胰腺癌磁共振波谱分析和胰周淋巴结转移的诊断研究

发布时间：2018-01-15 08:10

  本文关键词：胰腺癌磁共振波谱分析和胰周淋巴结转移的诊断研究　出处：《第二军医大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 胰腺 胰腺癌 磁共振成像 波谱 胰腺癌 淋巴结 转移 体层摄影术 X线计算机 胰腺癌 淋巴结 转移 磁共振成像

【摘要】：第一部分氢质子磁共振波谱对胰腺癌分析及其分化程度相关性研究研究目的:探讨氢质子磁共振波谱(~1H MRS)分析胰腺癌瘤体与瘤旁导管上皮内瘤变(Pan IN病变)及肿瘤不同分化程度的代谢物差异。研究方法:病理确诊为胰腺导管腺癌的患者47例(低分化17例、中分化30例),术前均行~1H MRS检查,使用呼吸门控的抑水PRESS序列对肿瘤的瘤体、瘤旁组织进行~1H MRS检测。分析出每个~1H MRS数据的胆碱峰(CCM)/脂肪峰(Lip)、胆固醇及不饱和脂肪酸峰(Chol+Unsat)/Lip、Chol+Unsat/CCM的峰下面积比,采用配对样本t检验比较瘤体和瘤旁组织的代谢物差异,用独立样本t检验比较胰腺导管腺癌低分化组和中分化组的代谢物差异。结果:同时获得瘤体和瘤旁数据共24例,瘤体组织的CCM/Lip(2.66±0.84)×10-1高于瘤旁组织(2.00±0.81)×10-1,瘤体组织的Chol+Unsat/Lip(3.24±1.09)×10-1高于瘤旁组织(2.58±0.92)×10-1,差异均有统计学意义(P0.05),瘤体和瘤旁组织的Chol+Unsat/CCM无统计学差异;胰腺低分化和中分化导管腺癌的CCM/Lip、Chol+Unsat/Lip、Chol+Unsat/CCM无统计学差异。结论:~1H MRS对鉴别胰腺癌与瘤旁Pan IN病变具有一定意义,但不可预测其肿瘤分化程度。第二部分胰腺癌淋巴结转移MSCT影像特征与病理对照研究研究目的:探讨胰腺癌淋巴结转移的MSCT影像学特征。研究方法:选取经病理确诊为胰腺癌且有淋巴结转移的患者30例,术前均进行多层螺旋CT(MSCT)胰腺增强扫描,分析转移淋巴结的部位、最大短轴径(MSAD)、淋巴结密度、强化、内部坏死及融合情况。结果:病理诊断转移淋巴结63枚,影像诊断转移淋巴结53枚。胰头癌以第13组、第17组转移率较高,胰体尾癌以第18组转移率较高。转移淋巴结MSAD为2~17mm,平均(7.23±4.03)mm。按淋巴结大小分为MSAD5mm组、5mm~10mm组和≥10mm组,每组转移淋巴结分别为10枚、18枚和25枚。3组转移淋巴结的强化枚数随淋巴结的增大而减少,而内部坏死、融合枚数随淋巴结的增大而增加,差异均有统计学意义(P0.05)。两两组间比较,MSAD5mm组(7/10)和5mm~10mm组(11/18)强化淋巴结枚数显著多于≥10mm组(2/25);MSAD5mm组(6/10)边缘清楚淋巴结显著多于≥10mm组(5/25);MSAD5mm组(2/10)内部坏死枚数显著少于≥10mm组(18/25);MSAD5mm组(0/10)和5mm~10mm组(2/18)融合淋巴结枚数显著少于≥10mm组(22/25),差异均有统计学意义(P0.05),其余指标差异均无统计学意义。结论:淋巴结不明显强化、内部坏死及融合为转移淋巴结主要影像学特征,结合淋巴结密度不均匀、边缘模糊的特征更有助于诊断转移淋巴结。第三部分胰腺癌淋巴结转移3.0T磁共振弥散加权成像的诊断研究研究目的:探讨术前3.0T磁共振弥散加权成像(DWI)对胰腺癌淋巴结转移的诊断价值。研究方法:选取经病理确诊为胰腺癌且有淋巴结转移的患者30例,术前均进行磁共振DWI检查,对应病理证实的转移和非转移淋巴结,分析淋巴结转移部位、测量淋巴结表观扩散系数(ADC)值和最大短轴直径(MSAD),采用受试者工作特征(ROC)曲线评估ADC值和MSAD对胰腺癌淋巴结转移的诊断价值。结果:DWI检查共明确淋巴结108枚,其中转移淋巴结54枚,非转移淋巴结54枚。胰头癌转移淋巴结的位置以第13组、16组、17组多见,胰体尾癌以第16组多见。转移淋巴结ADC值(1.51±0.28)×10-3 mm2/s明显低于非转移淋巴结ADC值(2.08±0.35)×10-3 mm2/s,转移淋巴结MSAD(7.03±2.49)mm长于非转移淋巴结MSAD(4.40±0.97)mm,差异均有统计学意义(P0.05)。ADC值诊断转移淋巴结的ROC曲线下面积为0.894,最佳阈值为1.78×10-3mm2/s,敏感度和特异度分别为85.2%、85.2%;MSAD诊断转移淋巴结的ROC曲线下面积为0.876,最佳阈值为5.65mm,敏感度和特异度分别为68.5%、90.7%。结论:3.0T磁共振DWI对胰腺癌淋巴结转移有较高的诊断价值。
[Abstract]:The first part of proton magnetic resonance spectroscopy of pancreatic cancer and its correlation analysis of differentiation research: Study of proton magnetic resonance spectroscopy (~1H MRS) of pancreatic carcinoma and peritumoral ductal intraepithelial neoplasia (Pan IN lesions) metabolite differences and tumour differentiation. Methods: 47 patients with pathologically diagnosed pancreatic ductal adenocarcinoma patients (17 cases of low differentiated, moderately differentiated in 30 cases), underwent ~1H MRS examination before operation, PRESS water suppression sequence using respiratory gating on tumor tumor and tumor adjacent tissues were detected. ~1H MRS analysis of each ~1H MRS according to the number of choline (CCM) / fat (peak Lip), cholesterol and unsaturated fatty acids (Chol+Unsat) /Lip, peak area of Chol+Unsat/CCM peak ratio, the difference of metabolite paired samples t test comparison of tumor and tumor adjacent tissues, independent samples t test to compare pancreatic ductal adenocarcinoma and low differentiation group and moderately differentiated group The difference of metabolites. Results: the tumor and its'contiguous also obtained data of a total of 24 