WB-DWI联合常规CT、MRI在恶性肿瘤全身转移中的应用价值1 - 图文

目 录

中文摘要……………………………………………………………………………1 英文摘要……………………………………………………………………………3 符号说明……………………………………………………………………………5 前 言………………………………………………………………………………6 材料与方法…………………………………………………………………………7 结 果………………………………………………………………………………10 讨 论………………………………………………………………………………17 结 论………………………………………………………………………………32 附 图………………………………………………………………………………33 参考文献……………………………………………………………………………47 综 述………………………………………………………………………………50 致 谢………………………………………………………………………………59

WB-DWI联合常规CT/MRI在恶性肿瘤全身转移中的应用价值

研究生：刘 辉

专 业：影像医学与核医学 导 师：李长勤 教授

中文摘要

目的

探讨全身弥散加权磁共振成像（whole body diffusion-weighted MRI，WB-DWI）及其联合常规CT/MRI在正常人体不同组织器官及诊断恶性肿瘤转移灶的临床应用价值。 材料与方法

对52例健康志愿者（男性25例，女性27例）和76例恶性肿瘤患者（男性41例，女性35例）进行WB-DWI检查，其中76例恶性肿瘤患者均在7天内完成常规CT及MR检查，部分行增强扫描。采用双盲法由两名资深影像医师对所有WB-DWI图像以及CT、MR图像进行分析。所有转移瘤均经手术或穿刺后病理学检查、影像学资料（CT、MRI或US）及实验室检查或随访至少3个月证实。统计正常成人不同组织器官的ADC值，比较腹部脏器ADC值有无差异及前列腺中央区、周缘区以及乳腺与年龄的相关性；统计单独应用WB-DWI和WB-DWI联合常规CT/MRI对转移瘤诊断的灵敏度、特异度和准确度；比较两者在转移瘤的诊断中是否存在统计学差异。 结果

在b值等于600mm2/s时，正常成人脑皮质、脑白质、肝脏、脾脏、胰腺、肾脏、脊柱、淋巴结、前列腺中央区、前列腺周缘区、乳腺的ADC值分别为（单位：10-3mm2/s）0.961±0.079、0.827±0.017、1.784±0.179、1.258±0.132、2.319±0.317、2.735±0.253、0.641±0.094、1.538±0.187、1.809±0.423、2.571±0.162、1.771±0.410。在同一b值时，四种腹部脏器的ADC值均存在显著统计学差异（P＜0.01）；前列腺周缘区和中央区ADC值在≤50岁组的人群中小于＞50岁组的人群（P＜0.05，P＜0.01）；乳腺ADC值在≤50岁组的人群中高于＞50岁组的人群（P＜0.01）。单独应用WB-DWI诊断转移瘤的灵敏度为75.9%，特异度为25%，准确度为69.8%；WB-DWI联合CT/MRI诊断转移瘤的灵敏度为94.8%，特异度为67.5%，准确度为91.5%。经卡方检验，两者对恶性肿瘤全身转移灶的检出率具有统计学意义（P＜0.05）。

结论

正常人体不同组织器官的ADC值存在差异，前列腺中央区、周缘区以及乳腺与年龄的相关性较大，了解不同组织器官ADC值的正常范围及变化趋势对于为弥散加权成像在临床中进一步应用及研究某些病变提供了良好基础。WB-DWI联合CT/MRI是诊断恶性肿瘤全身转移灶合理、有效、快捷的检查手段，具有较高的临床应用价值。 关键词 磁共振；弥散加权成像；恶性肿瘤；b值；转移

THE VALUES OF WB-DWI IN COMBINATION WITH CONVENTIONAL CT/MRI IN DIAGNOSING SYSTEMIC

METASTASES FROM MALIGNANT TUMORS

Postgraduate: Liu Hui

Speciality: Medical Imaging and Nuclear Medicine

Supervisor: Prof.Li Chang-qin

Abstract

Objective

To explore the values of whole body diffusion-weighted MRI (WB-DWI) and WB-DWI in combination with conventional CT/MRI in normal human tissues and organs and diagnosis of metastases of malignant tumors. Materials and Methods

Both 52 healthy volunteers (25 male and 27 female) and 76 patients with malignant tumors (41 male and 35 female) underwent WB-DWI examinations. 76 patients with malignant tumors underwent conventional CT and MRI examinations, few of which underwent enhanced CT OR MRI scan. Two experienced imaging physicians analyzed all of WB-DWI, CT and MR images by double-blind method. All metastases were confirmed by surgery or puncture pathology, imaging data (CT, MRI or US) and laboratory tests or follow-up at least 3 months. The ADC values of normal adult tissues and organs were calculated, compared the differences of The ADC values in abdominal organs, analyzed the relevance of age of prostate central zone, peripheral zone and the breast. The sensitivity, specificity and accuracy in the diagnosis of metastases of WB-DWI and WB-DWI in combination with conventional CT/MRI were compared. To compare the statistical differences in the diagnosis of metastases. Results

B value is equal to 600mm2/s, the ADC values of normal adult cerebral cortex, white matter, liver, spleen, pancreas, kidney, spine, lymph node, prostate central zone, peripheral zone and breast were (10-3mm2/s) 0.961±0.079, 0.827±0.017, 1.784±0.179, 1.258±0.132, 2.319±0.317, 2.735±0.253, 0.641±0.094, 1.538±0.187, 1.809±0.423, 2.571±0.162,

1.771±0.410 respectively. In the same b value, the ADC values of four abdominal organs existed significant statistical differences (P<0.01). The ADC values of prostate peripheral zone and central zone in the group less than 50 years old were lower than the group more than 50 years old(P<0.05,P<0.01). However, the ADC values of breast in the group less than 50 years old were more than the group more than 50 years old(P<0.01). The sensitivity, specificity and accuracy in detecting systemic metastases from malignant tumors were 75.9%, 25%, 69.8% respectively by WB-DWI, and 94.8%, 67.5%, 91.5% respectively by WB-DWI in combination with conventional CT/MRI. By the chi-square test, there statistical differences in detecting systemic metastases from malignant tumors between the two methods (P>0.05). Conclusion

The ADC values of normal adult tissues and organs are different; the ADC values of prostate central zone, peripheral zone and the breast are diverse in different age sections. We should know the normal range and trends of the ADC values of different tissues and organs, which provides a good basis for further application and study of diffusion weighted imaging. WB-DWI in combination with conventional CT/MRI is a reasonable, effective and efficient screening tool in detecting systemic metastases from malignant tumors, with high clinical value.

百度搜索“77cn”或“免费范文网”即可找到本站免费阅读全部范文。收藏本站方便下次阅读，免费范文网，提供经典小说教育文库WB-DWI联合常规CT、MRI在恶性肿瘤全身转移中的应用价值1 - 图文在线全文阅读。