Extended Tofts与Exchange模型的动态对比增强MRI参数在子宫肌瘤病理分型中应用

发布时间：2018-04-13 17:48

本文选题：子宫肌瘤 + 病理　；参考：《浙江大学》2017年硕士论文

【摘要】：目的探讨Extended Tofts和Exchange两种血流动力学模型的动态对比增强MRI(DCE-MRI)参数在子宫肌瘤病理分型中的应用。资料与方法2015年10月至2016年6月经手术病理证实的35例子宫肌瘤患者,术前行盆腔多期动态增强磁共振成像(DCE-MRI),选择Extended Tofts和Exchange血流动力学模型分别计算子宫肌瘤的定量灌注参数Ktrans(对比剂从血管(血浆)间隙渗漏到血管外细胞外间隙转运系数)、PS(毛细血管表面通透性)、Fp(血浆灌流量)、Kep(对比剂从血管外细胞外间隙返回血管(血浆)间隙的速率常数)、Ve(血管外细胞外间隙容积分数)、Vp(血管(血浆)间隙容积分数)。术后按病理分型分为细胞型(7例)、普通型(18例)、退变型(10例)三组,采用单因素方差分析子宫肌瘤三组间的组间差异,采用LSD检验分别分析两组间(普通型与细胞型、细胞型与退变型、普通型与退变型)的血流动力学参数差异,P0.05有统计学意义;筛选出有统计学意义的参数,绘制鉴别细胞型子宫肌瘤的ROC曲线;使用Pearson相关性分析观察两个模型间的参数有无相关性。结果一:在三组子宫肌瘤间,Extended Tofts模型中的Ktrans、Kep、Vp及Exchange模型中的Fp、Kep、Vp值差异有统计学意义(P0.05),其中细胞型子宫肌瘤 Extended Tofts 模型中 Ktrans(p0.001)、Kep(p =0.001)、Vp(p =0.003),Exchange模型中Kep(p =0.035)、Fp(tp0.001)值高于普通型子宫肌瘤;细胞型子宫肌瘤 Extended Tofts 模型中 Ktrans(p0.001)、Kep(p =0.019)、Vp(p =0.001),Exchange模型中Vp(p=0.017)、Fp(p0.001)值高于退变型子宫肌瘤;普通型子宫肌瘤ExtendedTofts模型中Ktrans(p=0.037)高于退变型子宫肌瘤,余定量灌注参数无明显统计学意义。二:Extended Tofts模型中的Ktrans、Kep、Vp及Exchange模型中的Fp、Kep、Vp值在鉴别细胞型子宫肌瘤的ROC曲线下面积分别为1.000、0.923、0.827、1.000、0.702、0.738;三:Extended Toft 模型中的 Ktrans 与 Exchange模型中的 PS 和 Fp相关(r=0.365,P=0.034,r=0.968,P=0.000),Kep、Vp 在 2 种模型中呈正相关(r=0.454,P=0.007,r=0.479,P=0.004),两种模型间的Ve值无相关性。结论 Extended Tofts 模型中的Ktrans、Kep、Vp 及 Exchange 模型中的 Fp、Kep、Vp值在鉴别子宫肌瘤病理分型中的应用价值较高,特别是Extended Tofts模型中的Ktrans值和Exchange模型中的Fp值诊断效能最高,且两者具有明显的相关性;同时Extended Tofts模型的Kep、Vp值诊断效能优于Exchange模型。
[Abstract]:Objective to investigate the application of dynamic contrast enhanced MRICE-MRI parameters in the pathological classification of uterine leiomyoma in Extended Tofts and Exchange hemodynamic models.Materials and methods from October 2015 to June 2016, 35 patients with hysteromyoma confirmed by surgery and pathology,Extended Tofts and Exchange hemodynamic models were used to calculate the quantitative perfusion parameters of uterine leiomyoma by dynamic enhanced pelvic magnetic resonance imaging (DCE-MRI) before operation.The rate constant of the return of the extracellular space to the vascular (plasma) space from the extracellular space of the contrast agent and the VpV volume fraction of the extracellular space of the vessel (plasma).According to the pathological classification, the patients were divided into three groups: 7 cases of cytomegaloid type, 18 cases of common type, 10 cases of degenerative type). The differences among the three groups of uterine leiomyoma were analyzed by univariate analysis of variance. LSD test was used to analyze the difference between the two groups (common type and cell type, respectively).The difference of hemodynamic parameters between cell type and degeneration type, common type and degenerative type (P0.05) was statistically significant. The parameters with statistical significance were screened out and the ROC curve was drawn to distinguish the cell type uterine leiomyoma.Pearson correlation analysis was used to observe the correlation between the two models.Results: there were significant differences between the three groups in the KtransP KepP of extended Tofts model and the Exchange model in the Exchange model (P 0.05). The value of Ktransp0.001VepP 0.001VpP in the Extended Tofts model was higher than that in the normal type of uterine myoma (P < 0.05). The results showed that the value of KTP in the model of extended Tofts was higher than that in the model of normal uterine leiomyoma (P < 0.05). The results showed that the value of KTP in the model of Extended Tofts was higher than that in the model of normal type of uterine myoma (P < 0.05), and the value of KTP was higher than that in the model of normal type of uterine leiomyoma (P < 0.05).In Extended Tofts model, the value of Ktransp0. 001 + KepP in the model of Extended Tofts was higher than that in the model of degenerative uterine leiomyoma, and the value of Ktransp0. 037 in ExtendedTofts model of normal uterine leiomyoma was higher than that of degenerative uterine leiomyoma, and there was no significant difference in the parameters of residual quantitative perfusion.There was no correlation between the two models.Conclusion Extended Tofts model and Exchange model have higher application value in differentiating the pathological types of uterine leiomyoma, especially the Ktrans value in Extended Tofts model and the FP value in Exchange model.At the same time, the diagnostic efficiency of Extended Tofts model was better than that of Exchange model.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R737.33

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