小肝癌MR多期增强信号特点与瘤体血供类型及病理分级的相关性研究

发布时间：2018-03-28 04:26

本文选题：小肝癌　切入点：MRI　出处：《苏州大学》2014年硕士论文

【摘要】：目的分析小肝癌瘤灶的多期增强信号变化特点，探讨其与血供类型及病理分级的相关性，旨在提高小肝癌术前诊断水平，预估其恶性程度。资料与方法选取90名患者经手术病理证实的93枚小肝癌病灶作为研究对象，男性74例，女性16例，年龄25~84岁，平均54.6±12.1岁。全部病例术前均分别进行T2WI（采用呼吸触发脂肪抑制快速恢复自旋回波）、T1WI（采用屏气的双回波扰相梯度回波）、采集b值为1000时的小肝癌结节灶的DWI信号，并采用肝脏容积超快速三维成像(LAVA) 序列进行多期增强扫描，轴位或者冠状位，测量并记录病灶在增强后各期图像上的相对信号值，制成强化曲线，将其分成流出型、平台型、单相型、乏血供型四类，分析各型的供血方式及其与病理分级的相关性；算出各期最大强化率[pCER=（SI增强-SI平扫）/SI平扫*100，其中SI增强为病灶各期增强后测量值，SI平扫为病灶平扫后测量值]，并将患者的性别、年龄、强化曲线类型及病理分级分别与病灶动脉期、门脉期及延迟期的最大强化率pCER做多元线性回归分析，P0.05为差异有统计学意义。结果 (1)小肝癌表现为流出型增强曲线者大多病理类型为低分化，，平台型大多表现为中分化，单相型大多表现为高分化（P0.05）；乏血供型无统计学意义；(2)瘤灶的DWI信号越高，病理分级越趋向于低分化（P0.05）；(3)动脉期最大强化率越高，门脉期最大强化率越低，瘤灶的病理分级越趋向于低分化（P0.05）；延迟期最大强化率无统计学意义；(4)在本研究年龄范围内（25-84岁，平均54.6±12.1），年龄越小，动脉期最大强化率相对越高，病理分级更趋向于低分化（P0.05）；而门脉期及延迟期最大强化率与年龄无统计学意义；各期最大强化率与性别无统计学意义。结论 (1)小肝癌的多期增强信号曲线与瘤体血供特点相关；(2)小肝癌的多期增强信号曲线、DWI信号、最大强化率及年龄等因素与病理分级有一定相关性，有望作为术前预估小肝癌分化程度的参考指标。
[Abstract]:Purpose. In order to improve the preoperative diagnosis level and predict the malignancy of small hepatocellular carcinoma (SHCC), the characteristics of multi-phase enhanced signal were analyzed, and the correlation with blood supply type and pathological grade was discussed. Data and methods. Ninety-three small hepatocellular carcinoma (SHCC) lesions confirmed by surgery and pathology were selected from 90 patients (74 males and 16 females, aged 25 to 84 years). The mean age was 54.6 卤12.1 years. All patients underwent T2WI (rapid recovery of spin echo T1WI with respiratory triggered fat suppression) before operation. The DWI signals of small hepatocellular carcinoma nodules with b value of 1000 were collected. Liver volume ultrafast three-dimensional imaging (LAVA) was used. The sequence was scanned by multi-phase enhancement, axial or coronal. The relative signal values of each phase of enhancement were measured and recorded, and the enhancement curve was made into four types: outflow type, platform-type, single-phase type and lack of blood supply type. The maximum enhancement rate of each stage was calculated by analyzing the blood supply mode of each type and its correlation with pathological grade. The maximum enhancement rate of each phase was calculated [pCER=(SI enhancement-SI plain scan / SI plain scan 100, in which SI enhancement was measured after each stage of enhancement and SI plain scan was taken as the measured value of lesion after plain scan], and the sex of the patients was calculated. Age, type of enhancement curve and pathological grade were significantly different from the maximal enhancement rate of arterial phase, portal phase and delayed phase by multiple linear regression analysis (pCER). Results. (1) in patients with small hepatocellular carcinoma with efflux enhancement curve, the pathological type was low differentiation, the platform type was moderately differentiated, and the monophasic type was highly differentiated P0.05G; the lack of blood supply type was not statistically significant; the higher the DWI signal was, the higher the DWI signal was in the tumor foci. The higher the maximum enhancement rate in arterial phase and the lower the maximum enhancement rate in portal vein phase, the more the pathological grade of tumor focus tended to be P0.05, while the maximum enhancement rate in delayed stage was not statistically significant (P 0.05) in the age range of this study, the maximum enhancement rate was 25 to 84 years old in the present study, and there was no significant difference between the pathological grade and the low differentiation P0. 05% (P 0. 05%, P 0. 05%, P 0. 05%). The average value was 54.6 卤12.1g, the younger the age, the higher the maximal enhancement rate of arterial phase, and the higher the pathological grade was, the lower the differentiation was (P0.05A), but there was no significant difference between the maximum enhancement rate and age in portal phase and delayed stage, and the maximum enhancement rate and sex in each stage were not statistically significant. Conclusion. (1) Multi-phase enhanced signal curve of small hepatocellular carcinoma was correlated with the characteristics of blood supply. (2) the multiphase enhanced signal curve of small hepatocellular carcinoma (SHCC) was correlated with the DWI signal, the maximum enhancement rate and age were correlated with the pathological grade. It is expected to be a reference index for predicting the differentiation of small hepatocellular carcinoma (HCC) before operation.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.2

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