脑胶质瘤及其瘤周区的fMRI研究

发布时间：2018-05-17 08:10

本文选题：磁共振成像 + 弥散加权成像　；参考：《兰州大学》2017年硕士论文

【摘要】：第一部分DWI、MRS在脑胶质瘤诊断和分级中的价值研究目的探讨DWI和MRS在脑胶质瘤术前诊断及分级中的临床应用价值。方法80例脑胶质瘤患者行常规MRI、DWI及1H-MRS检查,并与术后病理进行对照;其中高级别44例、低级别36例,分别测量瘤体区、瘤周区(≤1.0 cm)、对照区的r ADC、NAA/Cho、NAA/Cr、Cho/Cr值,比较各区间的差异;绘制DWI、MRS测量值的ROC曲线,分析其在高、低级别胶质瘤鉴别诊断中的价值。结果(1)常规MRI依据肿瘤部位、形态、信号、占位效应及强化程度对胶质瘤分级诊断的准确率为88.75%;(2)高、低级别胶质瘤瘤体区r ADC值(1.313±0.101、1.656±0.045)低于瘤周区r ADC值(1.451±0.102、1.841±0.040)(P0.01);高、低级别胶质瘤组内瘤体区和瘤周区r ADC值均有统计学差异(P0.01);(3)高级别胶质瘤瘤体区NAA/Cho(0.536±0.177)、NAA/Cr(1.121±0.246)、Cho/Cr(3.216±0.497)与低级别胶质瘤瘤体区NAA/Cho(0.760±0.161)、NAA/Cr(1.305±0.158)、Cho/Cr(2.439±0.231)间差异均有统计学意义(P0.05);高级别胶质瘤瘤周区NAA/Cho(0.613±0.110)、NAA/Cr(1.333±0.061)、Cho/Cr(2.236±0.197)与低级别胶质瘤瘤周区NAA/Cho(1.202±0.162)、NAA/Cr(1.587±0.189)、Cho/Cr(2.041±0.148)间差异具统计学意义(P0.05);高和低级别胶质瘤瘤体区与瘤周区NAA/Cho、NAA/Cr、Cho/Cr差异亦有统计学意义(P0.05);高和低级别胶质瘤瘤体区、瘤周区与对照区的NAA/Cho、NAA/Cr、Cho/Cr值间有统计学差异(P0.05);(4)瘤体区r ADC值1.59作为高、低级别胶质瘤鉴别诊断的阈值时,其灵敏度、特异度、准确度分别为83.3%、93.2%和92.50%;(5)Cho/Cr值2.72作为鉴别诊断的阈值时,其灵敏度、特异度、准确度分别为100%、80.6%和91.25%,明显优于NAA/Cho、NAA/Cr。结论DWI、1H-MRS有助于胶质瘤的术前诊断及分级评价,其准确率高于常规MRI。第二部分高级别胶质瘤浸润范围的DTI研究目的探讨DTI在高级别胶质瘤浸润范围中的临床价值。方法54例高级别脑胶质瘤患者行常规MRI、DTI检查,其中Ⅲ级25例、Ⅳ29例;ADC、FA图上分别测定肿瘤瘤体、瘤周区(≤1cm/1.1-2cm/2.1-3cm)和对照区平均ADC值、FA值,比较各区间的差异。结果(1)瘤体区、瘤周区、对照区的ADC值分别为1047.46±82.21,1157.73±88.08/1193.89±89.14/1062.34±66.69和797.66±16.14,中瘤周区ADC值达最大值;瘤体、近瘤周区、中瘤周区与远瘤周区间差异显著(P0.01),而近瘤周区与中瘤周区间差异无统计学意义(P0.05);瘤体至远瘤周区ADC值与对照区间比较差异均有统计学意义(P0.05)。(2)瘤体区、瘤周三区至对照区FA值分别为0.238±0.010、0.249±0.011/0.253±0.011/0.257±0.009和0.260±0.008,呈逐渐升高趋势,瘤体区与近瘤周区FA值差异有统计学意义(P0.05),其余相邻两组间差异均无统计学意义;瘤体至中瘤周区与对照区FA值间有显著性差异(P0.01),而近瘤周区与远瘤周区间有统计学差异(P0.05)。结论DTI对高级别胶质瘤瘤周区肿瘤细胞浸润范围的界定具有一定的指导价值。第三部分DWI、MRS在脑胶质瘤放疗后早期疗效评价中的价值研究目的探讨DWI和MRS在脑胶质瘤放射治疗早期疗效评价中的价值。方法18例脑胶质瘤患者分别在放疗前、放疗后3~4周行常规MRI、DWI、1H-MRS检查,其中Ⅱ级3例、Ⅲ级7例、Ⅳ级8例;测量瘤体区/瘤床区、瘤周区r ADC和MRS(NAA/Cho、NAA/Cr、Cho/Cr)值,并比较这些功能成像参数值在放疗前和放疗后的差异。结果(1)放疗前、放疗后瘤体/瘤床区Cho/NAA、NAA/Cr、Cho/Cr值分别为2.54±1.56/2.09±1.30、1.31±0.84/1.29±0.94和3.18±1.97/2.31±1.24,放疗后Cho/Cr值较放疗前显著下降(P0.01);放疗前、放疗后瘤周区Cho/NAA、NAA/Cr、Cho/Cr值分别为1.33±1.09/1.24±0.88、1.59±0.79/1.06±0.59、1.85±0.78/1.48±0.66,放疗后Cho/Cr值与放疗前相比具有统计学意义(P0.05)。(2)放疗前瘤体/瘤床区、瘤周区r ADC值分别为1.313±0.101和1.425±0.118,而放疗后分别为1.761±0.134和1.774±0.152,放疗后瘤体/瘤床区r ADC值较放疗前显著升高(P0.05)。结论DWI、1H-MRS对脑胶质瘤放疗疗效的早期评价具有一定辅助价值。
[Abstract]:The value of DWI and MRS in the diagnosis and classification of glioma objective to explore the clinical value of DWI and MRS in the preoperative diagnosis and classification of glioma. Methods 80 patients with glioma underwent routine MRI, DWI and 1H-MRS examination and compared with the postoperative pathology; of them, 44 cases of high grade and 36 low grade, respectively, measured the tumor area, Peritumoral region (less than 1 cm), R ADC, NAA/Cho, NAA/Cr, Cho/Cr