常见小肾肿瘤磁共振成像诊断效能与超声造影比较分析

发布时间：2018-03-08 11:46

本文选题：磁共振成像　切入点：超声造影　出处：《中国人民解放军医学院》2016年博士论文　论文类型：学位论文

【摘要】：背景：小肾肿瘤是临床常见病,MRI(magetic reasoance imaging,磁共振)和CEUS (contrast enhanced ultrasound,超声造影)是常用的影像学检查方法,比较两者哪种检查更优,对临床具有指导意义。目的：通过回顾性分析常见小肾肿瘤MRI主要征象,判断哪些征象在诊断中起主要作用。在此基础上,通过前瞻性分析比较两种检查方法的诊断正确率,进而比较哪种方法成本效果较高。材料与方法：第一至第四部分,采用多元回归分析自2009年1月年至2015年6月间病理证实的良恶性肾肿瘤80例,分析其主要诊断征象。采取病例对照分析法,恶性组为病例组,良性组为对照组。MRI征象分为定性和定量两种。定性征象有：有无肉眼所见脂肪、假包膜、囊变及坏死、T2WI信号、出血、楔形变、匍匐式生长、晕环结节。定量指标有：反相位信号改变,增强扫描皮质期、皮髓期、分泌期强化程度、性别、年龄.第五部分通过前瞻性分析经病理证实的良恶性肾肿瘤94例,比较MRI和超声造影对不同直径小肾肿瘤的检出率。第六至第七部分采用前瞻性分析MRI和超声造影对小肾良恶性肾肿瘤的诊断正确率,并对两者的成本效果进行比较分析。本研究应用SPSS19.0和CHISS统计软件,主要采用Logistic多元回归分析多种征象之间的相互关系,少部分采用单因素分析及卡方检验、t或t’检验、单向有序列联表等分析数据.结果：肾肿瘤主要征象中,按重要性关系依次为脂肪(良性征象)、囊变等级高和“晕环结节”征(恶性征象)。次要征象为假包膜、出血(恶性征象)、匍匐征(良性征象)。无或少脂肪的AML(angiomyolipoma,血管平滑肌脂肪瘤)和chRCC(chromophobe renal cell carcinoma,嫌色细胞癌)相比,有假包膜、囊变级别高、T2MI信号级别高的肿瘤诊断为恶性的可能性大；有楔形征或匍匐征其中之一的诊断良性的可能性大。定量指标中,反相位信号降低较多,皮质期增高较高的诊断为无或少脂肪的AMI,可能性大。无或少脂肪的AML与pRCC (papillary renal cell carcinoma,乳头状细胞癌)相比：T2信号、囊变和出血级别越高者,诊断乳头状癌的可能性越大。定量指标中皮质期强化级别越高者诊断良性的可能性越大。ccRCC(clear cell renal cell carcinoma,透明细胞癌)和chRCC目比：有假包膜、囊变级别高、“晕环结节”征的肿瘤诊断透明细胞癌的可能性大。定量指标中,反相位信号降低程度越高,诊断ccRCC的可能性越大。小于1.5cm组的肾肿瘤中,无论是否含有脂肪,MRI的检出率均高于超声造影(p0.008).MRI和超声造影对小肾肿瘤诊断正确率分别为93.62%、84.04%。成本效果分析显示后者高于前者。改良MRI增强的成本效果高于后者。结论：脂肪是良性肿瘤的主要征象,囊变程度高和“晕环结节”征是恶性肿瘤的主要征象。MRJ和超声造影对小肾肿瘤诊断正确率比较前者高于后者。超声造影成本效果更高。
[Abstract]:Background: MRImagetic reasoance imaging (MRI) and CEUS contrast enhanced ultrasound (ultrasound) are commonly used imaging methods for small renal tumors. Objective: to analyze the main signs of MRI in common small renal tumors and to determine which signs play an important role in the diagnosis. On the basis of this, the diagnostic accuracy of the two methods was compared by prospective analysis. Materials and methods: part 1 to 4th, 80 cases of benign and malignant renal tumors confirmed by pathology from January 2009 to June 2015 were analyzed by multivariate regression analysis. The main diagnostic signs were analyzed. The malignant group was the case group, and the benign group was the control group. The MRI signs were classified into qualitative and quantitative methods. The qualitative signs included fat, pseudocapsule, cystic degeneration and necrotic T2WI signal. Haemorrhage, wedge-shaped change, creeping growth, halo ring nodule. Quantitative indicators: change of anti-phase signal, enhancement of cortical phase, enhancement of medullary phase, enhancement of secretory phase, sex, Age. 5th. 94 cases of benign and malignant renal neoplasms confirmed by pathology were analyzed prospectively. To compare the detectable rate of MRI and contrast-enhanced ultrasonography in small renal tumors with different diameters. From 6th to 7th, the diagnostic accuracy of MRI and contrast-enhanced ultrasonography for benign and malignant renal tumors of small kidney was analyzed prospectively. In this study, SPSS19.0 and CHISS statistical software were used to analyze the correlation between the multiple signs, and a few of them were analyzed by single factor analysis and chi-square test (t or t 'test). Results: among the main signs of renal tumors, fat (benign sign, high cystic grade) and "halo ring nodule" (malignant sign) were the main signs of renal neoplasms. Hemorrhage (malignant sign, prostrate sign) and chRCC(chromophobe renal cell carcinoma (chRCC(chromophobe renal cell carcinoma) were more likely to be diagnosed as malignant than those with false capsule and higher signal level of cystic T2MI. The results showed that: (1) Hemorrhage (malignant sign), prostrate sign (benign sign: AML-angiomyolipoma) and chRCC(chromophobe renal cell carcinoma (chromophobe cell carcinoma) were more likely to be diagnosed as malignant than those with false capsule and high cystic grade T2MI signal level. One of the wedge-shaped or creeping signs is more likely to diagnose benign. The higher the cortical phase was, the more likely the diagnosis was that the amis had no or no fat. Compared with pRCC papillary renal cell carcinoma, AML with no or no fat had higher signal signal on T2, cystic degeneration and bleeding grade. The more the possibility of diagnosing papillary carcinoma is, the higher the degree of enhancement in cortical phase is, the higher the probability of diagnosing benign is. CcRCC clear cell renal cell carcinoma (transparent cell carcinoma) and chRCC ratio: false capsule. The higher the cystic grade, the greater the possibility of diagnosing transparent cell carcinoma with halo ring nodule sign. In quantitative indexes, the higher the degree of decrease of anti-phase signal, the greater the possibility of diagnosing ccRCC. The positive rate of MRI with or without fat was higher than that of contrast-enhanced MRI and contrast-enhanced MRI were 93.62or 84.04, respectively. Cost-effect analysis showed that the latter was higher than the former. The cost effect of modified MRI was higher than that of the latter. Conclusion: fat is the main sign of benign tumor. High degree of cystic degeneration and "halo ring nodule" sign were the main signs of malignant tumors. MRJ was higher than contrast-enhanced ultrasonography in the diagnosis of small renal tumors. The cost of contrast-enhanced ultrasound was higher than that of the latter.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R445;R737.11

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