磁共振图像对软组织肉瘤组织学级别的诊断价值

发布时间：2018-07-02 11:23

本文选题：磁共振 + 软组织肉瘤　；参考：《山东大学》2014年博士论文

【摘要】：目的：观察软组织肉瘤的磁共振图像特征并分析病理高级别与低级别软组织肉瘤的显著差异,确定能够预测高级别软组织肉瘤的图像特征。材料与方法：研究经本机构伦理委员会批准,无需签署知情同意书。回顾2010年1月至2013年1月于骨外科及肿瘤科就诊的患者临床资料,顺序选取符合条件的患者：经病理证实患有软组织肉瘤的患者；从肿瘤手术切除的病理结果中能得到明确的软组织肉瘤等级；在活检及任何治疗之前,患者曾行MRI检查,MRI图像由数据库可得。软组织肉瘤病理等级按FNCLCC (French Federation of Cancer Centers Sarcoma Group)系统分级。所有病人磁共振图像(包括平扫及增强扫描图像)均由两位经验丰富的骨骼肌肉放射医生进行盲法阅片,并达到意见一致。首先,评价并记录每个病例磁共振序列的图像质量是否达到诊断要求。记录病变位置,病变大小等。观察并记录肿瘤平扫T1/T2加权磁共振图像特征：肿瘤信号强度高低,信号均匀性,肿瘤边界是否清晰；是否有瘤周囊性征象、T2加权图像上肿瘤内低信号分隔征象、瘤周高信号等；是否有瘤周骨反应、是否侵犯骨皮质、骨髓等。记录肿瘤是否有神经血管组织包绕,血管是否闭塞。在增强扫描图像上记录肿瘤边界,肿瘤强化程度,以及是否存在瘤周强化。应用STATA10.0进行统计分析。病理等级为1级的肿瘤为低级别肿瘤,等级为2级和3级的为高级别肿瘤。Wilcoxon秩和检验分析男性与女性病人间年龄差异。x2检验评价高级别与低级别软组织肉瘤的平扫及增强磁共振图像特征有无显著差异。计算肿瘤磁共振图像特征对高级别肿瘤检出的敏感度、特异度。合并高级别与低级别肉瘤有显著差异的图像特征及高敏感度、特异度的特征,以及部分患者信息,建立多变量Logistic回归分析模型,分析识别出可以独立预测高级别肿瘤价值的磁共振图像特征。结果：在156例病人中,连续选取了95例符合条件的病例(年龄1-95岁,平均年龄55.5岁)。1级软组织肉瘤16例,2级34例,3级45例。95例的平扫磁共振图像质量均达到诊断要求,除了一例T2加权图像未达到诊断要求,其T2加权图像被排除分析。高级别与低级别软组织肉瘤在以下磁共振特征方面有显著差异：肿瘤大小(p.01),T2加权图像肿瘤信号均匀性(p.01),T2加权图像瘤周高信号(p.05),平扫及增强图像的肿瘤边界(p.01),瘤周强化表现(p.01)。肿瘤边界欠清的特征对检出高级别肿瘤有较高的敏感度、特异度(平扫T1/T2加权、增强T1加权图像分别为：72%和69%,76%和73%,74%和86%)。在95例符合条件的病例中,有82例磁共振检查有增强扫描图像。增强扫描图像质量均达到诊断要求。Logistic回归分析表明,增强扫描T1加权图像上瘤周增强表现是独立预测高级别软组织肉瘤的最强特征(比值比13.6；95%可信区间：2.9,64.6)。结论：在软组织肉瘤的特点及其磁共振图像特征中,肿瘤的大小、边界、部分T2加权图像特征及增强表现可以帮助鉴别与低级别有显著差异的高级别肿瘤；瘤周强化表现可以独立检出高级别肉瘤。软组织肉瘤的MRI图像征象可以作为活检的重要补充,提供高级别肉瘤的信息。
[Abstract]:Objective:
The magnetic resonance imaging features of soft tissue sarcoma were observed and the significant difference between high and low grade soft tissue sarcoma was analyzed, and the image features of the advanced soft tissue sarcoma could be predicted.
Materials and methods:
The study, approved by the institutional ethics committee, did not need to sign the informed consent. Review the clinical data of the patients in the osteossurics and oncology department from January 2010 to January 2013, in order to select eligible patients: Patients with soft tissue sarcomas confirmed by pathology; a clear soft group can be obtained from the pathological results removed from the tumor operation. Sarcoma grade; before biopsy and any treatment, MRI examination was performed in patients, MRI images were obtained by database. The pathological grade of soft tissue sarcoma was classified according to FNCLCC (French Federation of Cancer Centers Sarcoma Group) system. All patients' magnetic resonance images (including plain and enhanced scan images) were two experienced skeletal muscles First, evaluate and record the image quality of the MRI sequence of each case, and record the location of the lesion, the size of the lesion, and so on. Observe and record the features of the T1/T2 weighted MRI images: the intensity of the tumor signal, the uniformity of the signal, and the boundary of the tumor. Is it clear whether there are signs of peritumoral cysts, signs of low signal separation in T2 weighted images, high signal peritumoral, whether there is periosteal reaction, invasion of bone cortex, bone marrow, or not, whether the tumor has neurovascular wound, or whether the blood vessels are obliterated. Whether there was peritumoral enhancement. Statistical analysis was performed with STATA10.0. The pathological grade 1 was a low grade tumor with grade 2 and grade 3 for the rank of high grade tumor.Wilcoxon. The age difference between male and female patients was analyzed by.X2 test for the evaluation of high grade and low grade soft group sarcoma and enhanced MRI. The sensitivity, specificity, specificity, high sensitivity, high sensitivity, specificity, and information of some patients with high level and low grade sarcomas, and a multivariable Logistic regression model were established. A magnetic resonance imaging feature of the value of a high level tumor.
Result:
Of 156 patients, 95 consecutive cases (age 1-95, average age 55.5 years old) were selected in 156 cases, 16 cases of grade soft tissue sarcoma, 34 cases of grade 2, and 3 level 45 cases of plain scan magnetic resonance imaging quality met the diagnostic requirements. Except for one case of T2 weighted images, the T2 weighted image was excluded and analyzed. High grade and low grade There were significant differences in the following magnetic resonance characteristics of soft tissue sarcoma: tumor size (P.01), T2 weighted image tumor signal uniformity (P.01), T2 weighted image high signal (p.05), plain scan and enhanced image tumor boundary (P.01), peritumoral enhancement (P.01). The characteristics of the tumor boundary were highly sensitive to the detection of high grade tumors. Sensitivity, specificity (T1/T2 weighted, enhanced T1 weighted images were 72% and 69%, 76% and 73%, 74% and 86%). In 95 cases of eligible cases, there were 82 MRI enhanced scan images. The enhanced scan image quality reached the diagnostic requirement.Logistic regression analysis, and the enhanced scan T1 weighted image on the tumor Zhou Zengqiang performance was Independent prediction of the strongest features of high-grade soft tissue sarcoma (odds ratio 13.6; 95% confidence interval: 2.9,64.6).
Conclusion:
In the characteristics of soft tissue sarcoma and its magnetic resonance imaging features, the size, boundary, T2 weighted image features and enhanced performance of the tumor can help identify high grade tumors with significant differences in the low level. High grade sarcomas can be detected independently of the fortified peritumoral performance. The MRI image of the soft tissue sarcoma can be used as a biopsy. To supplement the information of high grade sarcoma.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R738.6

【参考文献】