values in the control area, and comparison of the differences in each interval; the value of ROC curves of DWI and MRS measurements was drawn to analyze their value in the differential diagnosis of high and low grade gliomas. Results (1) conventional MRI based on the tumor location, morphology, signal, occupying effect and strengthening degree for the diagnosis of glioma classification accuracy. For 88.75%, (2) high, low grade glioma area R ADC value (1.313 + 0.101,1.656 + 0.045) was lower than that of R ADC (1.451 + 0.102,1.841 + 0.040) in peritumoral region (P0.01); high, low grade glioma group and peritumoral region R ADC values were statistically different (P0.01); (3) high grade glioma region NAA/Cho (0.536 + 0.177), NAA/Cr (1.121 + 0.246), 1.121 /Cr (3.216 + 0.497) and low grade glioma area were NAA/Cho (0.760 + 0.161), NAA/Cr (1.305 + 0.158), Cho/Cr (2.439 + 0.231), NAA/Cho (0.613 + 0.110), NAA/Cr (1.333 + 0.061), Cho/Cr (2.236 + 0.061), Cho/Cr (1.333 + 0.061), and NAA/Cr (NAA/Cr). 587 + 0.189), Cho/Cr (2.041 + 0.148) had statistical significance (P0.05); high and low grade glioma area and peritumoral region NAA/Cho, NAA/Cr, Cho/Cr also had statistical significance (P0.05); high and low grade glioma area, the peritumoral region and the control area of NAA /Cho, NAA/Cr, Cho/Cr values were statistically different (P0.05); (4) the tumor region R 1.59 as a threshold for differential diagnosis of high and low grade gliomas, their sensitivity, specificity, and accuracy are 83.3%, 93.2% and 92.50%, respectively. (5) Cho/Cr value 2.72 as a threshold for differential diagnosis, its sensitivity, specificity, and accuracy are 100%, 80.6% and 91.25%, respectively, superior to NAA/Cho, NAA/Cr. conclusion DWI, 1H-MRS can help the preoperative glioma surgery Diagnostic and graded evaluation, its accuracy is higher than the DTI study of the invasive range of high grade glioma in MRI. second. Objective to explore the clinical value of DTI in the range of high grade glioma infiltration. Methods 54 cases of high grade glioma patients underwent conventional MRI, DTI examination, of which 25 cases of grade III, IV 29 cases, ADC, FA diagram, respectively, to determine tumor tumor body, tumor, tumor and tumor respectively. The average ADC value and FA value of the week area (< < 1cm/1.1-2cm/2.1-3cm) and the control area were compared. Results (1) the ADC values of the tumor body area, the peritumor region and the control area were 1047.46 + 82.211157.73 + 88.08/1193.89 + 66.69 and 797.66 + 16.14 respectively, and the maximum value of the median tumor peritumoral zone ADC value; the tumor body, the near tumor peritumor area, the middle tumor peritumor area and the far tumor peritumor interval The