STIR-FLAIR与T2W-SPIR序列在眼眶病变诊断中的对比研究

发布时间：2018-04-22 22:17

本文选题：磁共振成像 + 反转恢复　；参考：《苏州大学》2011年硕士论文

【摘要】：目的:通过STIR-FLAIR序列与T2W-SPIR序列在眼眶MRI检查中的综合应用和对比研究,探讨脂肪-水抑制序列—STIR-FLAIR序列在眼眶病变诊断中的应用价值。方法:收集51例眼眶病变患者(共计60只病变眼眶)的临床和影像(MRI)资料以及4例正常志愿者的MRI图像。所有病例均经“手术病理证实”或“临床、影像(MRI)特点和随访综合诊断”。从主观和客观两方面对STIR-FLAIR与T2W-SPIR序列横断位图像进行评价,从“正常眼眶及邻近结构、51例眼眶病变患者(60只病变眼眶)、脉络膜相关病变、眼外肌病变(Graves眼病)、视神经病变和眼眶血管源性病变”6个角度进行观察和分析两序列在眼眶部MRI检查中的应用价值。结果:1、正常眼眶及邻近结构:正常眼眶内各种组织结构和眼眶邻近结构在STIR-FLAIR与T2W-SPIR序列中的信号表现不同; 2、51例患者STIR-FLAIR与T2W-SPIR图像观察和分析结果:主观评价结果:两观察者对STIR-FLAIR与T2W-SPIR序列在“图像质量(伪影影响)、病变显示、病变与周围结构关系”三个方面的评价一致性检验结果(Kappa值)分别为:STIR-FLAIR序列(一致性一般～较好):0.827、0.659、0.645;T2W-SPIR序列(一致性较好):0.859、0.803、0.807;STIR-FLAIR序列图像伪影较T2W-SPIR序列少(双侧P0.05),STIR-FLAIR序列更利于病变的发现(双侧P0.05),两种序列对“病变与周围组织关系”的评价效能类似(双侧P值0.05)。客观评价结果(标准信号强度均用“Sn”表示,如眶脂体标准信号强度表示为Sn眶脂体):STIR-FLAIR序列正常结构的标准信号强度(Sn眶脂体、Sn眼睑、Sn泪腺和Sn眼外肌)均稍高于T2W -SPIR序列相应结构的标准信号强度,Sn玻璃体明显低于T2W-SPIR序列Sn玻璃体(双侧P值均小于0.05);STIR-FLAIR序列眼眶正常结构中Sn眼外肌最高,Sn玻璃体最低,Sn病灶高于Sn眼外肌,双侧P值均小于0.05;T2W-SPIR序列正常结构“Sn眶脂体、Sn眼睑、Sn泪腺和Sn眼外肌”与Sn病灶均低于明显低于Sn玻璃体,Sn泪腺与Sn眼外肌高于Sn眶脂体和Sn眼睑(双侧P值均小于0.05),Sn泪腺与Sn眼外肌二者之间无统计学差异(双侧P0.05);STIR-FLAIR序列病变组织与玻璃体间的信号对比度(R病变/玻璃体)高于T2W-SPIR序列R病变/玻璃体,T2W-SPIR序列R病变/眶脂体略高于STIR-FLAIR序列R病变/眶脂体(双侧P均小于0.05); 3、脉络膜相关病变观察和分析结果:主观评价结果:STIR-FLAIR序列伪影较T2W-SPIR序列少,STIR-FLAIR序列更利于病变的发现,STIR-FLAIR序列对“病灶与周围关系”的评价效能高于T2W-SPIR序列(双侧P均小于0.05)。客观评价结果:STIR-FLAIR序列Sn病灶明显高于Sn眶脂体、Sn玻璃体(双侧P值均小于0.05);T2W-SPIR序列Sn病变与Sn玻璃体均高于Sn眶脂体(双侧P值均小于0.05),Sn病灶与Sn玻璃体无统计学差异(双侧P0.05);STIR-FLAIR序列R病变/玻璃体明显大于T2W-SPIR序列R病变/玻璃体(双侧P0.05); 4、眼外肌病变(Graves眼病)观察和分析结果:观察结果:异常眼外肌(11条)在两种序列中均被显示;STIR-FLAIR序列对增粗眼外肌轮廓显示较T2W-SPIR序列清楚,T2W-SPIR序列所示部分眼外肌周围的高信号影在STIR-FLAIR序列中未见显示。客观评价结果:STIR-FLAIR序列Sn异常眼外肌稍高于Sn正常眼外肌,明显高于Sn眶脂体和Sn玻璃体(双侧P值均小于0.05);T2W-SPIR序列中Sn玻璃体明显高于Sn异常眼外肌、Sn正常眼外肌和Sn眶脂体,Sn异常眼外肌信号稍高于Sn正常眼外肌信号(双侧P值均小于0.05);STIR-FLAIR序列R异常眼外肌/正常眼外肌略大于T2W- SPIR序列R异常眼外肌/正常眼外肌,STIR-FLAIR序列R异常眼外肌/玻璃体明显高于T2W-SPIR序列R异常眼外肌/玻璃体(双侧P值均小于0.05);两序列R异常眼外肌/眶脂体无统计学差异(双侧P0.05); 5、视神经病变观察和分析结果:STIR-FLAIR序列对“3例视神经萎缩和1例急性早幼粒细胞白血病视神经受浸润患者的视神经的异常改变”显示较T2W-SPIR序列清楚; 6、血管源性病变观察和分析结果:主观评价结果:STIR-FLAIR、T2W-SPIR两序列在“病变显示、病变与周围组织关系”的评价效能类似(双侧P值均大于0.05)。客观评价结果:STIR-FLAIR序列Sn病灶高于正常结构的标准信号强度(Sn眼睑、Sn眶脂体与Sn玻璃体),双侧P值均小于0.05;T2W-SPIR序列Sn玻璃体高于Sn眼睑、Sn眶脂体及Sn病灶,Sn病灶明显高于Sn眼睑及Sn眶脂体(双侧P值均小于0.05);STIR-FLAIR序列R病变/玻璃体高于T2W-SPIR序列R病变/玻璃体(双侧P0.05),STIR-FLAIR序列R病变/眶脂体略低于T2W-SPIR序列R病变/眶脂体(双侧P0.05); 结论:在眼眶MRI检查中,STIR-FLAIR序列与T2W SPIR序列相比,图像伪影较少;STIR-FLAIR序列提高了组织间的对比度,利于病变的发现;在脉络膜相关病变的显示、病变位置和范围的评价方面,STIR-FLAIR序列优于T2W-SPIR序列;STIR-FLAIR序列更利于视神经病变的检出;STIR-FLAIR序列更利于Graves眼病活动期眼外肌增粗的评价,但对眼眶炎性浸润的显示STIR-FLAIR序列可能稍逊于T2W-SPIR序列;对于眼眶部血管源性病灶两种序列诊断效能类似,而在脉络膜血管瘤检出方面,STIR-FLAIR序列则有一定优势。由此,我们推荐将STIR-FLAIR序列用于临床眼眶MRI检查,尤其在临床怀疑有眼球或视神经病变时,可以考虑用STIR-FLAIR序列替代T2W-SPIR序列进行扫描。
[Abstract]:Objective : To investigate the application of STIR - FLAIR and T2W - SPIR sequences in the diagnosis of orbital lesions .

