DTI及PWI在脑膜瘤病理分型及外科治疗中的应用研究

发布时间：2018-05-17 22:26

本文选题：磁共振扩散张量成像 + 灌注成像　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:本研究采用磁共振扩散张量成像(DTI)及灌注成像技术(PWI)对脑膜瘤进行定量检测,探讨其与脑膜瘤病理学分型和免疫组化的相关性,为区别脑膜瘤的良恶性,提供新的依据,并用于术前评估肿瘤的质地,明确肿瘤与周围白质纤维解剖关系,指导术中神经功能的保护及评估患者的预后。方法:收集于2015年6月-2017年1月经西南医科大学附属中医院影像和病理证实为脑膜瘤的患者,术前均行磁共振平扫、常规增强扫描、DTI、PWI检查,依据2007年WHO脑膜瘤病理分级,分为I级、II级、III级。本研究将I级脑膜瘤归为良性,II级和III级脑膜瘤归恶性,研究分成两组,良性为A组,恶性为B组,对脑膜瘤肿瘤实质区、瘤周水肿区、对侧正常白质纤维的ADC值、FA值和rCBV值进行测量。在研究不同病理类型FA值时,按照病理学分型分为三组,第一组为非典型性和恶性脑膜瘤,第二组为纤维型脑膜瘤,第三组为其它类型良性脑膜瘤。术中将肿瘤的质地分为三级,质地柔软(吸引器可以吸除肿瘤),质地较硬(完全不能被吸除肿瘤),质地中等(介于二者之间)。术后对手术切除的脑膜瘤标本分别进行伊红-苏木素染色,检测血管内皮生长因子(VEGF),检测肿瘤微血管密度(MVD)采用链菌素-生物素-过氧化酶链接法。依据dti,显示白质纤维的走形及与肿瘤之间的解剖关系。选择我院术前未行磁共振扩散张量成像的脑膜瘤患者20例(包括i级脑膜瘤16例、ii级脑膜瘤2例,iii级脑膜瘤1例)及术前行磁共振扩散张量成像的脑膜瘤患者21例,选用karnofsky功能状态评分(kps)表对其神经功能恢复进行评分。采用spss17.0软件进行统计学处理,正态分布的资料以?x±s表示,比较a组与b组脑膜瘤相应部位的adc值、fa值和rcbv值及对比术后kps评分采用双侧配对t检验,检测rcbv值与vegf、mvd关系采用pearson相关分析法;采用spearman相关分析法检测fa值与肿瘤质地之间的关系;选用秩和检验对三组不同病理类型fa值进行检验;双侧检验以p0.05为差异有统计学意义。结果:a组脑膜瘤肿瘤实质区的adc值大于b组,差异具有统计学意义(p0.05),在瘤周水肿区和对侧白质纤维两组差异没有统计学意义(p0.05),a组脑膜瘤实质区rcbv值大于b组,而在瘤周水肿区则相反,差均有统计学意义(p0.05),a组和b组各部位fa值均无统计学意义(p0.05)。脑膜瘤肿瘤实质区rcbv值与vegf及mvd均成正相关性(p0.05)。当fa值0.3时,肿瘤质地较硬,不易于手术切除。术后3月,在术前行磁共振扩散张量成像患者的kps评分明显高于未行扩散张量成像的患者,差异有统计学意义(p0.05)。结论:脑膜瘤患者术前行磁共振扩散张量成像及灌注成像,结合adc值、rcbv值是脑膜瘤诊断和病理分级的有效的辅助手段,rcbv值还可以作为术前评估脑膜瘤微血管状态的辅助手段之一,FA值在术前评估脑膜瘤质地、手术切除脑膜瘤难易程度有重要的价值,术前DTI成像对明确肿瘤与周围白质纤维关系、术后预测患者的病情有重要作用。
[Abstract]:Objective: in this study, the quantitative detection of meningiomas by magnetic resonance diffusion tensor imaging (DTI) and perfusion imaging (PWI) was used to investigate the correlation between the pathological and immunohistochemical features of meningiomas, to provide a new basis for distinguishing the benign and malignant meningioma, and to evaluate the texture of the tumor before operation, and to clarify the fibrinization of the tumor and the surrounding white matter. To guide the protection of nerve function and to evaluate the prognosis of the patients. Methods: the patients with meningioma confirmed by the image and pathology of the affiliated Chinese Medicine Hospital of Southwest Medical University in June 2015 -2017, -2017, were all performed by magnetic resonance imaging, routine enhanced scan, DTI, PWI examination, and classified into I grade, II according to the pathological grade of WHO meningioma in 2007. Grade, III grade. This study classified I meningioma as benign, II and III meningiomas were malignant. The study was divided into two groups. The study was divided into two groups, benign A group and malignant group B. The meningioma tumor parenchyma, peritumoral edema area, ADC value, FA value and rCBV value of contralateral normal white matter fibers were measured. In the study of FA values of different pathological types, the pathological classification was divided into pathological types. The three group, the first group was atypical and malignant meningioma, the second group was fibrous meningioma, and the third group was other type of benign meningioma. The texture of the tumor was divided into three grades, the texture was soft (the suction device could absorb the tumor), the texture was hard (completely unable to be sucked out), and the texture was medium (between two cases). The operation was excised after operation. The meningioma specimens were stained with eosin and hematoxylin to detect vascular endothelial growth factor (VEGF), and to detect tumor microvascular density (MVD) using streptomycin biotin peroxidase linking method. According to DTI, the shape of white matter fiber and the anatomical relationship between the tumor and the tumor were revealed. The meninges were selected before operation in our hospital. 20 cases of tumor (including 16 cases of I meningioma, 2 cases of II meningioma, 1 cases of III meningioma) and 21 cases of meningioma with magnetic resonance diffusion tensor imaging before operation, the neurological functional recovery was scored by Karnofsky function state score (KPS). The data of normal distribution were treated with SPSS17.0 software, and the data of normal distribution were expressed as x + s. The ADC value, FA value and rCBV value of the corresponding parts of the meningioma in group A and group B were compared with the t test of bilateral paired KPS, and rCBV value was detected with VEGF, the relationship between MVD was Pearson correlation analysis, and the relationship between the value and the texture of the tumor was detected by Spearman correlation analysis, and the rank sum test was used for the three groups of pathological types. The results showed that the ADC value of the tumor parenchyma of the meningioma in group A was greater than that of the group B, and the difference was statistically significant (P0.05), and there was no statistical significance between the two groups of the peritumoral edema area and the contralateral white matter fiber (P0.05), and the rCBV value of the meninoma in the a group was greater than that of the B group, but the difference in the peritumoral edema area was the opposite, and the difference was poor in the peritumoral edema area. There were statistical significance (P0.05). The FA values in group A and B were not statistically significant (P0.05). The rCBV value of meningioma tumor parenchyma was positively correlated with VEGF and MVD (P0.05). When FA value was 0.3, the tumor texture was hard and not easy to be excised. In March, the KPS score of patients undergoing MR diffusion tensor imaging before operation was significantly higher than that of non expansion. The difference is statistically significant (P0.05). Conclusion: the patients with meningioma undergo magnetic resonance diffusion tensor imaging and perfusion imaging before operation, combined with the value of ADC, rCBV value is an effective auxiliary means for the diagnosis and pathological classification of meningioma, and the value of rCBV can also be used as one of the auxiliary methods for evaluating the microvascular status of meningioma before operation, FA value Preoperative evaluation of meningioma is of great value in surgical resection of meningiomas. Preoperative DTI imaging has an important role in identifying the relationship between tumor and peripheral white matter fiber and predicting the patient's condition after operation.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45

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