difference was significant (P0.01), but there was no significant difference between the near tumor peritumoral area and the middle tumor peritumor interval (P0.05), and the difference of the ADC value between the tumor and the far zone was statistically significant (P0.05). (2) the FA value of the tumor from Wednesday area to the control area was 0.238 + 0.010,0.249 + 0.010,0.249 + 0.011/0.257 + 0.009 and 0.260 + 0.008, respectively. There was significant difference in the FA value between the tumor and the peritumoral region in high trend (P0.05), and there was no significant difference between the two groups of the other adjacent groups, and there was a significant difference between the peritumoral area and the control area (P0.01), but there was a statistical difference between the peritumoral area and the far zone (P0.05). Conclusion DTI was used for the high grade glioma tumor cells in the peripheral region of the tumor (P0.05). The definition of the scope of infiltration has certain guiding value. The value of the third part DWI and MRS in the early evaluation of brain glioma after radiotherapy. Objective to explore the value of DWI and MRS in the early evaluation of brain glioma radiotherapy. Methods 18 cases of glioma patients were treated with routine MRI, DWI, 1H-MRS examination before radiotherapy and 3~4 weeks after radiotherapy respectively. There were 3 cases of grade II, 7 cases of grade III and 8 cases of grade IV, and the values of R ADC and MRS (NAA/Cho, NAA/Cr, Cho/Cr) in the tumor area / tumor bed area were measured, and the differences of these functional imaging parameters before and after radiotherapy were compared. Results (1) before radiotherapy, Cho/NAA, NAA/Cr, and Cho/Cr value of the tumor / tumor bed region after radiotherapy were 2.54 + 1.56/2.09 + 1.30,1.31 + 0.84/1.29. The Cho/Cr values of 0.94 and 3.18 + 1.97/2.31 + 1.24 were significantly lower than that before radiotherapy (P0.01). Before radiotherapy, the Cho/NAA, NAA/Cr, Cho/Cr values were 1.33 + 1.09/1.24 + 0.88,1.59 + 0.59,1.85 + 0.66 respectively. The ratio of Cho/Cr value to before radiotherapy was statistically significant. (2) the tumor / tumor bed area before radiotherapy. The R ADC values in the peritumoral region were 1.313 + 0.101 and 1.425 + 0.118 respectively, and 1.761 + 0.134 and 1.774 + 0.152 respectively after radiotherapy. The value of R ADC in the tumor / tumor bed region after radiotherapy was significantly higher than that before radiotherapy (P0.05). Conclusion DWI, 1H-MRS has a certain auxiliary value for the early evaluation of the therapeutic effect of brain glioma.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41;R445.2

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