DCE-MRI不同分析方法对垂体腺瘤诊断及鉴别诊断的研究

发布时间：2018-02-27 13:27

本文关键词： 垂体腺瘤垂体增生动态增强磁共振成像时间-信号强度曲线　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:量化分析动态增强磁共振成像(DCE-MRI)诊断正常垂体、垂体增生、微腺瘤和大腺瘤的各参数指标(TTP、Slopemax、Ktrans、Kep、Ve),探讨DCE-MRI对垂体腺瘤诊断及鉴别诊断的价值。方法:搜集我院2015年6月至2017年2月经内分泌检查、临床随访、诊断性治疗、术后病理等手段确诊的79例垂体病变和15例正常垂体(临床症状、内分泌及影像学检查均完全正常的对照组),前者包括垂体增生19例、微腺瘤34例、大腺瘤26例。对其均行常规和动态增强扫描后获得时间-信号强度(T-SI)曲线,将TSI曲线分为三型,并对T-SI曲线形态进行定性分析;分别测量正常垂体、垂体增生、微腺瘤和大腺瘤的半定量参数达峰时间(TTP)、最大上升斜率(Slopemax)和定量参数转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积比(Ve)。对正常垂体、垂体增生、微腺瘤、大腺瘤的T-SI曲线类型构成行卡方检验,分析两两差异有无统计学意义;对正常垂体、垂体增生、微腺瘤和大腺瘤的各参数值进行比较先采用单因素方差分析,然后两两间比较采用LSD法,最后对有统计学意义的参数值绘制ROC曲线,获得曲线下面积,分析垂体腺瘤诊断及鉴别诊断的最佳诊断阈值,并计算敏感度、特异度、准确度。结果:1、正常垂体T-SI三型曲线数目分别为13、2、0,垂体增生分别为15、4、0、垂体微腺瘤分别为1、24、9,垂体大腺瘤分别为14、10、2。2、正常垂体和垂体增生的TTP、Slopemax、Ktrans、Kep、Ve五个参数值差异均无统计学意义(P0.05)。正常垂体的Slopemax、Ktrans、Kep值均大于微腺瘤,TTP值小于微腺瘤,且差异均有统计学意义(P0.05)。ROC曲线分析:TTP、Ktrans的ROC曲线下面积较大(分别为0.866、0.954),以72.655s作为TTP的诊断阈值时,其敏感度、特异度和准确度分别为74%、87%、61%;以0.793min-1作为Ktrans的诊断阈值时,其敏感度、特异度和准确度分别为80%、97%、77%。正常垂体的Slopemax、Ktrans、Kep值均大于大腺瘤,且差异均有统计学意义(P0.05)。ROC曲线分析:Ktrans、Kep的ROC曲线下面积较大(分别为0.738、0.877),以0.808min-1作为Ktrans的诊断阈值时,其敏感度、特异度和准确度分别80%、69%、49%;以1.176min-1作为Kep的诊断阈值时,其敏感度、特异度和准确度分别为67%、92%、59%。3、微腺瘤的Slopemax、Ktrans值均小于大腺瘤,且差异均有统计学意义(P0.05)。ROC曲线分析:Slopemax、Ktrans的ROC曲线下面积分别为0.675、0.747,以1.679作为Slopemax的诊断阈值时,其敏感度、特异度和准确度分别为77%、53%、30%;以0.654min-1作为Ktrans的诊断阈值时,其敏感度、特异度和准确度分别为50%、97%、47%。4、垂体增生的Slopemax、Ktrans、Kep值均大于微腺瘤,TTP值小于微腺瘤,且差异均有统计学意义(P0.05)。ROC曲线分析:Slopemax、Ktrans的ROC曲线下面积较大(分别为0.874、0.878),以2.969作为Slopemax的诊断阈值时,其敏感度、特异度和准确度分别为87%、82%、69%;以0.720min-1作为Ktrans的诊断阈值时,其敏感度、特异度和特异度分别为79%、94%、73%。5、垂体增生的Slopemax、Ktrans、Kep值均大于大腺瘤,且差异均有统计学意义(P0.05)。ROC曲线分析:Slopemax、Kep的ROC曲线下面积较大(分别为(0.763、0.767),以2.904作为Slopemax的诊断阈值时,其敏感度、特异度分别为90%、65%、55%;以1.176min-1作为Kep的诊断阈值时,其敏感度、特异度和准确度分别为61%、96%、57%。结论:1、正常垂体和微腺瘤、垂体增生和微腺瘤,微腺瘤和大腺瘤的T-SI曲线类型构成均有差异,在一定程度上可以鉴别出微腺瘤。2、Slopemax、Ktrans参数能够半定量、定量鉴别诊断微腺瘤和大腺瘤,并反映了两者血流灌注不同,从血供方面解释两者大小不同的生物学特性。3、TTP、Slopemax、Ktrans、Kep参数能够半定量、定量鉴别诊断垂体增生和垂体腺瘤,其中Ktrans鉴别微腺瘤较好,Kep鉴别大腺瘤较好,并能进一步反映垂体增生和腺瘤的病理生理差异;Ve在各组间均无统计学意义。
[Abstract]:Objective: quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) diagnosis of normal pituitary, pituitary hyperplasia, micro adenoma and adenoma parameters (TTP, Slopemax, Ktrans, Kep, Ve), and to evaluate the value of DCE-MRI diagnosis and differential diagnosis of pituitary adenomas. Methods: clinical follow-up collected in our hospital from June 2015 to 2017 2 menstrual endocrine examination, diagnosis, treatment, postoperative 79 cases of pituitary lesions diagnosed by means of pathology and 15 cases of normal pituitary (control group, clinical symptoms, endocrine and imaging examination were completely normal), the former includes 19 cases of pituitary hyperplasia, 34 cases of micro adenoma, 26 cases of macroadenoma. The routine and dynamic contrast-enhanced scan obtained after the time signal intensity curve (T-SI), the TSI curve is divided into three types, and the T-SI curve of qualitative analysis; normal pituitary, pituitary hyperplasia were measured, semi quantitative parameters of micro adenoma and adenoma of the large peak time (TTP), the most Large ascending slope (Slopemax) and quantitative parameters transfer constant (Ktrans), the rate constant (Kep), extravascular extracellular space volume ratio (Ve) of normal pituitary, pituitary hyperplasia, micro adenoma, T-SI adenoma of curve type chi square test, analysis of 22 statistical difference to normal; the pituitary, pituitary hyperplasia, adenoma and micro parameters of large adenoma were compared by single factor analysis of variance, and 22 compared with LSD method, the parameters of