多模态磁共振成像在鼻腔鼻窦良恶性病变诊断中的应用价值

发布时间：2018-05-04 11:35

本文选题：鼻腔鼻窦病变 + 多模态磁共振成像　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:磁共振检查技术在诊断及鉴别诊断鼻腔鼻窦病变中发挥着越来越大的作用,尤其是功能磁共振成像,如弥散加权成像(Diffusion Weighted Imaging,DWI)、动态增强扫描(Dynamic Contrast-enhanced Magnetic Resonance Imaging,DCE-MRI)技术的应用。本研究的目的在于探讨多模态磁共振成像(Multi-parametric MRI,Mp-MRI)技术对鼻腔鼻窦良恶性病变的诊断价值。材料与方法:1.研究对象:收集2014年03月~2017年-03月于我院行鼻窦MRI检查的患者76例,年龄11~73岁,平均年龄48.6岁,其中男性患者42例,女性患者34例。所有患者均行常规MR扫描、DWI和DCE-MRI扫描,均得到手术或穿刺活检病理证实,回顾性分析其常规MR扫描、DWI和DCE-MRI扫描的影像表现及相关参数分析。2.研究方法:所有患者均行常规MR、DWI和DCE-MRI扫描,(1)常规MR扫描包括横轴位、冠状位的TI WI、FS T2WI序列,观察病变的形态学特征,如部位、形态、信号强度、边界、有无包膜、生长方式、有无转移等。(2)DWI成像采用SE平面回波(echo planarimaging,EPI)序列,采用扩散敏感系数(b值)为0、800s/mm2,选取感兴趣区(region of interest,ROI),测量表观扩散系数(Apparent Diffusion Coefficien,ADC)值,并计算其平均值。(3)DCE-MRI扫描采用vibe序列,选取ROI后处理获得病变的时间-信号强度变化曲线(Time Intensity Curve,TIC)。测量指标包括TIC类型,增强前信号强度(pre-enhanced signal intensity,SIpre)、最大信号强度(maximum signal intensity,SImax)、峰值信号强度(peak signal intensity,SIpeak)、达峰时间(time to peak,Tpeak),进而计算出最大线性斜率(the slope of signal intensity-time curve,Slope值)、边缘-中心向心强化程度比值(Rrim-center)等半定量参数值并进行分析。将鼻腔鼻窦病变的TIC分为三个类型:A型:缓慢上升型;B型:速升平台型;C型:速升速降型。测量并分析ROI内的定量参数值,如对比剂容积转换常数(volume transfer constant of the contrast agent,Ktrans)、运动速率常数(rate constant between plasma and EES,Kep)、单位体积容积分数(volume of EES,Ve)。采用受试者工作曲线(receiver operator characteristic cure,ROC)确定差异有统计学意义的ADC值、Slope值、Rrim-center、Ktrans的诊断阈值,进而对病灶的性质进行判定。结果:(1)良性病变35例,常规MRI上多表现为形态较规则,其内信号较均匀,边界较清楚,膨胀性生长为主。恶性病变41例多表现为形态不规则、囊变坏死多见、边界欠清、侵袭性生长、周围组织结构受累严重。单纯凭借MR常规扫描,从形态学表现分析判断病变的良恶性很容易造成误诊。(2)鼻窦炎、鼻息肉的平均ADC值分别为1.74±0.39×10-3mm2/s,1.58±0.26×10-3mm2/s,与恶性病变的平均ADC值1.24±0.92×10-3 mm2/s之间差异有统计学意义(P0.01);良、恶性病灶的平均ADC值分别为1.46±0.89×10-3mm2/s和1.24±0.92×10-3mm2/s,二者之间差异无统计学意义(P0.05)(3)35例良性病变TIC曲线以A型为主,41例恶性病变TIC表现为B或C型。本组良、恶性病变的Tpeak、Slope值、Rrim-center值、Ktrans有统计学差异(P0.05)。(4)良恶性病变的最大线性斜率Slope值分别为15.75±6.20×10-3、10.51±10.2×10-3,两者间差异有统计学意义(P0.05),取良、恶性病变的诊断阈值Slope=10.58×10-3,得到其敏感性为73.2%,特异性为78.1%。(5)鼻腔鼻窦良恶性病变的Rrim-center值分别为0.12±0.085、0.26±0.065,两者间差异具有统计学意义(P0.01),取诊断阈值Rrim-center=0.21,其敏感性为74.5%,特异性为91.6%。(6)本组良恶性病变的定量参数Ktrans有统计学差异(P0.05),取诊断阈值Ktrans=0.121,获得的敏感性为65%,特异性为75%,曲线下面积约0.733。而Ve及Kep差异无统计学差异(P0.05)。结论:(1)DWI成像在一定程度上可以提示鼻腔鼻窦病变的良恶性。(2)DCE-MRI成像对判断鼻腔鼻窦病变的良、恶性具有重要提示作用。TIC曲线有助于鼻窦病变的定性诊断。(3)良、恶性病变Slope值、Rrim-center值、Ktrans均有统计学差异(P0.05),在判断鼻腔鼻窦病变的良、恶性方面有较好的应用价值。
[Abstract]:Objective: magnetic resonance imaging (MRI) plays a more and more important role in diagnosis and differential diagnosis of nasal sinus diseases, especially functional magnetic resonance imaging (Diffusion Weighted Imaging, DWI), and the application of dynamic enhanced scan (Dynamic Contrast-enhanced Magnetic Resonance Imaging, DCE-MRI). The purpose of this study is to explore the diagnostic value of Multi-parametric MRI (Mp-MRI) technique in the diagnosis of benign and malignant nasal sinus diseases. Materials and methods: 1. the objective of this study was to collect 76 cases of MRI in our hospital in -03 month, 03 month, 2014, ~2017 years, age 11~73, with an average age of 48.6 years, including 42 male and female patients. 34 cases. All patients underwent routine MR scan, DWI and DCE-MRI scan. All patients were confirmed by surgery or biopsy. A retrospective analysis of conventional MR scans, DWI and DCE-MRI scan imaging features and related parameters analysis.2. study methods: all patients underwent conventional MR, DWI and DCE-MRI scans, and (1) routine MR scan included transverse axis, coronal T I WI, FS T2WI sequence, observe the morphological features of the lesions, such as location, morphology, signal intensity, boundary, or without envelope, growth mode, and metastasis. (2) DWI imaging uses the SE plane echo (echo planarimaging, EPI) sequence, and uses the diffusion sensitivity coefficient (b value) as 0800s/mm2, and selects the region of interest (region) to measure apparent