宫颈癌的磁共振波谱及扩散加权成像研究

发布时间：2018-05-29 15:19

本文选题：子宫颈癌 + 宫颈上皮内瘤变　；参考：《厦门大学》2014年硕士论文

【摘要】：目的本研究旨在探讨3.0T氢质子磁共振波谱技术('H-magnetic resonance spectroscopy,'H-MRS)及磁共振扩散加权成像(diffusion weighted imaging, DWI)对宫颈癌及宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)患者诊断价值。方法1.选取32例宫颈病变患者(包括14例宫颈中分化癌、9例宫颈低分化癌、9例宫颈上皮内瘤变(CIN))以及31例健康志愿者进行3.0T磁共振的单体素波谱扫描及磁共振扩散加权成像(DWI)扫描,宫颈病变均经病理证实,定量分析胆碱(cho3.2ppm)、甘油三酯-CH_2(lip1.3ppm)及ADC值。 2.分别对病例组与正常对照组；正常对照组、宫颈CIN组、宫颈浸润癌组；不同分化类型的宫颈病变患者(宫颈CIN、中分化癌及低分化癌)间cho峰、lip峰、ADC值进行统计学分析。最后应用受试者工作特征曲线(receive operating characteristic curve, ROC曲线)分析,找到正常组与病例组间合理的cho峰、lip峰及ADC值阂值。结果1.31例正常对照组、32例病例组cho峰值(峰下面积均值)分别为0.61±0.42,3.24±1.87,病例组cho峰明显升高,两组间差异具有统计学意义(P0.05)；正常对照组、病例组lip峰的峰下面积均值分别为0.67±0.46、3.48±1.94,病例组lip峰明显升高,两组间差异具有统计学意义(P0.05)。 2.31例正常对照组、9例宫颈上皮内瘤变组(CIN组)、23例宫颈浸润癌组cho峰值分别为0.61±0.42、0.85±0.56、4.98±2.42,lip峰值分别为0.67±0.46、1.17±0.78、4.52±2.61,宫颈CIN组cho、lip峰稍高于正常对照组,但两组间差异无统计学意义(P0.05),宫颈浸润癌组cho、lip峰明显高于正常对照组及宫颈CIN组,且差异有统计学意义(P0.05)；。 3.9例宫颈CIN组、14例宫颈中分化癌组、9例宫颈低分化癌组cho峰的峰下面积均值分别为0.85±0.56、4.93±2.75、5.01±2.89；宫颈CIN组cho峰明显低于宫颈中分化癌组及宫颈低分化癌组,且差异均有统计学意义(P0.05),宫颈低分化癌组cho峰稍高于宫颈中分化癌组,但两组间差异无统计学意义(P0.05)；宫颈CIN组、宫颈中分化癌组、宫颈低分化癌组lip峰的峰下面积均值分别为1.17±0.78、1.98±0.62、5.79±2.05；宫颈低分化癌组lip峰明显高于宫颈CIN组及宫颈中分化癌组,且差异有统计学意义(P0.05),宫颈中分化癌组lip峰稍增高于宫颈CIN组,但两组间差异无统计学意义(P0.05)； 4.31例正常对照组、32例病例组、23例宫颈浸润癌组、9例宫颈CIN组、14例宫颈中分化癌组、9例宫颈低分化癌组的ADC值平均值分别为(1.49±0.25)xl0-3mm2/s、(0.95±0.22)xl0-3mm2/s、(0.83±0.18)xl0-3mm2/s、(1.06±0.14)xl0-3mm2/s、(O.88±.16)xlO-3mm2/s、(0.79±0.12)xl0-3mm2/s、病例组ADC值明显低于正常对照组,差异有统计学意义(P0.05)；正常对照组、宫颈CIN组及宫颈浸润癌组的ADC值依次减低,且差异均有统计学意义(P0.05)；宫颈CIN组、宫颈中分化癌组及宫颈低分化癌组的ADC值依次减低,但只有低分化癌组与宫颈CIN组的差异有统计学意义(P0.05)。结论1、病例组cho峰、lip峰均明显升高,峰下面积均值明显高于正常对照组；2、宫颈CIN组、宫颈浸润癌组cho峰、lip峰均升高,但宫颈CIN组升高不明显：3、不同分化程度的宫颈癌cho峰升高程度也不同,宫颈低分化癌升高程度最明显,宫颈中分化癌升高程度仅次于宫颈低分化癌,宫颈CIN组仅见轻度升高；4、不同分化程度的宫颈癌lip峰升高程度也不同,宫颈低分化癌升高程度最明显,宫颈CIN组仅见轻度升高,宫颈中分化癌组仅稍高于宫颈CIN组；5、病例组及浸润癌组ADC值明显低于正常对照组；宫颈CIN组、宫颈中分化癌组及宫颈低分化癌组的ADC值依次减低。
[Abstract]:Objective the purpose of this study was to explore the diagnostic value of 3.0T'H-magnetic resonance spectroscopy ('H-MRS) and magnetic resonance diffusion-weighted imaging (diffusion weighted imaging, DWI) for cervical cancer and cervical intraepithelial neoplasia (cervical intraepithelial neoplasia).
Methods 1. 32 cases of cervical lesions (including 14 cases of cervical differentiated carcinoma, 9 cases of cervical low differentiation cancer, 9 cases of cervical intraepithelial neoplasia (CIN)) and 31 healthy volunteers were scanned by 3.0T magnetic resonance spectroscopy and magnetic resonance diffusion-weighted imaging (DWI). The cervical lesions were all confirmed by pathology, quantitative analysis of choline (cho3.2ppm), Gump Oil three ester -CH_2 (lip1.3ppm) and ADC value.
2. the case group and the normal control group, the normal control group, the cervical CIN group, the cervical infiltrating cancer group, the CHO peak, the lip peak and the ADC value between the different types of cervical lesions (cervical CIN, middle differentiated and low differentiated carcinoma) were statistically analyzed. Finally, the working characteristic curves of the subjects were applied (receive operating characteristic curve, ROC). The CHO peak, lip peak and ADC value between normal group and case group were found.
Results in the 1.31 normal control group, the peak value of CHO (mean below peak area) in 32 cases was 0.61 + 0.42,3.24 + 1.87 respectively. The CHO peak in the case group was significantly increased, and the difference between the two groups was statistically significant (P0.05). The mean value of the area under the peak area of the lip peak in the case group was 0.67 + 0.46,3.48 + 1.94 respectively. The lip peak of the case group was significantly elevated, and the two groups were significantly increased. The difference was statistically significant (P0.05).