Methods : The clinical and imaging ( MRI ) data of 51 patients with orbital lesions ( total 60 lesions ) and MRI images of 4 normal volunteers were collected . All cases were evaluated by " pathology of operation " or " clinical , imaging ( MRI ) characteristics and follow - up comprehensive diagnosis " . Results : 1 . Normal orbit and adjacent structure : the signals of the various tissue structures and orbital proximity in the normal orbit were different in STIR - FLAIR and T2W - SPIR sequences .

The results of subjective evaluation showed that the standard signal intensity of the STIR - FLAIR and T2W - SPIR sequences was lower than that of the T2W - SPIR sequence ( P < 0.05 ) .

Results : The results of subjective evaluation : The results of subjective evaluation : The results of subjective evaluation : The results of the subjective evaluation showed that the STIR - FLAIR sequence was less than T2W - SPIR sequence , and the STIR - FLAIR sequence was more beneficial to the lesion . The results of objective evaluation showed that the Sn lesion and the Sn glass body were higher than that of the Sn orbital fat body ( both P < 0.05 ) , and the lesion / vitreous body of the STIR - FLAIR sequence was significantly larger than that of the T2W - SPIR sequence ( P < 0.05 ) .

The results of observation and analysis of extraocular muscle disease ( Graves ophthalmicopathy ) were as follows : abnormal extraocular muscles ( 11 strips ) were shown in both sequences ; the higher signal shadows around the extraocular muscles of the STIR - FLAIR sequence were significantly higher than those of the normal extraocular muscles of Sn ( both P < 0.05 ) .

5 . The results of observation and analysis of optic neuropathy : STIR - FLAIR sequence showed a clear sequence of T2W - SPIR in 3 cases of optic atrophy and 1 case of optic nerve in patients with acute early myelocyte infiltration .

Results : The results of subjective evaluation : STIR - FLAIR , T2W - SPIR were similar to those of normal structure ( P < 0.05 ) .

Conclusion : The STIR - FLAIR sequences are superior to T2W - SPIR sequences and STIR - FLAIR sequences are superior to T2W - SPIR sequences compared with T2W - SPIR sequences . STIR - FLAIR sequences are superior to T2W - SPIR sequences .

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R777

【参考文献】