多b值DWI对兔闭袢性肠梗阻的诊断价值

发布时间：2018-03-20 06:15

本文选题：闭袢性肠梗阻　切入点：磁共振成像　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对不同梗阻时间点的闭袢性肠梗阻兔模型进行磁共振多b值DWI检查,分析DWI成像参数(ADC值)与病理评分之间的关系,探讨多b值DWI对兔闭袢性肠梗阻的诊断价值。方法:成年健康中国大耳白兔35只,雌雄不限,兔龄3-4月,体重(2.4±0.5)kg。将其进行随机分组,其中20只作为实验组(分为1h、2h、3h、4h、5h五个时间点,每个时间点4只),对照组15只(与实验组对应时间点,每时间点3只)。实验组兔采用“U”形结扎制作CLO模型;对照组仅打开腹腔,暴露并翻动肠管,而不损伤肠管。在造模后第1h、2h、3h、4h、5h行常规MRI、DWI(b=0、200、400、600、800、1000s/mm2)扫描及病理检查。统计分析肠壁ADC值与病理积分及肠壁厚度间相关关系。结果:1.病理结果:对照组肠壁呈自然肉粉色,肠蠕动明显,肠管未见扩张,肠系膜动脉搏动较明显。肠壁组织病理学未见异常,组织结构清晰完整。实验1h组梗阻肠管颜色明显加深,部分肠管稍扩张,肠蠕动较正常肠管减弱,实验3h组梗阻肠管呈深褐色,管腔明显扩张,腹腔可见较多血性积液,肠蠕动不明显,可闻及少许腥臭味。实验5h组开腹即闻及腥臭味,肠管颜色呈紫褐色,管腔进一步扩张、积液,临近正常肠管稍扩张,颜色稍加深。实验组主要镜下表现为梗阻肠组织绒毛坏死、脱落,黏膜下层组织疏松、水肿、出血,肌纤维结构松散,排列不规整,炎症细胞侵润,并且随着时间延长而逐渐加重。实验组病理评分与对照组有显著差异(P=0.000);实验组1h与2h,4h与5h肠壁的评分差异无统计学意义(P值分别为0.107和0.318),而梗阻时间相差2h及以上者,肠壁的病理评分差异均有统计学意义(P0.05)。2.DWI参数测量结果:实验组及对照组肠壁ADC值均随b值的增加而逐渐减小。对照组各b值下不同时间点肠壁ADC值无差异(P0.05)。实验组各b值下不同时间点肠壁ADC值差异存在统计学意义(P=0.000),其中在肠梗阻2h组b=600s/mm2和b=800s/mm2时及肠梗阻4h组b=200s/mm2和b=400s/mm2时肠壁ADC值差异无统计学意义(P值分别为0.267和0.344),余各时间点组不同b值间肠壁ADC值均存在差异(P=0.000)。实验组不同b值下,随时间延长,肠壁ADC值均逐渐减小,差异具有统计学意义(P=0.000)。r ADC值随着时间的延长而增加。实验组b=800s/mm2时肠壁ADC值与肠壁厚度中度负相关(|r|=0.449,P=0.047)。实验组不同b值下各组肠壁ADC值与病理积分呈负相关,且具有良好的相关性(|r|0.8,P=0.000),其中b=800s/mm2时ADC值与病理积分的相关性最好(|r|=0.893)。结论:1.闭袢性肠梗阻的ADC值与病理积分具有良好的相关性,其中b=800s/mm2时相关性最好。2.当ADC值变化率(r ADC)大于20.86%提示肠壁发生透壁性坏死。3.多b值DWI对兔闭袢性肠梗阻能够提供有用的诊断信息。
[Abstract]:Objective: to analyze the relationship between DWI imaging parameters and pathological score by using multi-b value DWI of magnetic resonance imaging (MRM) in rabbit models of closed loop intestinal obstruction at different obstructive time points. To investigate the diagnostic value of multi-b DWI in the diagnosis of closed loop intestinal obstruction in rabbits. Methods: 35 adult healthy Chinese large ear white rabbits, male and female, aged 3-4 months, weight of 2.4 卤0.5 kg, were randomly divided into two groups, 20 of them were divided into experimental group (1 h, 2 h, 3 h, 3 h, 4 h, 5 h, 5 h). There were 4 rats in each time point and 15 rats in the control group (3 rats in each time point corresponding to the experimental group). In the experimental group, the CLO model was made by "U" ligation, while in the control group, the abdominal cavity was opened, and the intestinal tube was exposed and turned over. No injury of intestinal duct was observed. Routine MRII / DWI / DWI / DWI / DWIBX / 200 / 200 / 600 / 800 / 1000 sm2 / m2) scan and pathological examination were performed at the first hour after modeling. The correlation between ADC value of intestinal wall and pathological score and thickness of intestinal wall was analyzed statistically. Results: 1. Pathological results: the intestinal wall of the control group was naturally pink with peristalsis, and the intestinal movement was obvious, and the results showed that the intestinal wall of the control group was pink in nature with obvious peristalsis, and the intestinal wall had obvious peristalsis. Mesenteric artery pulsation was not seen. The intestinal wall was not abnormal in histopathology, and the tissue structure was clear and complete. The color of intestinal obstruction was obviously deepened, some intestinal tubes were slightly dilated, and intestinal peristalsis was weaker in the experimental group than in the normal intestinal canal. In the experimental