宫颈癌与正常宫颈的PWI、MRS影像学表现及其临床价值的初步探讨

发布时间：2018-01-31 14:51

本文关键词： 宫颈癌磁共振功能成像灌注加权成像波谱成像　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：应用磁共振灌注加权成像（PWI）和磁共振波谱成像（MRS）技术，通过分析比较宫颈癌与正常宫颈之间的PWI时间-信号曲线（TIC）特点及其灌注参数、MRS特点，探讨宫颈癌与正常宫颈的PWI、MRS表现特征及临床应用价值。材料和方法：收集正常宫颈15例，宫颈癌35例(均经手术病理或活检证实)，其中，宫颈癌患者中15例行手术治疗、20例行根治性放疗为主的治疗，根据放疗后效果分为有效组和无效组。所有入组人员均接受MR检查，包括常规MR平扫、DWI、MRS、PWI和增强扫描，其中，20例接受放疗的患者在放疗后3周再次进行与放疗前相同序列的MR检查，获取其感兴趣区的MRS图像、PWI的TIC曲线及其相关灌注参数：强化峰值（PH）、最大上升斜率（MSI）、达峰时间（TTP）。分别比较正常宫颈与宫颈癌之间的MRS、TIC曲线及灌注参数差异，宫颈鳞癌与腺癌之间的TIC曲线及灌注参数差异，放疗前与放疗后之间的TIC曲线及灌注参数差异，有效组和无效组在放疗前的TIC曲线及灌注参数差异。结果： 1．TIC曲线间的比较：(1)35例宫颈癌患者多以速升缓降型为主，具体表现为：上升支较为陡峭，迅速达到峰值，达峰后曲线呈现为较长的平台期，其中，速升缓降型29例、速升速降型4例以及缓慢上升型2例；(2)15例正常宫颈多以缓慢上升型为主，具体表现为：缓慢而持续性上升，其中，缓慢上升型11例、速升缓降型4例。 2．PWI灌注参数间的比较：(1)宫颈癌组的PH、MSI值高于正常宫颈组， TTP值低于正常宫颈组，差异均有统计学意义(PPH=0.000,PMSI=0.000,PTTP=0.000)；(2)鳞癌组的PH、MSI值略低于腺癌组，，TTP值略高于腺癌组，差异均无统计学意义(PPH=0.321,PMSI=0.586,PTTP=0.082)；(3)放疗前的PH、MSI值高于放疗后， TTP值低于放疗后，差异均有统计学意义(PPH=0.000,PMSI=0.000,PTTP=0.000)；(4)放疗有效组的PH、MSI值略高于无效组，TTP值略低于无效组，只有PH、MSI值的差异具有统计学意义(PPH=0.025,PMSI=0.004)， TTP值差异无统计学意义(PTTP=0.324)。 3．MRS分析显示：（1）宫颈癌组的MRS形态大致可归纳为：Cho峰、Lip峰及Cr峰三峰共同出现，但Cho峰较高、Lip峰显著增高，即Lip峰Cho峰Cr峰。（2）正常宫颈组MRS未见明显Cho峰、Lip峰及Cr峰。结论： 1．PWI通过TIC曲线和灌注参数来反映组织的的灌注情况和血流动力学变化，可用于鉴别宫颈癌与正常宫颈组织，对宫颈癌的定性诊断、治疗疗效监测及预测放化疗的敏感性有重要价值。 2．1H MRS能活体无创地监测宫颈癌的代谢改变，能为宫颈癌的诊断和治疗提供分子代谢水平的信息。
[Abstract]:Objective: to apply Mr perfusion weighted imaging (PWI) and magnetic resonance spectroscopy (MRS) techniques. By analyzing and comparing the characteristics of PWI time-signal curve and its perfusion parameter Mrs between cervical cancer and normal cervix, we discussed the PWI of cervical cancer and normal cervix. MRS features and clinical application value. Materials and methods: 15 cases of normal cervix and 35 cases of cervical carcinoma were collected. According to the effect of radiotherapy, the patients were divided into effective group and non-effective group. All the patients were examined by Mr, including conventional Mr plain scan, DWII-MRSPWI and enhanced Mr scan. Twenty patients who received radiotherapy underwent the same sequence of Mr imaging at 3 weeks after radiotherapy to obtain MRS images of their region of interest. The TIC curve of PWI and its related perfusion parameters were compared between normal cervix and cervical cancer. The difference of TIC curve and perfusion parameter, the difference of TIC curve and perfusion parameter between squamous cell carcinoma of cervix and adenocarcinoma, and the difference of TIC curve and perfusion parameter before and after radiotherapy. The difference of TIC curve and perfusion parameters between effective group and ineffective group before radiotherapy. Results: 1. Comparison of TIC curves among 35 patients with cervical cancer, most of them were characterized by rapid rise and slow decrease. The specific manifestation was that the ascending branch was steep and reached the peak rapidly, and the curve after reaching the peak presented a long plateau period. There were 29 cases of rapid ascending and slow descending type, 4 cases of rapid rising and falling type and 2 cases of slow rising type. In 15 cases of normal cervix, the main type of normal cervix was slow rise type, including 11 cases of slow rising type and 4 cases of rapid rising and decreasing type. 2. Comparison of perfusion parameters of PWI: 1) the TTP of cervical carcinoma group was higher than that of normal cervix group, and the TTP value was lower than that of normal cervix group. The differences were statistically significant (P < 0.05), PPH 0.000, PMSI 0.000, PTTP0.000; (2) the MSI value of PHN in squamous cell carcinoma group was slightly lower than that in adenocarcinoma group and TTP level was slightly higher than that in adenocarcinoma group, and there was no significant difference between them in PPH 0.321 and PMSI 0.586. PTTPN 0.082; 3) before and after radiotherapy, the value of PHI was higher than that after radiotherapy, and the TTP value was lower than that after radiotherapy. The difference was statistically significant (P < 0.05). PTTPN 0.000; (4) the value of PHN MSI in the effective radiotherapy group was slightly higher than that in the ineffective group, and only the difference in the MSI value of PHN was statistically significant (P < 0.05). There was no significant difference in TTP value between the two groups. 3. Mrs analysis showed that the morphology of MRS in cervical cancer group could be summed up as the peak of Lip of Cho and the peak of Cr, but the peak of Cho was higher than that of Lip. That is, Lip peak, Cho peak, Cr peak. 2) in normal cervix group, there was no obvious Cho peak, Lip peak and Cr peak in MRS. Conclusion: 1. PWI can be used to distinguish cervical cancer from normal cervical tissue and to diagnose cervical cancer qualitatively by TIC curve and perfusion parameters. Monitoring the therapeutic efficacy and predicting the sensitivity of radiotherapy and chemotherapy are of great value. 2.1H MRS can monitor the metabolic changes of cervical cancer in vivo and provide molecular metabolic information for the diagnosis and treatment of cervical cancer.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

【参考文献】