the significant value of ROC curve, the area under the curve obtained, the best diagnostic threshold of diagnosis and differential diagnosis of pituitary adenoma, and calculate the sensitivity degree of specificity, accuracy. Results: 1, the number of type three T-SI curve of normal pituitary pituitary hyperplasia were 13,2,0 and 15,4,0 respectively, pituitary microadenoma were 1,24,9, pituitary adenomas were 14,10,2.2, normal pituitary and pituitary hyperplasia TT P, Slopemax, Ktrans, Kep, Ve values of five parameters showed no significant difference (P0.05). Normal pituitary Slopemax, Ktrans, Kep values were greater than the micro adenoma, TTP value is less than the micro adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: TTP, Ktrans and ROC curve under a large area (0.866,0.954), using 72.655s as the diagnostic threshold of TTP, its sensitivity, specificity and accuracy were 74%, 87%, 61%; 0.793min-1 Ktrans as a diagnostic threshold, the sensitivity, specificity and accuracy were 80%, 97%, 77. The normal pituitary Slopemax, Ktrans, Kep value was more than that of adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: Ktrans, ROC under the Kep curve of large area (0.738,0.877), using 0.808min-1 as the diagnostic threshold of Ktrans, its sensitivity, specificity and accuracy were 80%, 69%, 49%; 1.176min-1 as Kep the The diagnostic threshold, the sensitivity, specificity and accuracy were 67%, 92%, 59%.3, Slopemax micro adenoma, Ktrans values were less than macroadenomas, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC area under the Ktrans curve was 0.675,0.747, with 1.679 as the diagnostic threshold of Slopemax when the sensitivity, specificity and accuracy were 77%, 53%, 30%; 0.654min-1 Ktrans as a diagnostic threshold, the sensitivity, specificity and accuracy were 50%, 97%, 47%.4, Ktrans, Slopemax of pituitary hyperplasia, Kep values were greater than the micro adenoma, TTP value is less than the micro adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC under the Ktrans curve of large area (0.874,0.878), with 2.969 Slopemax as a diagnostic threshold, the sensitivity, specificity and accuracy were 87%, 82%, 69%; 0.720min-1 as Ktrans The diagnostic threshold, the sensitivity, specificity and specificity were 79%, 94%, 73%.5, Ktrans, Slopemax of pituitary hyperplasia, Kep values were greater than the adenomas, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC area under the Kep curve of large (respectively (0.763,0.767) in 2.904, Slopemax as a diagnostic threshold, the sensitivity and specificity of 90%, respectively, 65%, 55%; 1.176min-1 Kep as a diagnostic threshold, the sensitivity, specificity and accuracy were 61%, 96%, 1, 57%.. Conclusion: the normal pituitary and pituitary micro adenoma, hyperplasia and adenoma T-SI, curve type and micro adenoma adenoma which were different, in a certain extent can identify the micro adenoma.2, Slopemax, Ktrans parameters can be semi quantitative, quantitative differential diagnosis of micro adenoma and colorectal adenoma, and reflects the blood flow perfusion, for both interpretation of different sizes from the blood The biological characteristics of.3, TTP, Slopemax, Ktrans, Kep parameters can be semi quantitative, quantitative differential diagnosis of pituitary hyperplasia and pituitary adenoma, in which the identification of Ktrans micro adenoma good Kep differential adenoma is better, and can further reflect the pathophysiological differences of pituitary hyperplasia and adenoma; Ve had no statistical significance between the two groups.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4;R445.2

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