基于多指数模态扩散加权成像评价急性胰腺炎的诊断价值研究

发布时间：2018-04-08 17:34

本文选题：急性胰腺炎　切入点：弥散加权成像　出处：《川北医学院》2017年硕士论文

【摘要】：目的:探讨单指数模型、基于体素内不相干运动(intravoxel incoherent motion,IVIM)理论的双指数模型和基于水通道蛋白(aquaporin,AQP)的拉伸指数模型(stretched exponential model)弥散加权成像对急性胰腺炎(acute pancreatitis,AP)的诊断及临床严重程度分型方面的价值。方法:前瞻性按纳入标准收集本院2016年8月~2017年2月53名临床确诊为急性胰腺炎患者(AP)及20名健康志愿者(NP)进行上腹部常规MRI和14个b值(0、25、50、75、100、150、200、400、600、800、1000、1200、1500、2000s/mm2)的DWI检查,通过Balthazar分级标准评价急性胰腺炎MRSI,分出轻症、中重症、重症AP三型,测量并比较DWI单指数模型参数Standard ADC,双指数模型参数slow ADC mono、fast ADC mono、Ff ADC mono、slow ADC Bi、fast ADC Bi、Ff ADC Bi,和拉伸指数模型参数DDC(扩散分布指数)、α(水分子扩散异质性指数)在AP诊断及临床严重程度分型方面的价值。结果:独立样本t检验显示,AP组与NP组DWI单指数模型参数standard ADC、双指数模型参数Ff ADC mono、拉伸指数模型参数DDC和α有统计学差异(p值分别为0.003、0.009、0.000、0.000),slow ADC mono、fast ADC mono、slow ADC Bi、fast ADC Bi、Ff ADC Bi值无统计学差异(p值分别为0.658、0.582、0.494、0.483、0.975)。ROC曲线显示,standard ADC、Ff ADC mono、DDC、α值AUC分别为0.758、0.697、0.744、0.806,敏感性分别为81.1%、64.2%、81.1%、79.2%,特异性分别为65.0%、75.0%、60.0%、75.0%。配对比较显示,standard ADC与FfADC mono、standard ADC与DDC、standard ADC与α、Ff ADC mono与DDC、Ff ADC mono与α、DDC与α间诊断效能无统计学差异(p值分别为0.235、0.728、0.590、0.212、0.237、0.488)。单因素方差分析显示,轻症、中重症、重症AP的standard ADC、Ff ADC mono、DDC、α值有统计学差异(p值分别为0.002、0.007、0.000、0.017)。LSD两两比较显示,对区分轻症与重症AP参数standard ADC、Ff ADC mono、DDC、α有统计学差异(p值分别为0.001、0.002、0.002、0.013);对区分轻症与中重症AP参数Ff ADC mono、α有统计学差异(p值分别为0.028、0.026),参数standard ADC、DDC无统计学差异(p值分别为0.074、0.059);对区分中重症与重症AP参数standard ADC、Ff ADC mono、DDC有统计学差异(p值分别为0.012、0.000、0.046),参数α无统计学差异(p值为0.253)。结论:单指数模型参数standard ADC、双指数模型参数Ff ADC mono、拉伸指数模型参数DDC和α可用于急性胰腺炎的诊断,并有助于急性胰腺炎临床严重程度的分型。
[Abstract]:Objective: to explore a single exponential model,The value of dual exponential model based on intravoxel incoherent motion1 and aquaporin aquaporin aquaporin aqua aqua (aquaporin aqua) extension index model (DWI) diffusion weighted imaging in the diagnosis and clinical severity of acute pancreatitis (AP).Methods: from August 2016 to February 2017, 53 clinically diagnosed patients with acute pancreatitis and 20 healthy volunteers were prospectively collected according to the inclusion criteria to perform DWI examination of routine epigastric MRI and 14 b values of 2550,75100200400400800,10002001200,1500 / 2000s / m2).According to Balthazar grading criteria, acute pancreatitis was classified into mild, moderate and severe AP types.The parameters of DWI single exponential model Standard, slow ADC fast ADC fast ADC F F ADC slow ADC fast ADC ADC F f ADC, and extension index model parameters DDC (Diffusion Distribution Index, 伪) were measured and compared in the diagnosis and clinical practice of AP.The value of severity classification.Results: t test of independent samples showed that there were significant differences in standard, F _ f ADC, DDC and 伪 between AP group and NP group. The values of DDC and 伪 were 0.003 ~ 0.009 ~ 0.000 and 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1) ~ (-1), respectively.Pairwise comparison showed that there was no significant difference in diagnostic efficacy between standard ADC and monochromatic ADC and DDCF ADC mono and DDCF ADC mono and 伪 -DDC and 伪 -DDC, respectively. The diagnostic efficacy of standard ADC and FfADC monochromatic ADC and DDCF ADC mono were 0.235 卤0.7280.590 and 0.2120.2370.488respectively.Univariate analysis of variance showed that there were significant differences in standard ADCF F ADC ADC DDCA between mild, moderate and severe AP, and the 伪 values were 0.002 ~ 0.007 ~ 0.000 ~ 0.000 ~ 0.017 ~ (?) L ~ (SD), respectively.There were significant differences in the parameters of standard ADCF F ADC monoDDC between the severe and the severe AP, the values of P were 0.012 ~ 0.000 ~ 0.046, and there was no significant difference in parameter 伪 between the two groups (P = 0.253).Conclusion: single exponential model parameter standard, double exponential model parameter F f ADC mono, stretching index model parameter DDC and 伪 can be used in the diagnosis of acute pancreatitis, and it is helpful for clinical classification of acute pancreatitis.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R576

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