腮腺肿瘤的磁共振弥散加权评价研究

发布时间：2018-07-07 17:25

本文选题：腮腺 + 肿瘤　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的： ①探究不同b值条件下，腮腺肿瘤中不同区域（实质区和囊变区）对表观弥散系数（apparent diffusion coefficient, ADC）的影响。 ②评价磁共振弥散加权成像（diffusion-weighted MR imaging, DW-MRI）区别腮腺不同肿瘤的诊断价值。 ③对ADC区别腮腺肿瘤的价值做进一步验证。材料和方法： ①对经过手术病理证实并于术前行DWI检查的32例腮腺囊实性肿瘤（良性肿瘤22例，恶性肿瘤10例）进行回顾性分析。分别在b值取0，500s/mm2和0，1000s/mm2时，对肿瘤整体、肿瘤实质区和肿瘤囊变区的ADC均值进行测量，并比较其间差异。 ②对经手术病理证实并于术前行DWI检查的162例腮腺肿瘤（良性肿瘤108例，恶性肿瘤54例）进行回顾性分析。在b值取0，1000s/mm2的情况下，选取各个肿瘤实质部分作为ROI获取其ADC均值。比较不同肿瘤之间ADC均值的差异。 ③收集69例拟诊腮腺肿瘤并将行手术治疗的病人，术前行DWI检查后根据先前回顾性分析获得的结果给予影像学诊断，并对照病理结果进行可靠性评估。结果： ①32例囊实性肿瘤组：b值取500s/mm2时，肿瘤囊变部分ADC均值为2.44±0.31×10-3mm2/s；实质部分为1.35±0.23×10-3mm2/s；整体部分的ADC均值为1.73±0.35×10-3mm2/s。b值取1000s/mm2时，肿瘤囊变部分ADC均值为1.94±0.30×10-3mm2/s；实质部分为1.12±0.22×10-3mm2/s；整体部分为1.35±0.28×10-3mm2/s。上述三种取样法所测肿瘤ADC均值间存在明显统计学差异（P0.01）。此外，在选用肿瘤实质部分为ROI获取的ADC均值在恶性肿瘤、腮腺腺淋巴瘤、多形性腺瘤与其他良性肿瘤之间亦存在统计学差异（P0.01）。 ②169例腮腺肿瘤病例组：腮腺良性肿瘤组ADC均值，，多形性腺瘤（1.46±0.29×10-3mm2/s），腺淋巴瘤（0.86±0.14×10-3mm2/s）和其他良性上皮性肿瘤（1.15±0.36×10-3mm2/s），两两间P 0.05；恶性腮腺肿瘤组ADC均值，恶性上皮性肿瘤0.96±0.21×10-3mm2/s和其他恶性肿瘤（包括淋巴瘤和肉瘤，0.71±0.13×10-3mm2/s）两者间P 0.01。此外，腮腺良性肿瘤（1.15±0.36×10-3mm2/s）和恶性肿瘤（0.88±0.22×10-3mm2/s）的ADC均值之间P 0.01。若以1.125×10-3mm2/s（b=1000s/mm2）为良恶性肿瘤的阈值，获得的灵敏度是88.9%，特异度50.0%，准确率63.0%。 ③69例病人研究组中，单纯采用ADC值来区别腮腺良性肿瘤与恶性肿瘤，灵敏度为82.6%，特异度为65.2%，准确率为71.0%；加入常规影像学表现作为参考后诊断腮腺恶性肿瘤的灵敏度为73%，特异度为87%，准确率为81%。结论： ①腮腺肿瘤中囊变和实质区能分别导致不同ADC均值的产生。在b值为0,1000s/mm2时从腮腺肿瘤实质区取样的ADC均值能为其鉴别诊断提供更多有益信息。 ②DWI对腮腺良性和恶性肿瘤的鉴别诊断能够提供有价值的信息。 ③ADC值结合传统影像学表现能提高腮腺肿瘤良恶性诊断的准确率。
[Abstract]:Objective: 1 to explore the conditions of different b values, The effect of different regions (parenchyma and cystic zone) on the apparent diffusion coefficient (apparent diffusion coefficient,) in parotid tumors. 2 to evaluate the diagnostic value of diffusion-weighted diffusion weighted imaging (DW-MRI) in differentiating different tumors of parotid gland. 3 the value of ADC in differentiating parotid gland tumors was further verified. Materials and methods: 1 A retrospective analysis of 32 cases of parotid cystic solid tumor (benign tumor 22 cases, malignant tumor 10 cases) proved by operation and pathology and performed DWI before operation was carried out. The mean values of 0500s/mm2 of the whole tumor, tumor parenchyma and cystic zone were measured at b values of 0500s/mm2 and 0 ~ 1000s / mm ~ 2, respectively. The difference was analyzed retrospectively in 162 cases of parotid gland tumors (108 benign tumors and 54 malignant tumors) proved by operation and pathology and examined by DWI before operation. When b value is 0 ~ 1000s / mm ~ 2, each tumor substance is selected as the ADC mean value of ROI. To compare the difference of ADC mean value among different tumors. 