWI susceptibility rate of the uterus was 13.46% when the intestine was mainly liquid, and the average rate of false positivity was 13.46%. Two physicians evaluated the magnetic susceptibility artifacts with statistical differences (P1=0.OOO, P2=0.000). Conclusion: intestinal preparation before DWI examination can help reduce the production of DWI susceptibility artifacts and improve the image quality of uterine DWI, which is more conducive to the study of uterine histology, diagnosis and monitoring of uterine diseases. The second part of the normal uterine myometrium diffusion weighted imaging ADC value in time and space: To explore the difference between the ADC values of the uterine myometrium in the healthy women and the uterine cervix at the menopause and the childbearing age. Methods: 90 healthy women (menopause, proliferation, and secretory period 30) were all received MR scan, The ADC values of the uterine and cervical muscles were measured and compared. Results: the ADC values of the myometrium in the menopause, the secretory period and the proliferation period were (1.23 + 0.31) x 10-3mm2/s, (1.86 + 0.13) x 10-3mm2/s and (1.72 + 0.18) x 10-3mm2/s, and the difference was statistically significant (F=67.30, P0.001), and the ADC value of the cervix cervix was (1.19 + 0.37) x 10-3mm, respectively. 2/s (1.82 + 0.18) x 10-3mm2/s, (1.68 + 0.16) x 10-3mm2/s, the difference was statistically significant (F=47.89, P0.001). There was no statistical difference between the menopause period, the proliferative stage and the ADC value of the uterine cervix and cervix (P 0.05). The ADC value of the menopause myometrium was significantly lower than that of the colonization period, the secretory phase of muscularis ADC value (P0.05), and the ADC value of the proliferation stage muscle layer was lower than the secretory period. (P0.05) conclusion: the changes in the ADC values of different physiological cycles and different uterine regions have important reference value in imaging diagnosis of uterine lesions, identifying the physiological changes and pathological changes of the uterine myometrium, establishing the range of the invasion of the malignant tumor and the follow-up of the treatment of the disease before and after the treatment. The third part of the normal uterine myometrium is different from the menstrual cycle ADC. Objective: To investigate the repeatability of the ADC values in the normal uterine myometrium, the consistency between the surveyors and the repeatability of the ADC values of the normal uterine myometrium in different menstrual cycles. Methods: 3 T MRI were used in 34 healthy women (18 in proliferating period, 16 in secretory phase) for 2 pelvic MR scans, and one of the two intervals. The menstrual cycle. The ADC values of the myometrium of the uterus were measured independently by two radiologists, two measurements per week at the same doctor at each scan. The consistency of the two measurements before and after each (the consistency of the measured person) was compared, and the mean value of the ADC value of the uterine myometrium measured by each doctor at each scan was taken. The consistency test between the two doctors of the same scan (the consistency between the surveyors) and the reproducibility test of the normal uterine myometrium ADC value of the two scans in different menstrual cycles were tested. Results: the consistency of the two physicians in the two MR scans was better, the ICC was 0.95,0.82,0.85,0.89 respectively, and the one between the two MR scanned measurements. The ADC values of the ICC of the two physicians of 0.92,0.88. were all higher than the proliferation period, and the difference was statistically significant (P0.05). The difference between the proliferative and secretory phases in the two examinations was not statistically significant (P 0.05).Bland-Altman analysis found the A of the uterine myometrium measured by two physicians. The confidence intervals of the DC value of 95% in the proliferation period were -14.3%-13.6% and -11.5%-12.8%, respectively, and the confidence intervals of 95% in the secretory period were respectively: -7.6%-7.0% and -7.7%-7.8%. secreting phase were better than the proliferation period. Conclusion: the consistency of the surveyors is better within the ADC values of normal uterine myometrium, and it is widely used for the ADC value of the normal uterine myometrium. It provides evidence in clinical practice, but the ADC value of normal myometrium is reproducible in secretory phase than in proliferative phase.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.2

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