3.0TMRI多b值弥散加权成像对女性盆腔病变的诊断价值

发布时间：2018-02-25 02:23

本文关键词： 3.0TMRI DWI 双指数衰减模型盆腔肿瘤鉴别诊断　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过3.0TMRI对女性盆腔扫描，用多b值双指数衰减模型对病变部位进行处理，通过记录多种参数，用多种方法进行比较，来探讨多b值双指数衰减模型在盆腔良、恶性病变中的鉴别诊断价值。资料与方法：对56例病人69个病灶行MR750-DWI扫描，其中良性病变35个：肌瘤12个，囊肿12个，巧克力囊肿6个，囊腺瘤3个，畸胎瘤2个；恶性病变34个：宫颈癌16个（均为鳞癌），子宫内膜癌15个（均为腺癌），卵巢癌3个。把b值设置为0、50、300、600、800、1200s/mm2，通过AW451工作站，利用Functool-MADC软件进行处理，取三次测量的平均值，感兴趣区（RegionOfInterest，ROI）选择横断面较大、密度均匀的地方，尽量避开囊变、坏死、出血的地方，囊腺瘤测量实性部分，畸胎瘤测量脂肪成分，三次测量的感兴趣区面积尽量一致（每次浮动范围不超过20mm2），分别记录SlowADC值、FastADC值、StandardADC值、FractionoffastADC值，并分别进行比较。最后，把轴位T2脂肪抑制图像与StandardADC图融合，能够更好的显示盆腔的结构，更精确的定位肿瘤。把发病率高的子宫内膜癌和宫颈癌分别进行比较，以查看多b值双指数衰减模型对恶性肿瘤病理类型鉴别的价值。结果：良性病变的SlowADC值（1.74±0.89）×10-3mm2/s、StandardADC值（1.73±0.79）×10-3mm2/s值均大于恶性肿瘤[SlowADC值=（0.97±0.28）×10-3mm2/s、StandardADC值=（1.11±0.27）×10-3mm2/s]，良性病变与恶性病变的SlowADC值之间、StandardADC值之间的均有统计学意义（p均0.05），且SlowADC值在良、恶性病变间的差异较大。此外，良、恶性病变的FastADC值均大于SlowADC值，且良性病变的SlowADC值、FastADC值分别为（1.74±0.89）×10-3mm2/s、（15.94±9.01）×10-3mm2/s，两者之间有统计学意义（p0.05）；恶性病变的SlowADC值与FastADC值分别为（0.97±0.28）×10-3mm2/s、（13.85±8.96）×10-3mm2/s，两者之间亦有统计学意义（p0.05）。子宫内膜癌和宫颈癌的SlowADC分别为（0.96±0.23）×10-3mm2/s、（0.91±0.29）×10-3mm2/s，两者间没有统计学意义（p=0.54）；FastADC值分别为（11.14±6.58）×10-3mm2/s、（17.24±10.49）×10-3mm2/s，两者间亦没有统计学意义（p=0.15）。结论：DWI技术是一种快速的、准确的、无辐射的成像技术，且能结合ADC值的测量，对临床诊断很重要。作为MRI的一种功能成像，从微观结构监测组织的改变，早于常规影像学显示的形态改变。本文DWI双指数衰减模型使用多种参数、从多方面描述盆腔肿瘤的特性，在分子水平反映肿瘤组织的改变，比常规的MRI扫描更早的发现病灶，，并且通过对肿瘤组织定量测量对其定性，诊断常规MRI不能诊断的初级恶性肿瘤，同时提供肿瘤的血流灌注情况，有望代替增强扫描，避免有创检查及造影剂的后期肝肾损害。为鉴别盆腔良、恶性肿瘤提供丰富的鉴别诊断依据，但对肿瘤的病理类型的鉴别没有统计学意义，这可能本文病例数较少有关。
[Abstract]:Objective: to scan the female pelvic cavity with 3.0 T MRI and treat the lesion with multiple b value double exponential attenuation model. By recording various parameters and comparing them with various methods, we can explore whether the multi b value double exponential attenuation model is good in the pelvic cavity. Value of differential diagnosis in malignant lesions. Materials and methods: MR750-DWI scanning was performed on 69 lesions in 56 patients, including 35 benign lesions: 12 leiomyomas, 12 cysts, 6 chocolate cysts, 3 cystadenomas and 2 teratoma. 34 malignant lesions: 16 cervical carcinomas (all squamous cell carcinomas, 15 endometrial carcinomas, 3 adenocarcinoma and 3 ovarian carcinomas). The b value was set to 0 50 ~ 300 ~ 600 ~ (600) ~ 800 ~ 1200s / mm ~ (2). The mean value of three measurements was taken by AW451 workstation and Functool-MADC software. Region of interest (region of interest): select areas with large cross section and uniform density, avoid cystic degeneration, necrosis, bleeding, measure solid parts of cystadenoma, measure fat content in teratoma. The area of the area of interest measured three times is as consistent as possible (no more than 20mm ~ 2mm). The SlowADC value and the