本文選題：BLADE　切入點：DWI　出處：《復旦大學》2014年博士論文

【摘要】：第一部分鞍區(qū)DWI成像：BLADE序列與EPI序列成像效果的對比研究目的：該部分實驗的目的是比較BLADE序列以及單次激發(fā)平面回波成像(EPI)擴散加權成像方法在鞍區(qū)顯像的效果以及圖像質量。方法：該部分研究,共納入55名具有可疑鞍區(qū)病變的患者(其中52人磁共振發(fā)現(xiàn)鞍區(qū)病變,3名掃描結果正常)。所有的檢查都是用西門子3.0T磁共振設備,所有受試者都要對病灶進行BLADE序列以及EPI序列下的擴散加權成像。所有檢查圖像都需要檢測圖像的信噪比(SNR),同時由兩位有經(jīng)驗的放射科醫(yī)生對兩種擴散加權成像圖像中的頸內動脈,視交叉,垂體柄,垂體,鞍區(qū)病灶以及圖像整體的顯像質量進行獨立評估,另兩位放射科醫(yī)生對病灶的大小進行測量。結果：BLADE序列的擴散加權成像與EPI序列的擴散加權成像在圖像信噪比方面沒有顯著性差異(P0.05)。在對于鞍區(qū)結構顯像方面,BLADE DWI也顯著優(yōu)于EPI DWI,尤其是在頸內動脈以及總體圖像質量方面。將兩種方法中所獲得的圖像質量評分以及病灶的大小進行關聯(lián),擬合曲線后發(fā)現(xiàn),在BLADE DWI成像中病灶冠狀位最小直徑≥12mm時,圖像效果較好,而對于EPI DWI成像,病灶冠狀位最小直徑需≥31mm。第二部分：垂體瘤質地與磁共振信號的關系目的：垂體瘤質地對于手術方式的選擇以及預后的判斷具有重要價值,如果可以在術前通過影像學判斷腫瘤質地將會給臨床提供術式指導,改善患者預后。本部分通過獲取垂體瘤各項磁共振信號,結合術中所見,研究垂體瘤的各項磁共振參數(shù)與腫瘤的術中質地是否具有顯著性聯(lián)系。方法：該部分為前瞻性研究,共納入符合垂體瘤臨床表現(xiàn),于我院接受手術,且術后病理證實為垂體瘤的受試者34名,完善術前各項檢查,使用西門子3.OT磁共振設備對病灶行T1冠狀位,T2冠狀位,BLADE序列的冠狀位擴散加權成像以及T1增強后冠狀位掃描。術中收集患者的質地評估結果,并結合術后病理免疫組化對患者資料進行分析。結果：腫瘤質地與患者年齡,性別,發(fā)病年齡,病程,腫瘤侵襲性,腫瘤的功能均無顯著相關性。腫瘤的磁共振檢查結果包括腫瘤處T1信號值/正�；屹|T1信號值,腫瘤處T2信號值/正常白質T2信號值,腫瘤處T1增強信號值/灰質T1增強信號值以及腫瘤處ADC值/正常腦干ADC值與腫瘤質地之間沒有顯著的相關性,P0.05,對于幾種影像學檢查方法做ROC曲線后發(fā)現(xiàn),相比于其他幾種方法,腫瘤處ADC值/正常腦干ADC值對于腫瘤質地的診斷具有一定的價值,其曲線下面積(AUC)為0.7724,臨界值為1.077。垂體瘤是否具有分泌功能與腫瘤處T2信號值/正常白質T2信號值具有顯著相關性,P=0.03110.05,做ROC曲線,曲線下面積為0.7747,臨界值為1.990,提示腫瘤處T2信號值/正常白質T2信號值大于該值時,腫瘤為無功能性垂體瘤的可能大。第三部分：垂體瘤質地與腫瘤內膠原含量的關系目的：本部分研究為探討垂體瘤質地以及術前影像學信號與術后病理膠原含量之間是否具有相關性,各個類型的腫瘤間質中的膠原含量是否具有差異。方法：該部分研究,共納入符合垂體瘤臨床表現(xiàn),于華山醫(yī)院神經(jīng)外科接受手術,且術后病理證實為垂體瘤的受試者34名,完善術前各項檢查,使用西門子3.OT磁共振設備對病灶行磁共振冠狀位掃描。術中收集患者的質地評估結果,使用HE染色,Masson膠原染色對腫瘤組織分別進行膠原含量的定性以及定量的分析。結果：不同質地分組中膠原含量無論定性或是定量均具有顯著性差異,質地軟組中膠原含量為7.27±1.18%,質地韌組的平均膠原含量為17.72±2.00%,P=0.0013,通過使用ROC曲線,可以發(fā)現(xiàn)膠原含量為15.39%可以作為不同質地的臨界值。研究中發(fā)現(xiàn)腫瘤處ADC值/正常腦干ADC值與腫瘤內的膠原含量具有一定的相關性,在膠原定性分組(+),(++), (+++)中,腫瘤處ADC值/正常腦干ADC值(rADC)分別為1.5172,1.0998,1.0431,P=0.016,可以認為rADC值隨著膠原含量的增加信號值下降,但膠原含量與rADC之間并非線性相關,R2=0.2175。其他組影像學數(shù)據(jù)包括rTl, rT2以及rTl增強值與腫瘤內膠原含量均沒有顯著相關性,同時臨床數(shù)據(jù)如患者年齡,性別,病程,腫瘤大小,腫瘤的臨床功能,腫瘤侵襲性以及病理功能分類與腫瘤膠原含量無顯著相關性。
[Abstract]:The first part of the sellar region DWI imaging: Objective To compare the effect of BLADE sequence and EPI sequence imaging effect: the part of experiment is to compare BLADE sequence and single shot echo planar imaging (EPI) diffusion weighted imaging method in sellar region imaging effect and image quality. Methods: this part of the study, 55 patients with suspicious saddle lesions were included (including 52 magnetic resonance imaging revealed a sellar region lesions and 3 normal scans). All the checks are using SIEMENS 3.0T MRI equipment, all subjects are diffusion weighted imaging BLADE sequence and EPI sequence on the lesion. All images are needed to detect image signal the signal-to-noise ratio (SNR), at the same time by two experienced radiologists on two kinds of diffusion weighted imaging in the image of the internal carotid artery, optic chiasm, pituitary stalk, pituitary gland, sellar region lesions and the overall image quality of imaging alone Li assessment, another two radiologists in lesion size were measured. Results: diffusion weighted imaging diffusion weighted imaging and EPI BLADE sequences in the image signal to noise ratio had no significant difference (P0.05). In the sellar region structure imaging, BLADE DWI was significantly better than EPI DWI, especially in the areas of the internal carotid artery and overall image quality. The two methods to obtain the image quality score and the size of the lesion were correlated, fitting curves show that the BLADE in DWI imaging of lesions of coronal minimum