预判垂体瘤质地：弥散加权成像—病理基础对照研究

发布时间：2018-03-24 14:31

本文选题：BLADE　切入点：DWI　出处：《复旦大学》2014年博士论文

【摘要】：第一部分鞍区DWI成像：BLADE序列与EPI序列成像效果的对比研究目的：该部分实验的目的是比较BLADE序列以及单次激发平面回波成像(EPI)扩散加权成像方法在鞍区显像的效果以及图像质量。方法：该部分研究,共纳入55名具有可疑鞍区病变的患者(其中52人磁共振发现鞍区病变,3名扫描结果正常)。所有的检查都是用西门子3.0T磁共振设备,所有受试者都要对病灶进行BLADE序列以及EPI序列下的扩散加权成像。所有检查图像都需要检测图像的信噪比(SNR),同时由两位有经验的放射科医生对两种扩散加权成像图像中的颈内动脉,视交叉,垂体柄,垂体,鞍区病灶以及图像整体的显像质量进行独立评估,另两位放射科医生对病灶的大小进行测量。结果：BLADE序列的扩散加权成像与EPI序列的扩散加权成像在图像信噪比方面没有显著性差异(P0.05)。在对于鞍区结构显像方面,BLADE DWI也显著优于EPI DWI,尤其是在颈内动脉以及总体图像质量方面。将两种方法中所获得的图像质量评分以及病灶的大小进行关联,拟合曲线后发现,在BLADE DWI成像中病灶冠状位最小直径≥12mm时,图像效果较好,而对于EPI DWI成像,病灶冠状位最小直径需≥31mm。第二部分：垂体瘤质地与磁共振信号的关系目的：垂体瘤质地对于手术方式的选择以及预后的判断具有重要价值,如果可以在术前通过影像学判断肿瘤质地将会给临床提供术式指导,改善患者预后。本部分通过获取垂体瘤各项磁共振信号,结合术中所见,研究垂体瘤的各项磁共振参数与肿瘤的术中质地是否具有显著性联系。方法：该部分为前瞻性研究,共纳入符合垂体瘤临床表现,于我院接受手术,且术后病理证实为垂体瘤的受试者34名,完善术前各项检查,使用西门子3.OT磁共振设备对病灶行T1冠状位,T2冠状位,BLADE序列的冠状位扩散加权成像以及T1增强后冠状位扫描。术中收集患者的质地评估结果,并结合术后病理免疫组化对患者资料进行分析。结果：肿瘤质地与患者年龄,性别,发病年龄,病程,肿瘤侵袭性,肿瘤的功能均无显著相关性。肿瘤的磁共振检查结果包括肿瘤处T1信号值/正常灰质T1信号值,肿瘤处T2信号值/正常白质T2信号值,肿瘤处T1增强信号值/灰质T1增强信号值以及肿瘤处ADC值/正常脑干ADC值与肿瘤质地之间没有显著的相关性,P0.05,对于几种影像学检查方法做ROC曲线后发现,相比于其他几种方法,肿瘤处ADC值/正常脑干ADC值对于肿瘤质地的诊断具有一定的价值,其曲线下面积(AUC)为0.7724,临界值为1.077。垂体瘤是否具有分泌功能与肿瘤处T2信号值/正常白质T2信号值具有显著相关性,P=0.03110.05,做ROC曲线,曲线下面积为0.7747,临界值为1.990,提示肿瘤处T2信号值/正常白质T2信号值大于该值时,肿瘤为无功能性垂体瘤的可能大。第三部分：垂体瘤质地与肿瘤内胶原含量的关系目的：本部分研究为探讨垂体瘤质地以及术前影像学信号与术后病理胶原含量之间是否具有相关性,各个类型的肿瘤间质中的胶原含量是否具有差异。方法：该部分研究,共纳入符合垂体瘤临床表现,于华山医院神经外科接受手术,且术后病理证实为垂体瘤的受试者34名,完善术前各项检查,使用西门子3.OT磁共振设备对病灶行磁共振冠状位扫描。术中收集患者的质地评估结果,使用HE染色,Masson胶原染色对肿瘤组织分别进行胶原含量的定性以及定量的分析。结果：不同质地分组中胶原含量无论定性或是定量均具有显著性差异,质地软组中胶原含量为7.27±1.18%,质地韧组的平均胶原含量为17.72±2.00%,P=0.0013,通过使用ROC曲线,可以发现胶原含量为15.39%可以作为不同质地的临界值。研究中发现肿瘤处ADC值/正常脑干ADC值与肿瘤内的胶原含量具有一定的相关性,在胶原定性分组(+),(++), (+++)中,肿瘤处ADC值/正常脑干ADC值(rADC)分别为1.5172,1.0998,1.0431,P=0.016,可以认为rADC值随着胶原含量的增加信号值下降,但胶原含量与rADC之间并非线性相关,R2=0.2175。其他组影像学数据包括rTl, rT2以及rTl增强值与肿瘤内胶原含量均没有显著相关性,同时临床数据如患者年龄,性别,病程,肿瘤大小,肿瘤的临床功能,肿瘤侵袭性以及病理功能分类与肿瘤胶原含量无显著相关性。
[Abstract]:The first part of the sellar region DWI imaging: Objective To compare the effect of BLADE sequence and EPI sequence imaging effect: the part of experiment is to compare BLADE sequence and single shot echo planar imaging (EPI) diffusion weighted imaging method in sellar region imaging effect and image quality. Methods: this part of the study, 55 patients with suspicious saddle lesions were included (including 52 magnetic resonance imaging revealed a sellar region lesions and 3 normal scans). All the checks are using SIEMENS 3.0T MRI equipment, all subjects are diffusion weighted imaging BLADE sequence and EPI sequence on the lesion. All images are needed to detect image signal the signal-to-noise ratio (SNR), at the same time by two experienced radiologists on two kinds of diffusion weighted imaging in the image of the internal carotid artery, optic chiasm, pituitary stalk, pituitary gland, sellar region lesions and the overall image quality of imaging alone Li assessment, another two radiologists in lesion size were measured. Results: diffusion weighted imaging diffusion weighted imaging and EPI BLADE sequences in the image signal to noise ratio had no significant difference (P0.05). In the sellar region structure imaging, BLADE DWI was significantly better than EPI DWI, especially in the areas of the internal carotid artery and overall image quality. The two methods to obtain the image quality score and the size of the lesion were correlated, fitting curves show that the BLADE in DWI imaging of lesions of coronal minimum diameter greater than or equal to 12mm, the image effect is better, and for EPI DWI imaging, coronary lesions required minimum diameter larger than 31mm. second part objective: the relationship between pituitary adenoma with magnetic resonance signals: the pituitary adenoma has important value for the choice of surgical approach and prognosis, if the preoperative imaging by judging swelling The texture will be provided for the clinical tumor operation guidance, improve the prognosis of the patients. This part by acquiring the pituitary magnetic resonance signal, combined