diffusion. The value of the coefficient (Apparent Diffusion Coefficien, ADC) and the average value are calculated. (3) the DCE-MRI scan uses the vibe sequence and selects the ROI post-processing to obtain the time signal intensity change curve (Time Intensity Curve, TIC). The measurement index includes the TIC type, the enhancement before the signal intensity, the maximum signal intensity. Ximum signal intensity, SImax), peak signal intensity (peak signal intensity, SIpeak), peak time (time to peak, Tpeak), and then calculate and analyze the semi quantitative parameter values of the maximum linear slope, edge center centripetal intensification range ratio and analysis. The TIC of the lesion is divided into three types: A type: slow rising type; B type: speed rise platform type; C type: speed rise and speed drop type. Measurement and analysis of quantitative parameter values in ROI, such as the volume conversion constant of the contrast agent volume (volume transfer constant of the contrast agent), motion rate constant, Volume Volume Volume Scores (volume of EES, Ve). Use the subjects' working curve (receiver operator characteristic cure, ROC) to determine the statistically significant ADC values, Slope values, Rrim-center, and the diagnosis threshold, and then determine the nature of the lesion. Results: (1) 35 cases of benign lesions, the regular patterns are more regular, and the internal signal is more than the normal. 41 cases of malignant lesions were characterized by irregular shape, more cystic degeneration, less clear boundary, invasive growth, and serious involvement of the surrounding tissue structure. It was easy to judge the misdiagnosis of pathological changes from morphological analysis by MR routine scan. (2) the average AD of sinusitis and nasal polyps. The C values were 1.74 + 0.39 x 10-3mm2/s and 1.58 + 0.26 x 10-3mm2/s respectively. The difference between the average ADC value of malignant lesions 1.24 + 0.92 x 10-3 mm2/s was statistically significant (P0.01). The average ADC values of benign and malignant lesions were 1.46 + 0.89 x 10-3mm2/s and 1.24 + 0.92 x 10-3mm2/s respectively. There was no statistically significant difference between two (P0.05) (P0.05) (P0.05) (P0.05) The curve was A type, and the TIC of 41 cases of malignant lesions was B or C. The Tpeak, Slope value, Rrim-center value and Ktrans of the malignant lesions were statistically different (P0.05). (4) the maximum linear slope Slope values of the benign and malignant lesions were 15.75 + 6.20 * 10-3,10.51 + 10.2 x 10-3, respectively. There were statistical significance (P0.05), benign and malignant lesions. The diagnostic threshold was Slope=10.58 x 10-3, and its sensitivity was 73.2% and the specificity of 78.1%. (5) of benign and malignant nasal sinus lesions was 0.12 + 0.085,0.26 + 0.065. The difference was statistically significant (P0.01), the diagnostic threshold was Rrim-center=0.21, its sensitivity was 74.5%, and the specificity was 91.6%. (6) benign and malignant lesions. The quantitative parameters Ktrans were statistically different (P0.05), the diagnostic threshold was Ktrans=0.121, the sensitivity was 65%, the specificity was 75%, the area under the curve was about 0.733. and there was no statistical difference between Ve and Kep (P0.05). Conclusion: (1) DWI imaging could indicate the benign and malignant of the nasal sinus diseases to a certain extent. (2) DCE-MRI imaging to judge nasal nasal nasal. The.TIC curve of the benign and malignant sinus lesions is helpful to the qualitative diagnosis of the sinus diseases. (3) the Slope value, the Rrim-center value and the Ktrans of malignant lesions have statistical differences (P0.05). It has a good application value in judging the benign and malignant aspects of the sinus and sinus diseases.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R739.62;R765

【参考文献】