良恶性骨髓增生IVIM参数比较及组织学意义

发布时间：2018-03-16 15:45

  本文选题：体素内不相干运动　切入点：急性白血病　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对规范化治疗前急性白血病(acute leukemia,AL)患者、增生性贫血患者腰椎行基于体素内不相干运动(intravoxel incoherent motion,IVIM)的多b值DWI技术扫描,明确ADC值、D、D*及?参数值对疾病的评估价值;并阐明IVIM参数值与骨髓病理学、血清改变、年龄的相关性。方法:收集山西医科大学第二医院血液科2016年8月~2017年2月经病理确诊为初发急性白血病、增生性贫血的患者共43例,其中初发急性白血病患者28例、增生性贫血患者15例。1.腰椎MRI检查。MRI检查采用1.5T超导型磁共振扫描仪,序列为矢状位自旋回波序列T1加权像、传统DWI(b=500s/mm~2)、基于IVIM的多b值DWI(b=0,10,25,50,100,200,400,600,800,1000,1200s/mm~2,逐渐递增共11个b值)。经Functool、MADC软件后处理,分别测量腰2-4椎体的ADC、D、D*及?值。2.采集初发急性白血病、增生性贫血共43例患者清晨空腹血样约1ml,离心后提取血清,并置于-80℃冷冻保存。用博士德人血管内皮细胞生长因子ELISA试剂盒,对血清中血管内皮生长因子(vascular endothelial growth factor,VEGF)含量进行测定。3.用CD34染色计数微血管密度(microvascular density,MVD)。先在低倍镜(10×10)下寻找血管密度最高的区域,再换为高倍镜(10×20)。计数视野内被染色的血管数,选取3个视野读取其平均值。比较初发急性白血病组与增生性贫血组ADC、D、D*及f值的差异。采用ROC曲线下面积评估各参数值对良恶性骨髓增生疾病的评估能力。分析IVIM各参数值与VEGF、MVD、年龄的相关性。结果:1.D值、?值、D*值在两组间差异均有统计学意义(P0.05)。相较于增生性贫血组,AL组D值显著减低(P0.01),f值显著高(P=0.01),D*值减低(P0.01)。ADC值组间差别不具有统计学意义(P=0.18)。2.对AL组、增生性贫血组患者做ROC曲线分析,可知AUCD=0.880,敏感度为0.964,特异度为0.667,临界点为D=0.28×10~(-3)mm~2/s;AUCf=0.776,敏感度为0.679,特异度为0.800,临界点为f=24.93%;AUCD*=0.917,敏感度为0.964,特异度为0.733,临界点为D*=9.75%,即D值、f值、D*值对疾病良恶性有一定评估价值。3.骨髓MVD、外周血VEGF、D、D*、f值做相关性分析可知,f与MVD之间r=0.419、f与VEGF之间r=0.407,呈正相关;D*与MVD之间r=-0.512、D*与VEGF之间r=-0.418,D与MVD之间r=-0.407、D与VEGF之间r=-0.443,呈负相关。ADC(r=0.197)、D(r=0.955)、D*(r=0.533)、f(r=0.060)值与年龄无统计学相关。结论:基于IVIM的多b值DWI技术对疾病有一定的评估意义,使无创性评估患者预后成为可能。当患者f24.93%,D0.28×10~(-3)mm~2/s,D*9.75%时恶性疾病可能性大。IVIM参数与MVD、VEGF有相关性,可以反映骨髓的血管新生。其中,f与MVD、VEGF呈正相关,D、D*与MVD、VEGF呈负相关。IVIM参数与年龄无统计学相关。
[Abstract]:Objective: to scan the lumbar vertebrae of patients with acute leukemia and hyperplastic anemia based on intra voxel incoherent motionless IVIMI before standardized treatment, and to determine the ADC value of D * and D *? The evaluation value of parameter value to disease, and to clarify the parameter value of IVIM and bone marrow pathology, serum changes, Methods: from August 2016 to 2017, 43 patients with primary acute leukemia and proliferative anemia were collected from Department of Hematology, second Hospital of Shanxi Medical University, including 28 patients with primary acute leukemia. 15 patients with proliferative anemia were examined by 1.5T superconducting magnetic resonance scanner. The sequences were T1 weighted images of sagittal spin echo sequences, conventional DWII-BX 500s / mmm-2, and IVIM based multi-b values DWIIBX / 10 ~ 2550,100400400600 / 1000000s/ mmmm-2, which were gradually increased by a total of 11 b / mm2, and were processed by the Functool-MADC software. The ADCA D * and D * of lumbar 2-4 vertebrae were measured respectively. The fasting blood samples were collected from 43 patients with primary acute leukemia and proliferative anemia. The serum was extracted after centrifugation and cryopreserved at -80 鈩，

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