with intraoperative findings, the magnetic resonance parameters and tumor of pituitary tumor surgery were associated with the texture is. Methods: as part of the forward research, included with the clinical manifestations of pituitary tumor in our hospital underwent surgery and postoperative pathology were subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment on the lesion of coronal T1, coronal T2, BLADE series of coronal diffusion weighted imaging and T1 enhanced after the coronal scan texture. Evaluation results were collected during surgery, and postoperative pathology immunohistochemistry of patients were analyzed retrospectively. Results: the tumor texture and patient age, gender, age of onset, course of disease, tumor invasion, tumor function was no significant Correlation between MRI results. Tumor including tumor T1 signal value / normal gray matter T1 signal value, the value of the T2 signal at the tumor / normal white matter T2 signal values of tumor enhanced T1 signal value / gray T1 signal enhancement value and ADC value of tumor / normal brain ADC value and there is no significant tumor texture correlation, P0.05, for several imaging methods of ROC curves show that compared with other methods, the ADC value of tumor / normal brain stem ADC value has a certain value for the diagnosis of tumor texture, the area under the curve (AUC) was 0.7724, the critical value is whether 1.077. has the secretion of pituitary tumor and tumor. The value of the T2 signal / normal white matter was significantly correlated with the value of the T2 signal, P=0.03110.05, ROC curve, the area under the curve was 0.7747, the critical value is 1.990, the value of the T2 signal at tumor / normal white matter signal value is greater than the T2 value, tumor reactive Of pituitary tumor may be large. The third part: the objective relationship between collagen content of tumor and tumor in the pituitary of texture: this part is to study whether there is any correlation between study of pituitary adenoma and the preoperative imaging signal and postoperative pathological collagen content, various types of tumor whether there is difference in the content of collagen quality. Methods: this part of the study, in accordance with clinical manifestations of pituitary tumor in Huashan Hospital Department of Neurosurgery, surgery, and postoperative pathology confirmed subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment for lesions underwent magnetic resonance coronary scanning. Texture evaluation results were collected during operation, using HE staining, the tumor tissue collagen content were qualitative and quantitative analysis of collagen Masson staining. Results: the collagen content of different texture in both qualitative and quantitative grouping is all out There are significant differences, the collagen content of soft texture group was 7.27 + 1.18%, the average content of collagen texture was 17.72 + ductile group 2%, P=0.0013, by using the ROC curve, can be found in collagen content of 15.39% can be used as the critical value of different texture. The tumor was found at the ADC / ADC value normal collagen and brainstem tumor in a certain correlation study, qualitative groups in collagen (+), (+ +), (+ + +), tumor / normal brain stem ADC value ADC value (rADC) were 1.5172,1.0998,1.0431, P=0.016, rADC value can be considered along with the increase of signal collagen content decreased, but the content of collagen and rADC and nonlinear correlation, R2=0.2175. imaging data of other groups including rTl, rT2 and rTl enhance the value and content of collagen within the tumor showed no significant correlation, while the clinical data such as age, gender, disease duration, tumor size, clinical features of tumor, tumor invasion There was no significant correlation between the classification of sex and pathological function and the content of tumor collagen.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R736.4

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