group, the intestinal obstruction was dark brown, the lumen was obviously dilated, more bloody effusion was found in the abdominal cavity, the intestinal peristalsis was not obvious, and a little smell of fishy odor could be smelled. In the experiment group of 5 h, the abdominal obstruction was smell and smell, the color of the intestinal tube was purple-brown, and the lumen was further dilated. The main findings of the experimental group were intestinal villus necrosis, shedding, loose submucosal tissue, edema, hemorrhage, loose structure of muscle fiber, irregular arrangement. Inflammatory cells infiltrate, The pathological score of the experimental group was significantly different from that of the control group (P = 0.000), and the score of the intestinal wall of the experimental group was not significantly different from that of the control group (P = 0.107 and 0.318g, respectively), but the difference of the obstruction time was 2 h or more than that of the control group. The difference of pathological score of intestinal wall was statistically significant. 2. The results of parameter measurement on DWI showed that the ADC value of intestinal wall in experimental group and control group decreased gradually with the increase of b value, but there was no difference in ADC value of intestinal wall in control group at different time points under b value. The experiment showed that there was no difference in ADC value of intestinal wall at different time points in control group. There was significant difference in ADC value of intestinal wall between groups at different time points under b value. There was no significant difference in ADC value of intestinal wall between 2 h group and 4 h group (P < 0. 267 and 0. 34 4), respectively, when bnr 600 s / mm2 and bN 800 s / mm2, and 4 h group with intestinal obstruction, bn 200 s / mm2 and 4 h group respectively (P = 0. 267 and 0. 344 / mm2, P < 0.05). There were differences in ADC values of intestinal wall between different b values of point group and different b values in experimental group. Over time, the ADC values of intestinal wall decreased gradually. The difference was statistically significant (P < 0.01). The value of ADC increased with time. The ADC value of intestinal wall in the experimental group was negatively correlated with the thickness of the intestinal wall at 800 s / mm ~ 2 (r = 0.449). The ADC value of the intestinal wall in the experimental group was negatively correlated with the pathological score under different b values. The correlation between ADC value and pathological score was the best (r 0.800 s / mm2) (r = 0.8930.Conclusion: 1. The ADC value of closed loop intestinal obstruction has a good correlation with pathological score, and there is a good correlation between ADC value and pathological score in BX 800s / mm2, r = 0.8930.Conclusion: 1) there is a good correlation between ADC value and pathological score in closed loop intestinal obstruction. The best correlation was at 800 s / mm2. When the change rate of ADC value was greater than 20.86%, it suggested that transmural necrosis occurred in the intestinal wall. Multi-b DWI could provide useful diagnostic information for closed loop intestinal obstruction in rabbits.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R574.2

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