2.31 cases of normal control group, 9 cases of cervical intraepithelial neoplasia (CIN group), 23 cases of cervical invasive cancer group Cho peak of 0.61 + 0.42,0.85 + 0.56,4.98 + 2.42, lip peak of 0.67 + 0.46,1.17 + 0.78,4.52 + 2.61, cervical CIN CHO, lip peak a little higher than the normal control group, but there is no statistically significant difference between the two groups (P0.05), cervical infiltrating cancer group Cho The IP peak was significantly higher than that of the normal control group and the cervical CIN group, and the difference was statistically significant (P0.05).
3.9 cases of cervical CIN group, 14 cases of cervical differentiation cancer group, 9 cases of cervical low differentiation cancer group Cho peak area average of 0.85 + 0.56,4.93 + 2.75,5.01 + 2.89, cervical CIN group Cho peak significantly lower than the cervical differentiation and cervical low differentiation cancer group, and the difference was statistically significant (P0.05), cervical low differentiation cancer group Cho peak was slightly higher than the cervix In the medium differentiated carcinoma group, there was no significant difference between the two groups (P0.05), and the average value of the lip peak area in the cervical CIN group, the cervical differentiated carcinoma group and the low differentiated cervical cancer group was 1.17 + 0.78,1.98 + 0.62,5.79 2.05, and the low differentiated cervical cancer group was significantly higher than that of the cervical CIN group and the cervical middle differentiated carcinoma group, and the difference was statistically significant (P0.05). The lip peak in the moderately differentiated cervical cancer group was slightly higher than that in the cervical CIN group, but there was no significant difference between the two groups (P0.05).
4.31 normal control group, 32 case group, 23 cervical infiltrating cancer group, 9 cervical CIN group, 14 cervical middle differentiated carcinoma group and 9 cervical low differentiated carcinoma group, the average value of ADC value was (1.49 + 0.25) xl0-3mm2/s, (0.95 + 0.22) xl0-3mm2/s, (0.83 + 0.18) xl0-3mm2/s, (1.06 +.16) xlO-3mm2/s, (O.88 +.16) xlO-3mm2/s, xl0-3mm2/s, disease (O.88 +.16) xl0-3mm2/s, disease The ADC value of the case group was significantly lower than that of the normal control group, the difference was statistically significant (P0.05). The normal control group, the ADC value of the cervical CIN group and the cervical invasive cancer group decreased in turn, and the difference was statistically significant (P0.05). The ADC value of the cervical differentiated carcinoma group and the cervical low differentiated carcinoma group decreased in sequence, but only the low differentiated cancer group and the cervical C. The difference in group IN was statistically significant (P0.05).
Conclusion 1, the CHO peak and lip peak of the case group were significantly higher than those of the normal control group. 2, the cervical CIN group, the CHO peak of the cervical infiltrating cancer group and the lip peak were all elevated, but the increase of the cervical CIN group was not obvious: 3, the degree of CHO peak in the cervical cancer with different degree of differentiation was different, the level of cervical low differentiation cancer was the most obvious, the differentiation of cervix in the cervix was in the cervical differentiation. The level of cancer in the cervical CIN group was only slightly higher than that of the low differentiated cervical carcinoma. 4, the level of lip peak of cervical cancer with different degree of differentiation was also different, the level of cervical low differentiation cancer was the most obvious, the CIN group in the cervix was slightly higher, the cervical differentiation cancer group was only slightly higher than that of the uterine cervix CIN group, and the ADC value of the case group and the infiltrating cancer group was obviously lower than that of the ADC. In normal control group, the ADC values of cervical CIN group, cervical squamous cell carcinoma group and cervical poorly differentiated cancer group decreased in turn.
【学位授予单位】：厦门大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

【参考文献】