磁共振IDEAL-IQ技术评估原发性肝细胞癌分化程度的价值

发布时间：2018-02-28 13:03

  本文关键词： 磁共振成像 肝细胞癌分化程度 IDEAL-IQ序列 R2*值 脂肪分数值　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨磁共振IDEAL-IQ序列的R2*值及脂肪分数值评估原发性肝细胞癌分化程度的价值。方法回顾性分析2016年1月至2017年1月期间于我院行肝脏MRI检查,并经手术或穿刺病理证实为原发性HCC,且行MR检查前未进行任何治疗的患者,MR检查需包含IDEAL—IQ序列。最终入组患者20例,共22个病灶,其中4个病灶经穿刺活检证实,18个病灶行手术切除。男16例,女4例,平均年龄58.7岁。IDEAL—IQ扫描参数为:翻转角3°;回波时间分别为0.9、1.6、2.4、3.1、3.9、4.7、5.4、6.2、7.0、7.7、8.5 及 9.3ms,重复时间 6.9ms,带宽 200kHz,视野 40×32cm,层厚6mm,层间距1mm,扫描层数24层。扫描结束后在操作平台进行图像重建,获得T2*water图、T2*fat图、R2*弛豫率图、脂肪分数图四组图像。将IDEAL-IQ重建图像传至AW4.5工作站,经compare软件进行测量。ROI放置于HCC病灶内实质成分处,另在距病灶3cm以上增强扫描无明显占位肝实质内放置等大ROI,并避开肝内大血管及胆管。实验数据由两名MRI诊断经验3年的影像医生,采用双盲法测量各ROI的R2*值及脂肪分数值。22个HCC灶的病理学分级按照根据Edmondson-Steiner分级法分为高、中、低分化组。根据病理学或影像学检查确定肝背景是否有肝硬化,分为肝硬化组和非肝硬化组。采用SPSS 21.0统计分析软件进行统计学分析。采用组内相关系数检验两位观察者所测得各参数一致性。HCC与其肝背景各值比较,采用独立样本t检验,p0.05,认为差异具有统计学意义。HCC的R2*值及脂肪分数值与病理学分化程度相关性,采用Spearman相关分析。HCC不同病理级别组间的R2*值、脂肪分数值差异性采用ANOVA的LSD法检验。采用ROC曲线评价R2*值及脂肪分数值预估以肝背景为基准各病理学分化程度HCC的诊断效能。结果HCC各病理学分化组、不同肝背景组肿瘤瘤体及肝背景R2*值和脂肪分数,两名观察者测量结果一致性良好。HCC与其肝背景R2*值差异均具有统计学意义,(p0.05),病灶内R2*值均低于其肝背景。HCC病灶内与肝背景脂肪分数无统计学意义。HCC的R2*值与其病理学分化程度间呈中度相关(p0.05,rs=0.453)。随着HCC分化程度减低,其R2*值程增高趋势。HCC高、中和低分化组三组间总体R2*值及脂肪分数值差异具有统计学意义。应用脂肪分数值预估高分化HCC曲线下面积(AUC)为0.856,以脂肪分数值=6.05%为界,敏感度为66.7%,特异度为100%。结论IDEAL-IQ序列获得的脂肪分数值可作为判定高分化HCC的定量指标。IDEAL-IQ测得R2*值与HCC的病理学分化程度,呈中度相关。
[Abstract]:Objective to evaluate the value of R2 * value and fat fraction of IDEAL-IQ sequence in evaluating the differentiation of primary hepatocellular carcinoma (HCC). Methods MRI examination of liver was performed in our hospital from January 2016 to January 2017. IDEAL-IQ sequence should be included in Mr examination of the patients who were proved to be primary HCC by operation or biopsy and without any treatment before Mr examination. Finally, 20 patients (22 lesions) were included in the group. Among them, 4 lesions were confirmed by puncture biopsy, 18 lesions were surgically resected. The average age was 58.7 years old. IDEAL-IQ scan parameters were as follows: turnover angle 3 掳, echo time 0.91.6U 2.4C 3.1C 3.9U 4.75.4ng 7.78.5 and 9.3msrespectively, repetition time 6.9ms, bandwidth 200kHz, visual field 40 脳 32cm, layer thickness 6mm, interval between layers 1mm. Image reconstruction was carried out on the operating platform after scanning. Four sets of images were obtained from T2water and T2FAT-R2 * relaxation rate and fat fraction images. The reconstructed images were transferred to AW4.5 workstation, and measured by compare software. ROI was placed in the solid components of HCC lesions. In addition, the enhancement scan more than 3 cm away from the lesion had no significant space occupying in the hepatic parenchyma and avoided the large vessels and bile ducts in the liver. The experimental data were obtained from two imaging doctors with 3 years' experience in the diagnosis of MRI. The R2 * value and fat score of each ROI were measured by double blind method. The pathological grades of 22 HCC foci were divided into high, middle and low differentiation groups according to Edmondson-Steiner classification. It was divided into two groups: cirrhosis group and non-cirrhosis group. The statistical analysis was carried out with SPSS 21. 0 software. The consistency of parameters measured by two observers was tested by intragroup correlation coefficient, and the liver background values were compared with each other. The independent sample t test (p0.05) showed that the difference was statistically significant. The R2 * value and fat fraction of HCC were correlated with the degree of pathological differentiation. The R2 * value of different pathological grades of HCC was analyzed by Spearman correlation analysis. The difference of fat content was tested by LSD method of ANOVA. R2 * value and fat fraction value were used to evaluate the diagnostic efficacy of HCC based on liver background. Results all pathological differentiation groups of HCC were evaluated. R2 * value and fat fraction of tumor body and liver background in different liver background groups, The difference of R2 * between HCC and its liver background was statistically significant. The R2 * value in the lesion was lower than that in the liver background. There was no significant difference between the fat fraction in the HCC lesion and the liver background. The R2 * value of HCC and its disease was not statistically significant. The degree of differentiation was moderately correlated with the degree of differentiation of HCC. The R2 * value of HCC was higher than that of low differentiation group. The difference of total R2 * value and fat fraction between the three groups was statistically significant. The area under the well-differentiated HCC curve predicted by fat fraction value was 0.856, and the fat fraction value was 6.05%. The sensitivity is 66.7 and the specificity is 1000.Conclusion the fat fraction obtained by IDEAL-IQ sequence can be used as a quantitative index to judge highly differentiated HCC. The R2 * value measured by IDEAL-IQ is moderately correlated with the degree of pathological differentiation of HCC.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R445.2
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本文编号：1547407