3 69 patients with parotid gland tumors who were diagnosed as parotid gland tumors and treated by operation were examined by DWI before operation, and the imaging diagnosis was performed according to the results obtained from previous retrospective analysis. The reliability was evaluated according to the pathological results. Results: the mean value of 500s/mm2 was 2.44 卤0.31 脳 10 ~ (-3) mm ~ (-2) / s in cystic tumor group, 1.35 卤0.23 脳 10 ~ (-3) mm ~ (-2) / s in solid part, 1.94 卤0.30 脳 10 ~ (-3) mm ~ (-2 / s) in whole part and 1.12 卤0.22 脳 10 ~ (-3) mm ~ (-2 / s) in whole part. The whole part is 1.35 卤0.28 脳 10 ~ (-3) mm ~ (-2) / s. There was significant difference in ADC between the three methods (P0.01). In addition, the ADC mean value of ROI obtained in the selection of tumor parenchyma was found in malignant tumors, parotid gland lymphoma, There was also statistical difference between pleomorphic adenoma and other benign tumors (P0.01). In 2169 cases of parotid benign tumors, the mean ADCs of parotid benign tumors, pleomorphic adenomas (1.46 卤0.29 脳 10-3mm2/s), adenomatous lymphoma (0.86 卤0.14 脳 10-3mm2/s) and other benign epithelial tumors (1.15 卤0.36 脳 10-3mm2/s) were observed (P 0.05). The mean value of ADC in malignant parotid tumors was 0.96 卤0.21 脳 10-3mm2/s for malignant epithelial tumors and 0.71 卤0.13 脳 10-3mm2/s for other malignant tumors (including lymphoma and sarcoma) (P 0.01). In addition, the mean value of ADCs between benign parotid tumors (1.15 卤0.36 脳 10-3mm2/s) and malignant tumors (0.88 卤0.22 脳 10-3mm2/s) was P 0.01. If 1.125 脳 10-3mm2/s (b=1000s/mm2) was used as the threshold value for benign and malignant tumors, the sensitivity was 88.9, the specificity was 50.0 and the accuracy was 63.0. The sensitivity, specificity and accuracy were 82.6, 65.2 and 71.0 respectively, and the sensitivity, specificity and accuracy were 73, 87 and 81, respectively. Conclusion: 1 in parotid gland neoplasms, cystic degeneration and parenchymal region can lead to different ADC mean values. When the b value is 0 ~ 1000s / mm2, the ADC mean value from the parotid tumor parenchyma area can provide more useful information for differential diagnosis. 2DWI can provide valuable information for the differential diagnosis of parotid benign and malignant tumors. ADC value combined with traditional imaging findings can improve the accuracy of benign and malignant diagnosis of parotid tumors.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.8;R445.2

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