核磁共振波谱成像在垂体腺瘤药物疗效预测及手术预后评估中的应用

发布时间：2018-04-15 05:28

本文选题：MRSI + SSA　；参考：《第三军医大学》2016年硕士论文

【摘要】：目的:核磁共振波谱成像(magnetic resonance spectroscopic imaging,MRSI)在垂体生长激素(growth hormone,GH)腺瘤术前预测生长激素类似物(somatostain analogs,SSA)药物治疗敏感性和评估垂体无功能促性腺激素腺瘤(non-function gonadotrophin adenomas,NFGA)手术预后的价值。方法:筛选我科21经蝶手术的垂体生长激素腺瘤患者。常规收集患者的年龄、性别、体质指数(body mass index,BMI)、术前激素水平等资料,MRI和MRSI检查在我院1.5T或3.0T磁共振扫描仪上进行。3D核磁共振(magnetic resonance imaging,MRI)和MRSI检查:采用多体素(multivoxel,MV)波谱成像,点分辨波谱成像(point resolved spectroscopy,PRESS)序列,重复时间(repetition time,TR)/回波时间(echo time,TE)=1000/144ms,体素=7.5mmx7.5mmx10mm,选择100-200cm2包含尽可能多的肿瘤区域感兴趣区和周围正常区域,读取或者计算获得胆碱(choline,Ch),3.36-3.21百万分之一(parts per million,ppm),N-乙酰天门冬氨酸(N-acetylaspartate,NAA),2.18-2.01 ppm,肌酸(creatine,Cr),3.15-3.0 ppm,以及Ch/Cr,Ch/NAA和NAA/Cr的比值。垂体生长激素腺瘤的组织学超微结构使用电镜分析,手术标本使用免疫组化评分系统(immunoreactivity scoring system,IRS)评估分析生长抑素受体(somatostatin receptor subtype,SSTR)2和5,P27和P21的表达。使用SPSS19.0和Graph Pad Prism6.0分析MRSI与病理超微结构,生长抑素受体等的相关性,预测SSA治疗敏感性的价值。随访28例病理检查为卵泡刺激素(follicule-stimulating hormone,FSH)/黄体生成素(luteinizing hormone,LH)免疫阳性的临床无功能促性腺激素腺瘤患者,常规收集患者年龄、性别、Knosp分级、侵袭性等资料,MRI和MRSI按上述设置扫描。对FSH/LH免疫阳性的无功能性促性腺激素腺瘤患者,术前及术后晨起完善垂体激素检查,按时随访,定期复查MRI。使用SPSS19.0分析预测MRSI在术前预测Knosp分级和预后评估的价值。结果:本研究GH腺瘤组共纳入13例稀疏性垂体腺瘤和5例致密性垂体腺瘤患者,受试者工作曲线(receiver operator characteristic,ROC)分析Ch/Cr的比值在预测垂体生长激素腺瘤的超微结构类型的敏感性为92.3%,特异性为100%,准确度为94.4%,曲线下面积(AUC)为0.923(P=0.007),Ch/Cr的比值的阈值为1.27。Ch在预测垂体生长激素腺瘤超微结构类型的敏感性为69.2%,特异性为100%,曲线下面积为0.877(P=0.016),Ch的阈值是3140.5。相关性分析Ch/Cr的比值与SSTR2表达量呈负相关(P0.05),与Ki-67值呈正相关(P0.05),与T2信号值正相关(P0.05),与年龄、肿瘤大小、侵袭性、P27、P21等表达差异无统计学意义。FSH/LH腺瘤组共纳入28例患者,在随访的4~53月中,6例患者有残留的再生或者复发。在FSH/LH腺瘤组中Knosp分级3~4级患者Ch/NAA的比值较Knosp分级1~2级患者明显增高(P0.05),ROC曲线显示:Ch/NAA曲线下面积为0.841,结果显著,Ch/NAA的阈值为2.24,区分FSH/LH腺瘤Knosp分级的敏感性为80%,特异性为84.6%,阳性预测值为85.71%,阴性预测值为78.57%,准确度为为89.28%;6例复发患者的Ch/Cr的比值比未复发的患者高(P0.05),ROC曲线示Ch/Cr的阈值为2.27,评估预后复发的敏感性为83.3%,特异性为72.7%,阳性预测值为45.45%,阴性预测值为94.12%,准确度为75%。结论:MRSI是一种无创的提供代谢和生化信息的检查,可以预测垂体生长激素腺瘤的病理超微结构类型,与SSTR2、Ki-67表达和T2高信号相关。患者MRSI检查Ch/Cr的比值1.27时,稀疏颗粒型生长激素腺瘤可能性大,且Ch/Cr的比值越大,SSTR2表达就越低,Ki-67表达就越高,T2高信号的可能性越大,对SSA治疗越不敏感。因此,MRSI可能是术前预测SSA治疗垂体生长激素垂体大腺瘤敏感性的有效方法。在FSH/LH腺瘤组,MRSI可以预测Knosp级别,评估预后残留再生或复发。Ch/NAA的比值越大,侵袭的可能越大,Knosp分级在3~4的可能性就越大。Ch/Cr的比值越大,术后复发的可能性大。因此应加强随访,如有残余,早期放疗。
[Abstract]:Objective : To investigate the value of magnetic resonance spectroscopy imaging ( MRSI ) in the treatment of pituitary growth hormone ( SSA ) and evaluate the prognosis of pituitary growth hormone ( NFGA ) . Methods : The age , sex , body mass index ( BMI ) and preoperative hormone level were examined by MRI and MRSI . MRI and MRSI were performed on 1.5T or 3.0 T magnetic resonance scanners in our hospital . The histological and ultrastructural features of pituitary growth hormone adenoma were analyzed by electron microscope . The results showed that the sensitivity of MRI and MRSI was 92 . 3 % , specificity 100 % and accuracy of 94 . 4 % . There was a negative correlation between the ratio of Ch / Cr and the value of Ch / Cr in the FSH / LH adenoma group ( P0.05 ) . Therefore , MRSI may be an effective method to predict the sensitivity of SSA in the treatment of pituitary growth hormone pituitary macroadenoma . In FSH / LH adenoma group , the greater the ratio of Ch / NAA , the greater the likelihood of invasion . The larger the ratio of Ch / Cr , the greater the probability of relapse after operation . Therefore , the follow - up should be enhanced , such as residual and early radiotherapy .

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.4

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