多参数MRI成像在甲状腺结节良恶性鉴别诊断中应用价值的研究

发布时间：2018-04-27 21:41

本文选题：甲状腺结节 + 良恶性　；参考：《江苏大学》2017年硕士论文

【摘要】：目的:探讨应用多参数MRI平扫、动态增强及常规增强的单一参数及联合应用多参数MRI成像各参数在鉴别甲状腺结节良恶性中的价值。材料与方法:共计85例甲状腺结节患者被纳入本研究,这些患者被检测出一个或多个甲状腺结节。对患者进行甲状腺区的常规MRI平扫、MRI弥散加权成像(Diffusion weighted imaging,DWI)及MRI增强(包括MRI动态增强)扫描。在T2WI、DCE-MRI及常规MRI(Contrast-Enhanced MRI,CE-MRI)增强图像中,观察结节边界(分别标为MT2、MDCE及MCE)是否清楚,并将其分为边界清楚和边界不清两组。对每个结节表观弥散系数(Appearent Diffusion Coeficient,ADC)值、动态增强MRI(Dynamic Contrast-Enhanced MRI,DCE-MRI)的时间信号强化曲线(Time Signal-intensity Curve,TIC)等各主要参数等定量分析资料进行了测量、记录和分析。本研究中所有患者均于检查后72小时内行甲状腺一侧叶切除或甲状腺全切手术。最后将MR检查结果与手术病理结果进行对比分析。结果:本组病例共检出144个甲状腺结节,病理及免疫组化结果显示其中的83个为恶性结节,61个为良性结节。以单个结节为观察单位,恶性结节组患者的年龄较良性结节组小。多参数MRI成像显示的单个变量(MT2、MDCE、MCE、ADC及IR)对甲状腺结节的良恶性的鉴别诊断存在显著的统计学差异,P0.01。恶性结节倾向于边界不清,但是MT2、MDCE及MCE显示良恶性甲状腺结节边界是否清楚的特异性较低,不足以满足临床诊断的需求。恶性甲状腺结节的最大径较良性结节小;恶性结节在不同b值(b-300s/mm2,b-500s/mm2和800s/mm2)时的ADC值、DCE-MRI增强前的病灶信号值(Signal-intensity of precontrast,Ipre)较良性结节小;而恶性结节的流入增强比(Increment Ratio,IR)明显高于良性结节。运用Logistic回归分析中的Forward/Wald方法对所有的多参数数据进行筛选、分析时,我们发现联合应用b-500 ADC、MDCE和IR(%)时,可以得到最佳的鉴别诊断效果(P0.0001)。最终联合应用多参数进行的统计学分析,其AUC为0.853,敏感性为81.25%,特异性为76.67%,PPV为82.3%、NPV为75.4%。在联合应用的分析方法中,b值取500 s/mm2时的ADC值,MDCE和IR(%)的P值分别为0.026,0.002和0.009。结论:本研究中,联合运用多参数MRI扫描可以提高MR鉴别诊断甲状腺结节良恶性的能力,最佳的解决方案是联合应用b-500时的ADC值,MDCE和IR(%)对甲状腺结节的良恶性进行鉴别诊断。
[Abstract]:Objective: To investigate the value of multi parameter MRI scan, dynamic enhanced and conventional enhanced single parameters and the combination of multi parameter MRI imaging parameters in the differential diagnosis of benign and malignant thyroid nodules. Materials and methods: a total of 85 patients with thyroid nodules were included in this study, and these patients were detected one or more thyroid nodules. Routine MRI scan, MRI diffusion weighted imaging (Diffusion weighted imaging, DWI) and MRI enhancement (including MRI dynamic enhancement) scan were performed in the thyroid region. In the enhanced images of T2WI, DCE-MRI, and conventional MRI (Contrast-Enhanced), it was observed whether the boundary of nodules was clear and divided into clear boundaries and edges. Two groups were not clearly defined. Quantitative analysis data, such as the apparent dispersion coefficient (Appearent Diffusion Coeficient, ADC) of each nodule, the dynamic enhanced MRI (Dynamic Contrast-Enhanced MRI, DCE-MRI) time signal enhancement curve (Time Signal-intensity Curve,) were measured, recorded and analyzed. All the patients in this study were recorded and analyzed. 72 hours after examination, the thyroidectomy or total thyroidectomy was performed within 72 hours. Finally, the results of the examination were compared with the results of the operation and pathology. Results: 144 thyroid nodules were detected in this group. Pathological and immunohistochemical results showed that 83 of them were malignant nodules and 61 were benign nodules. Single nodules were observed. The age of the patients with malignant nodules was smaller than that in the benign nodule group. The single variable (MT2, MDCE, MCE, ADC, and IR) of multiple parameter MRI imaging showed significant differences in the differential diagnosis of benign and malignant thyroid nodules. The P0.01. malignant nodules tended to be indistinct, but MT2, MDCE, and MCE showed whether the border of benign and malignant thyroid nodules was on the border. The clear specificity is low enough to meet the needs of the clinical diagnosis. The maximum diameter of the malignant thyroid nodule is smaller than the benign nodule; the ADC value of the malignant nodules at different b values (b-300s/mm2, b-500s/mm2 and 800s/mm2), the signal value of the lesion before DCE-MRI enhancement (Signal-intensity of precontrast, Ipre) is smaller than the benign nodule; and the flow of the malignant nodules. The Increment Ratio (IR) was significantly higher than the benign nodule. Using the Forward/Wald method in the Logistic regression analysis, all the multiparameter data were screened. When we found the combined application of b-500 ADC, MDCE and IR (%), we found the best diagnostic diagnostic effect (P0.0001). Finally, the combined application of multi parameter statistics was found. The AUC was 0.853, the sensitivity was 81.25%, the specificity was 76.67%, the PPV was 82.3%, and the NPV was 75.4%. in the combined application. The b value was 500 s/mm2 ADC, MDCE and IR (%) P values were 0.026,0.002 and 0.009. conclusions: in this study, the combined use of multi parameter scanning can improve the differential diagnosis of thyroid nodules. The best solution is the ADC value when combined with b-500, and MDCE and IR (%) are used for differential diagnosis of benign and malignant thyroid nodules.

【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581;R445.2

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