乳腺增生病不同中医辨证分型的MRI影像学研究

发布时间：2018-06-20 01:39

  本文选题：乳腺增生病 + 中医辨证分型　； 参考：《济南大学》2017年硕士论文

【摘要】：目的通过分析乳腺增生病中医辨证分型和磁共振成像(MRI)在临床上的应用,并基于乳腺增生病症的影像资料表现与中医辨证归类之间关系,本文对各证型的MRI成像进行了分析。并且对各证型影像扫描的指标进行了探究,对比中医不同证型与不同的MRI影像学表现之间的关系分布情况,为今后中医在乳腺增生病的辨证治疗提供科学依据。方法挑选196名在2014年2月至2016年6月期间在医院就诊的乳腺增生患者,其中年龄在24至54岁范围内不等。基于患者提供的一般信息(如年龄、哺乳史、月经史等),由专业的中医师对所挑选的患者进行初步诊断并辨别分类。并对所有患者采用乳腺专用线圈(线圈同时并行采集通道数为8道)进行常规MRI成像,动态增强成像(DCE-MR)、扩散加权成像(DWI)扫描,成像序列完整,图像清晰。扫描视野(FOV):根据乳腺大小而选择300×300到350×350mm。通过SS-EPI成像,DWI扫描的平面影像只出现横向切面上,并在X、Y、Z轴上施加扩散敏感梯度脉冲(DSGP)。其中选取敏感系数800秒每平方毫米和一个空白参照,选用马根维显(德国先灵药业公司)为造影剂,注射流速为3毫升每秒,试剂用量(浓度为0.5毫摩尔每毫升)为0.1摩尔每千克。并采用SPSS17.0统计软件对得到的数据进行统计分析,计量资料采用%来表示,并选用卡方检验,并且P0.05,表明该计算有统计学意义。结果根据MRI成像显示:图像中局部有致密阴影部位,强化呈条索状的患者中以冲任失调居多(占总样的50%);其次依次为肝郁气滞型、痰瘀互结型,分别占总样的33.33%和16.67%;图像中患者的双乳呈少量腺体型,腺体为斑片状且强化呈片状的患者中以冲任失调者居多(占总样50%),其次依次为痰瘀互结型、肝郁气滞型,分别占总样的35.29%和14.71%;在双侧乳房呈团片状多发类结节样、点状强化的患者中以以肝郁气滞型、痰瘀互结型居多,而冲任失调型较少。三种证型之间的对比(P0.05)。TIC曲线对于分析三种症状类型的分布具有重要意义。根据TIC曲线显示:I型曲线主要为肝郁气滞型;Ⅱ型和Ⅲ型曲线均以痰瘀互结型居多;其中只有一位冲任失调型患者的TIC曲线隶属于Ⅳ型。结论乳腺增生不同证型患者的MRI影像各不相同,有着明显特征。借助MRI影像资料可以为中医对于乳腺增生辨证施治提供科学支持。
[Abstract]:Objective to analyze the clinical application of traditional Chinese medicine syndrome differentiation and magnetic resonance imaging (MRI) of mammary hyperplasia, and to analyze the MRI imaging of each syndrome type based on the relationship between the imaging data of mammary hyperplasia and TCM syndrome differentiation and classification. And the indexes of imaging scanning of each syndrome type were explored, and the relationship between different syndromes and different MRI manifestations of TCM was compared, which provided the scientific basis for the treatment of hyperplasia of mammary gland in the future. Methods 196 patients with breast hyperplasia from February 2014 to June 2016 were selected. The age ranged from 24 to 54 years. Based on the general information provided by the patient (such as age, history of lactation, menstrual history, etc.), the selected patient is diagnosed and classified by a professional Chinese medicine practitioner. All patients were performed conventional MRI imaging with special coil (8 channels were simultaneously collected by coils), dynamic enhanced imaging (DCE-MRA) and diffusion-weighted imaging (DWI) scan. The imaging sequence was complete and the image was clear. Scan visual field FOV: choose 300 脳 300 to 350 脳 350 mm according to mammary gland size. The plane images scanned by SS-EPI imaging and DWI only appear on the transverse section and apply diffusion sensitive gradient pulse on the axis of XMY _ (YZ). A sensitivity factor of 800 seconds per square millimeter and a blank reference were selected, and Magan Weixian (Germany's Shenling Pharmaceutical Company) was selected as contrast agent. The flow rate of injection was 3 milliliters per second. The dosage of reagent (concentration 0.5 ml / ml) is 0.1 mol / kg. SPSS 17.0 statistical software was used to analyze the obtained data, the measurement data was expressed in%, and chi-square test was used, and P0.05, which showed that the calculation had statistical significance. Results according to MRI imaging, there were dense shadow areas in the local images, and the most of the patients with stripe enhancement were the disorder of flushing and letting (50% of the total), followed by the type of stagnation of liver-qi, the type of phlegm and blood stasis, and the type of phlegm and blood stasis. 33. 33% and 16. 67% of the total samples, respectively. In the image, the double breasts of the patients showed a small amount of gland type, and the majority of the patients whose glands were patchy and enhanced were dysfunctional (accounting for 50% of the total, followed by phlegm and blood stasis type, liver stagnation and qi stagnation type, respectively). Among the patients with bilateral breast, the majority were liver stagnation, phlegm and blood stasis, but the disorder of rush and discharge was less. The proportion of patients with bilateral breast was patchy and multiple nodular, and the patients with punctate enhancement were liver stagnation, phlegm and blood stasis, and phlegm and blood stasis, respectively, which accounted for 35.29% and 14.71% of the total breast samples, respectively. The comparison between the three syndromes is of great significance for the analysis of the distribution of the three symptom types. According to the TIC curve, the TIC curve of type I was mainly the type of stagnation of liver-qi, the type 鈪，

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