cases, the tumor tissue of CCM/Lip (2.66 + 0.84) * 10-1 higher than the tumor adjacent tissues (2 + 0.81) * 10-1, tumor Chol+Unsat/Lip (3.24 + 1.09) * 10-1 higher than the tumor adjacent tissues (2.58 + 0.92) * 10-1, the difference had statistical significance (P0.05), no significant difference between tumor and tumor adjacent tissues Chol+Unsat/CCM; low differentiated pancreatic ductal adenocarcinoma of the CCM/Lip, Chol+Unsat/Lip, Chol+Unsat/CCM no significant difference. Conclusion: ~1H MRS has a certain significance for the differential diagnosis of pancreatic carcinoma and tumor adjacent Pan IN lesions, but can not predict the the degree of tumor differentiation. The second part of lymph node metastasis of pancreatic cancer MSCT image and pathology study objective: To explore the MSCT imaging features of lymph node metastasis in pancreatic cancer. Methods: selected pathologically confirmed pancreatic cancer and lymph node metastasis in 30 cases of patients, surgery All of multi-slice spiral CT (MSCT) pancreatic enhancement scanning, analysis of lymph node metastasis sites, the maximum short axis diameter (MSAD), lymph node density, internal enhancement, necrosis and fusion. Results: the pathological diagnosis of metastatic lymph node 63, imaging diagnosis of lymph node metastasis in 53 cases. Pancreatic cancer in thirteenth groups seventeenth, group transfer rate is high, with eighteenth groups of pancreatic body and tail carcinoma metastasis rate of lymph node metastasis is higher. MSAD is 2~17mm, the average (7.23 + 4.03) mm. according to the size of lymph node were divided into MSAD5mm group, 5mm~10mm group and 10mm group, each group of metastatic lymph nodes were 10, 18 and 25 in group.3 lymph node metastasis were enhanced to reduce the number of lymph nodes increases, and increases the number of internal necrosis, fusion with lymph node increased, the differences were statistically significant (P0.05). The comparison between the 22 groups, MSAD5mm group (7/10) and 5mm~10mm group (11/18) enhanced lymph node number was significantly higher than than in group 10mm (2/25); MSAD5mm group (6 /10) clear edge lymph nodes were significantly more than 10mm group (5/25); MSAD5mm group (2/10) were significantly less than the number of internal necrosis than 10mm group (18/25); MSAD5mm group (0/10) and 5mm~10mm group (2/18) fusion lymph node number was significantly less than 10mm group (22/25), the differences were statistically significant (P0.05), the other indexes showed no significant difference. Conclusion: the lymph node is not obvious enhancement, necrosis and fusion for internal features of metastatic lymph node imaging, combined with lymph node density, blurred edge features more helpful in the diagnosis of lymph node metastasis of pancreatic cancer. The third part to study lymph node diagnosis of 3.0T magnetic resonance diffusion weighted imaging transfer: To investigate the preoperative 3.0T magnetic resonance diffusion-weighted imaging (DWI) node metastases diagnostic value for pancreatic cancer lymph. Methods: selected pathologically confirmed pancreatic cancer and lymph node metastasis in 30 cases of patients, preoperative MRI 鎸疍WI妫，

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