MRI结合PET-CT提高胶质瘤诊断准确性的相关研究

发布时间：2018-05-13 13:07

本文选题：胶质瘤 + MRI　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的多模态影像融合理念对于胶质瘤诊断及鉴别诊断具有重要意义。本研究首先基于已发表的应用MRI结合PET-CT进行胶质瘤诊断的相关研究,进行系统评价及meta分析。以此更加系统的评估使用常规MRI和不同示踪剂的PET-CT进行胶质瘤诊断的优劣及特点。而后,对于临床实践中,多模态影像综合诊断对于肿胀性脱髓鞘病变急性期与弥漫性胶质瘤鉴别的应用价值进行探讨。其中,多模态影像手段包括CT、MRI、~(18)F-FDG PET-CT与~(11)C-MET PET-CT。方法以Pubmed及Cochrane Library为检索文献数据库。文献检索期限为2015年12月之前(包括12月)。按照规定的纳入和排除标准筛选出目标文献,将文献中对于本meta分析有效的信息进行提取、综合,采用非定量方法进行系统评价,探讨MRI和不同示踪剂的PET-CT扫描用于胶质瘤诊断的优劣及特点。随后,回顾性搜集患者31例。患者疾病特点为在就诊初期,难以仅通过单一影像学检查,形成肿胀性脱髓鞘病变急性期或弥漫性胶质瘤的诊断。所有胶质瘤病例均经过组织病理学证实;部分肿胀性脱髓鞘病变病例经过组织病理学证实,其他肿胀性脱髓鞘病变病例经过内科治疗炎症好转证实。共纳入胶质瘤患者17例,脱髓鞘病变患者14例。纳入的患者都在疾病诊断阶段进行过常规MRI检查,包含MRI平扫以及强化MRI(强化对比剂为钆喷酸葡胺)。患者在MRI检查后两周内分别进行了以~(18)F-FDG及~(11)C-MET为示踪剂的PET-CT扫描。分析讨论,(1)各项影像学成像特点对于弥漫性胶质瘤及肿胀性脱髓鞘病变急性期鉴别的权重;(2)两种不同示踪剂的PET-CT对于肿胀性脱髓鞘病变急性期的诊断是否具有价值;(3)CT扫描对于胶质瘤鉴别诊断的价值。采用R 3.3.2对数据进行统计学分析。结果参照设定的标准共纳入14篇目标文献。每篇文献涉及的研究,均包含常规MRI检查。与此同时,其中4篇文献涉及~(18)F-FDG PET-CT;5篇文献涉及~(11)C-MET PET-CT;5篇文献涉及~(18)F-FET PET-CT;3篇文献涉及~(18)F-FLT PET-CT。其中包含单一文献涉及多种不同示踪剂的PET-CT的研究。各篇文献具有不可忽视的内在局限性,故最终的研究结论得出采用的是非定量的系统评价方法。常规MRI作为胶质瘤诊断的基石,能够提供较为直接的初步诊断信息。基于不同的成像机理,常规MRI对于解剖结构的显示能力远高于PET-CT。但PET-CT对于肿瘤生物学行为的显示优于MRI。具有活性的细胞能够摄取~(18)F-FDG,从而显示出胶质瘤内部的坏死组织。~(11)C-MET PET-CT所显示的胶质瘤边界较常规MRI更加接近生物学边界,为手术治疗提供更加准确的信息。此二者均具有预估胶质瘤恶性程度的能力。相较~(18)F-FLT PET-CT,~(18)F-FET PET-CT所显示的肿瘤边界更加接近肿瘤的生物学边界。~(18)F-FET PET-CT对于高级别胶质瘤的诊断具有一定意义。病例研究发现,如果仅仅考虑常规MRI影像学特点对于胶质瘤及肿胀性脱髓鞘病变的鉴别能力,占位效应及病变周围水肿程度对于形成正确的初步诊断的价值具有统计学意义。~(18)F-FDG PET-CT及~(11)C-MET PET-CT对于胶质瘤和肿胀性脱髓鞘病变鉴别诊断的价值也具有统计学意义。结合二者所得信息,能够形成更加正确的指导治疗方案制定的诊断。结论常规MRI扫描能够更加清晰的显示胶质瘤的解剖结构;不同种类示踪剂的PET-CT扫描基于肿瘤的代谢水平对胶质瘤的恶性程度及边界等的判断更具优势。不同示踪剂的PET-CT所提供的胶质瘤相关信息不尽相同。常规MRI成像特征对诊断胶质瘤,鉴别诊断胶质瘤及肿胀性脱髓鞘病变的价值已被广泛认可。基于这样的特点进行二者的鉴别诊断具有统计学意义。而对于一些MRI特点表现得不典型的脱髓鞘病变病例,有条件的单位可以进行~(18)F-FDG PET-CT与~(11)C-MET PET-CT检查,从而提供附加信息。此外,患者就诊后首先进行的检查——CT,对于肿胀性脱髓鞘病变急性期及弥漫性胶质瘤的鉴别诊断具有特殊意义。结合不同影像学检查手段所提供的信息,取长补短,能够在很大程度上提高胶质瘤的初步诊断准确性。多模态影像学综合诊疗理念有助于疾病的早期诊断、早期治疗,从而达到更好的预后。
[Abstract]:Objective multimodal image fusion is of great significance for the diagnosis and differential diagnosis of glioma. First, based on the published application of MRI combined with PET-CT in the diagnosis of glioma, systematic evaluation and meta analysis were carried out to make a more systematic assessment of the use of conventional MRI and different tracer PET-CT for glioma diagnosis. The application value of multimodal imaging comprehensive diagnosis for the differential diagnosis of swelling demyelinating disease and diffuse glioma is discussed in clinical practice. Among them, multimodal imaging methods include CT, MRI, ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT. method with Pubmed and Cochrane Library as the retrieval text The document retrieval period is before December 2015 (including December). According to the prescribed inclusion and exclusion criteria, the target literature is selected and the effective information of the meta analysis in the literature is extracted and integrated, and the non quantitative method is used for systematic evaluation to explore the advantages of PET-CT scanning of MRI and different tracers for the diagnosis of glioma. Then, 31 patients were collected retrospectively. The patient's disease was characterized by the difficulty of the diagnosis of acute or diffuse glioma in the early stage of the treatment by a single imaging examination. All cases of glioma were confirmed by histopathology, and the cases of swollen demyelinating lesions were histopathologically histopathologically divided. It was confirmed that other cases of swollen demyelinating lesions were confirmed by internal medical treatment. 