~1H-MRS对肝脏囊型包虫病的应用研究

发布时间：2018-05-20 14:29

本文选题：磁共振 + 磁共振波谱成像　；参考：《青海大学》2017年硕士论文

【摘要】：实验目的:通过分析1H-MRS肝脏囊型包虫病药物治疗前后的代谢产物的波峰形态特征及代谢差异性,为临床早期判定囊型包虫病药物治疗效果提供一种新的影像学途径。对象和方法:收集2015年4月至2016年12月在青海大学附属医院通过实验室检查、影像学检查与临床方法确诊为肝脏囊型包虫病患者23例,分别于药物治疗前及药物治疗半年后行3.0T MRI腹部常规序列及磁共振波谱序列扫描,每个病人选一个病灶,每个病灶测一个体素,其中多发病灶选取最大病灶,观察并对比分析其谱线特点及差别,并分别测量出组织内水(H2O)、脂肪亚甲基(Lip2)峰高及峰下面积、胆碱复合物(Cho)峰高及峰下面积、Cho/Lip2峰高的比值,并对其结果进行对比和分析。结果:23个肝脏囊型包虫病灶中,药物治疗前MRS显示18个病灶内检测出轻度升高的Cho峰,检出率达到78.3%(18/23),其中3个病灶检测到倒置的Cho峰,所有病灶内均检测到H2O峰及Lip2峰,检出率100%(23/23);药物治疗后MRS显示20个病灶内检测出略高的Cho峰,检出率达到86.9%(20/23),其中有1个病灶内检测到倒置的Cho峰,所有病灶内均检测到H2O峰及Lip2峰,检出率100%(23/23);23个肝脏囊型包虫病病灶中药物治疗前的Cho峰有19个低于药物治疗后;23个肝脏囊型包虫病灶中药物治疗前的Lip2峰有15个高于药物治疗后;23个肝脏囊型包虫病灶中药物治疗前的Cho峰下面积有14个低于药物治疗后;23个肝脏囊型包虫病灶中药物治疗前的Lip2峰下面积有14个低于药物治疗后;比较两组样本中Lip2峰的峰高及峰下面积变化不明显,差异无统计学意义(t=-0.882、0.346,P0.05);比较两组样本中Cho的峰高及峰下面积及Cho/Lip2峰高的比值,均较前明显减低,差异有统计学意义(t=5.641、2.442、3.157,P0.05)。结论:肝脏囊型包虫病药物治疗前与药物治疗半年后常规磁共振检查,大小、信号未见明显差异;然而通过氢质子磁共振波谱检查发现一定的特异性,1H-MRS能够无创性的早期通过Cho的峰高、峰下面积及Cho/Lip2的峰高比值的变化发现病变进展情况,为早期判定囊型包虫病药物治疗效果提供新的途径,亦为临床进一步治疗提供一定的帮助。
[Abstract]:Objective: to provide a new imaging approach for early clinical evaluation of the efficacy of drug therapy for cystic hydatid disease by analyzing the peak morphological characteristics and metabolic differences of metabolites before and after drug therapy in 1H-MRS liver cystic hydatid disease. Participants and methods: from April 2015 to December 2016, 23 patients with hepatic cystic hydatid disease were diagnosed by laboratory, imaging and clinical methods in the affiliated Hospital of Qinghai University. 3. 0T MRI abdominal routine sequence and magnetic resonance spectrum sequence were performed before and half a year after drug treatment. Each patient selected one lesion, each lesion measured an individual element, and multiple lesions selected the largest lesion. The characteristics and differences of the spectral lines were observed and compared. The peak height and the area under the peak of H _ 2O _ 2, lipid methylene lipid _ (2), the ratio of the peak height of choline complex Choand the area under the peak of Cho-P / Lip2 were measured respectively, and the results were compared and analyzed. Results: of the 23 hepatic cystic hydatidosis foci, MRS showed slightly elevated Cho peaks in 18 lesions before drug therapy, and the detection rate was 78.3% 18 / 23%. Among them, 3 lesions detected inverted Cho peaks, and all lesions detected H2O peaks and Lip2 peaks. After drug treatment, MRS showed slightly higher Cho peaks in 20 lesions, and the detectable rate reached 86.9 / 20 / 23. In one of the 20 lesions, inverted Cho peaks were detected, and H2O and Lip2 peaks were detected in all the lesions. The detection rate was 100% 23 / 23; 19 of 23 hepatic cystic hydatid lesions were lower than those after drug treatment; 15 of 23 hepatic cystic hydatid foci had higher Lip2 peaks before and after drug treatment; and 23 liver cystic hydatid foci had higher Lip2 peaks before and after drug treatment. The subpeak area of Cho in 23 hepatic cystic hydatid foci before and after drug therapy was 14 lower than that after drug therapy. There was no significant difference in peak height and subpeak area of Lip2 between the two groups, there was no significant difference between the two groups, and the ratio of peak height and subpeak area to Cho/Lip2 peak height in the two groups was significantly lower than that in the previous two groups, and the difference was statistically significant (P 0.05). Conclusion: there was no significant difference in the size and signal intensity of hepatic cystic hydatid disease before and six months after drug treatment. However, the results of hydrogen proton magnetic resonance spectroscopy showed that a certain specificity of 1H-MRS could noninvasively detect the progression of Cho by changing the peak height of Cho, the area under the peak and the ratio of peak height to peak height of Cho/Lip2. It provides a new approach for early evaluation of the efficacy of drug therapy for cystic hydatid disease, and also provides some help for further clinical treatment.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R532.32;R445.2

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