standard ADC value are recorded and compared respectively. Finally, the axial T2 fat suppression image is fused with the StandardADC image. It can better display the structure of the pelvic cavity and locate the tumor more accurately. Comparing the high incidence endometrial carcinoma and cervical cancer to see the value of multiple b value double exponential attenuation model in differentiating the pathological types of malignant tumors. Results: the SlowADC value of benign lesions was 1.74 卤0.89 脳 10-3 mm ~ (-2) / s and the value of SlowADC was 1.73 卤0.79) 脳 10 ~ (-3) mm ~ 2 / s, which was higher than that of malignant tumors [SlowADC = 0.97 卤0.28) 脳 10 ~ (-3) mm ~ (2 / 2) 脳 10 ~ (-3) mm ~ (2 / s). The SlowADC values of benign and malignant lesions were significantly higher than those of benign and malignant lesions (P < 0.05). In addition, there were significant differences between benign and malignant lesions. The FastADC value of benign and malignant lesions was higher than that of SlowADC. The SlowADC values of benign lesions were 1.74 卤0.89) 脳 10-3 mm ~ (-2) / s, respectively (15.94 卤9.01) 脳 10 ~ (-3) mm ~ (2) / s (P = 0.05), and the SlowADC and FastADC values of malignant lesions were 0.97 卤0.28) 脳 10 ~ (-3) mm / s 13.85 卤8.96 脳 10 ~ (-3) mm ~ 2 / s, respectively. The SlowADC of endometrial carcinoma and cervical carcinoma were 0.96 卤0.23 脳 10 ~ (-3) mm ~ (-2) P ~ (-1) 0.91 卤0.29) 脳 10 ~ (-3) mm ~ 2 / s, respectively. There was statistical significance (P = 11.14 卤6.58) 脳 10 ~ (-3) mm ~ (2) / s = 17.24 卤10.49) 脳 10 ~ (-3) mm ~ (2 / s), and there was no significant difference between them. ConclusionDWI is a rapid, accurate, radiation-free imaging technique, which can be combined with the measurement of ADC value, which is very important for clinical diagnosis. As a functional imaging of MRI, the changes of tissue are monitored from the microstructure. The DWI double exponential attenuation model uses a variety of parameters to describe the characteristics of pelvic tumors in many ways and reflect the changes of tumor tissues at the molecular level. The lesions were detected earlier than conventional MRI scans. And through the quantitative measurement of tumor tissue, the diagnosis of primary malignant tumor, which can not be diagnosed by conventional MRI, and at the same time provide the blood flow perfusion of the tumor, which is expected to replace the enhanced scan. In order to differentiate benign and malignant tumors from pelvic cavity, there is abundant basis for differential diagnosis, but there is no statistical significance in the differentiation of pathological types of tumors, which may be related to the small number of cases in this article.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R737.3

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