扩散峰度成像在脑星形细胞瘤分级中的应用价值

发布时间：2018-04-30 06:32

本文选题：磁共振成像 + 扩散峰度成像　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的：探讨扩散峰度成像(DKI)对脑星形细胞瘤分级的应用价值。方法：收集自2012年1月至2013年12月,就诊于山西医科大学第一临床医院脑星形细胞瘤患者共34例(高级别星形细胞瘤21例,低级别星形细胞瘤13例)。所有患者均进行头颅常规MRI扫描、增强扫描及DKI扫描,通过工作站对图像进行后处理,得到平均峰度(mean kurtosis, MK)参数图、平均弥散(mean diffusion,MD)参数图、各向异性分数(fraction anisotropy,FA)参数图,在相应参数图中分别测量高低级别肿瘤实质及对侧正常脑白质的参数值MK、FA、MD,上述肿瘤实质DKI参数与对侧正常脑白质相应参数值进行标准化分别得到相应标准化参数值MK'、FA'、MD'(标准化方法及公式参见材料与方法第三部分),高级别与低级别星形细胞瘤患者肿瘤实质区的所有DKI参数值比较,采用Mann-Whitney-Wilcoxon检验(P0.05有统计学意义),并绘制鉴别高低级别星形细胞瘤分级有统计学意义的参数值的ROC曲线,判断AUC大小。结果：①高级别星形细胞瘤组的肿瘤实质MK值比低级别星形细胞瘤组的肿瘤实质MK值明显升高(P=0.020),临界值为0.54,MK值灵敏度及特异度分别是76.1%和84.6%,AUC为0.886；②未进行标准化的MD、FA值在两组星形细胞瘤中差异不明显,无统计学意义(P0.05)；③标准化值MK'、FA'、MD'在高低级别两组肿瘤中差别较大,有统计学意义(MK'的P=0.024,FA'的P=0.033,MD'的P=0.031),MK'临界值为0.50,其灵敏度及特异度分别是85.7%和76.9%,AUC为0.897,FA'值临界值为0.62,其灵敏度及特异度分别为71.4%和69.2%,AUC为0.762,MD'值临界值为1.54,其灵敏度及特异度分别为71.4%和69.2%,AUC为0.788。结论：高、低级别星形细胞瘤的扩散峰度参数差异具有统计学意义,能更好对高级别、低级别星形细胞瘤进行分级,因此可用于术前脑星形细胞瘤分级诊断。
[Abstract]:Objective: to evaluate the value of DKI in grading astrocytoma. Methods: from January 2012 to December 2013, 34 cases of astrocytoma (21 cases of high grade astrocytoma and 13 cases of low grade astrocytoma) in the first Clinical Hospital of Shanxi Medical University were collected. All the patients underwent routine MRI scan, enhanced scan and DKI scan. The mean kurtosissis (MK) parameter map, the mean diffusion-MDM parameter map and the anisotropic fractional fraction anisotropy parameter map were obtained by workstation post-processing. The parameters of high and low grade tumor and contralateral normal white matter were measured in the corresponding parameter map. The DKI parameters of tumor parenchyma and the corresponding parameter value of contralateral normal white matter were standardized respectively. The value of MK / FAA Md (standardized methods and formulas see materials and methods part III, comparison of all DKI parameters in the tumor parenchyma region of high and low grade astrocytomas, Mann-Whitney-Wilcoxon test (P0.05) was used to determine the size of AUC, and the ROC curve was drawn to distinguish the parameter value of high and low grade astrocytoma. Results the MK value of tumor parenchyma in the high-grade astrocytoma group was significantly higher than that in the low-grade astrocytoma group. The critical value of MK value was 0.54mK, the sensitivity and specificity were 76.1% and 84.6%, respectively. The MK value of the tumor parenchyma was not standardized. There was no significant difference in MDFA between the two groups. There was no statistically significant difference between the two groups in the difference between high and low grade tumors. The critical value of P0. 031 MK' of P0. 033 MD' is 0. 50, its sensitivity and specificity are 85. 7% and 76. 9% respectively. The critical value of FA' is 0. 897. The sensitivity and specificity are 71. 4% and 69. 2% respectively. The critical value of MD' is 1. 54, and its sensitivity and specificity are 0. 762. The AUC of 71.4% and 69.2% were 0.788. Conclusion: the diffusive kurtosis parameters of high and low grade astrocytoma are statistically significant and can be used for the diagnosis of high grade and low grade astrocytoma before operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41;R445.2

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