17 patients with glioma, 14 cases of demyelinating disease were included. All the patients were performed routine MRI examination at the stage of disease diagnosis, including MRI plain scan and intensifying MRI (intensifying contrast agent gadolinium gadolinium). Patients had two weeks after MRI examination. PET-CT scanning with ~ (18) F-FDG and ~ (11) C-MET as tracer. Analysis and discussion, (1) the weight of various imaging features for differential diagnosis of diffuse glioma and swelling demyelinating disease; (2) the value of two different tracer PET-CT for the diagnosis of the acute stage of swollen demyelinating disease; (3) CT scan The value of the differential diagnosis of glioma. R 3.3.2 was used to analyze the data statistically. The results were included in the 14 target literature with reference to the set standard. The study involved in each literature included conventional MRI examination. At the same time, 4 of them involved ~ (18) F-FDG PET-CT; 5 literature involved ~ (11) C-MET PET-CT; 5 literature involved ~ (18). F-FET PET-CT; 3 papers related to ~ (18) F-FLT PET-CT. which contains a single document involving a variety of different tracers of PET-CT. The literature has the inherent limitations that can not be ignored. Therefore, the final conclusions draw a non quantitative system evaluation method. Conventional MRI, as the cornerstone of the diagnosis of glioma, can provide more Direct preliminary diagnosis information. Based on different imaging mechanisms, conventional MRI shows much higher ability to display anatomical structures than PET-CT., but PET-CT shows that cells with active MRI. can take ~ (18) F-FDG to show the necrotic tissues within the glioma. ~ (11) C-MET PET-CT shows gliomas. The boundary is closer to the conventional MRI than the biological boundary, providing more accurate information for surgical treatment. These two all have the ability to predict the malignancy of glioma. Compared with ~ (18) F-FLT PET-CT, the tumor boundary displayed by ~ (18) F-FET PET-CT is closer to the biological boundary of the tumor. ~ (18) F-FET PET-CT is a diagnostic tool for high grade glioma The case study found that the value of the occupying effect and the degree of peripheral edema in the differential diagnosis of glioma and swollen demyelinating lesions is statistically significant for the formation of a correct initial diagnosis. ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT are for glioma and swelling. The value of differential diagnosis of demyelinating disease is also of statistical significance. Combined with the information obtained by the two, it can form a more correct guidance for the diagnosis of the treatment plan. Conclusion conventional MRI scan can show the anatomical structure of glioma more clearly; the PET-CT scan of different tracers based on the metabolic level of tumor to glioma The diagnosis of gliomas provided by PET-CT with different tracers is different. The value of conventional MRI imaging features for the diagnosis of gliomas, the differential diagnosis of gliomas and swelling demyelinating lesions has been widely recognized. The differential diagnosis based on such a point is statistically significant in the differential diagnosis of the two For some cases of demyelinating lesions characterized by atypical MRI characteristics, conditional units can perform ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT examination to provide additional information. In addition, the first examination after the patient's treatment is CT, for the differential diagnosis of the acute stage of swelling demyelinating lesions and diffuse glioma. It is of special significance. The information provided by different imaging methods can improve the preliminary diagnosis accuracy of glioma to a great extent. The concept of multimodal imaging comprehensive diagnosis and treatment will help the early diagnosis and early treatment of the disease, so as to achieve better prognosis.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41;R445.2;R730.44

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