diameter greater than or equal to 12mm, the image effect is better, and for EPI DWI imaging, coronary lesions required minimum diameter larger than 31mm. second part objective: the relationship between pituitary adenoma with magnetic resonance signals: the pituitary adenoma has important value for the choice of surgical approach and prognosis, if the preoperative imaging by judging swelling The texture will be provided for the clinical tumor operation guidance, improve the prognosis of the patients. This part by acquiring the pituitary magnetic resonance signal, combined with intraoperative findings, the magnetic resonance parameters and tumor of pituitary tumor surgery were associated with the texture is. Methods: as part of the forward research, included with the clinical manifestations of pituitary tumor in our hospital underwent surgery and postoperative pathology were subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment on the lesion of coronal T1, coronal T2, BLADE series of coronal diffusion weighted imaging and T1 enhanced after the coronal scan texture. Evaluation results were collected during surgery, and postoperative pathology immunohistochemistry of patients were analyzed retrospectively. Results: the tumor texture and patient age, gender, age of onset, course of disease, tumor invasion, tumor function was no significant Correlation between MRI results. Tumor including tumor T1 signal value / normal gray matter T1 signal value, the value of the T2 signal at the tumor / normal white matter T2 signal values of tumor enhanced T1 signal value / gray T1 signal enhancement value and ADC value of tumor / normal brain ADC value and there is no significant tumor texture correlation, P0.05, for several imaging methods of ROC curves show that compared with other methods, the ADC value of tumor / normal brain stem ADC value has a certain value for the diagnosis of tumor texture, the area under the curve (AUC) was 0.7724, the critical value is whether 1.077. has the secretion of pituitary tumor and tumor. The value of the T2 signal / normal white matter was significantly correlated with the value of the T2 signal, P=0.03110.05, ROC curve, the area under the curve was 0.7747, the critical value is 1.990, the value of the T2 signal at tumor / normal white matter signal value is greater than the T2 value, tumor reactive Of pituitary tumor may be large. The third part: the objective relationship between collagen content of tumor and tumor in the pituitary of texture: this part is to study whether there is any correlation between study of pituitary adenoma and the preoperative imaging signal and postoperative pathological collagen content, various types of tumor whether there is difference in the content of collagen quality. Methods: this part of the study, in accordance with clinical manifestations of pituitary tumor in Huashan Hospital Department of Neurosurgery, surgery, and postoperative pathology confirmed subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment for lesions underwent magnetic resonance coronary scanning. Texture evaluation results were collected during operation, using HE staining, the tumor tissue collagen content were qualitative and quantitative analysis of collagen Masson staining. Results: the collagen content of different texture in both qualitative and quantitative grouping is all out There are significant differences, the collagen content of soft texture group was 7.27 + 1.18%, the average content of collagen texture was 17.72 + ductile group 2%, P=0.0013, by using the ROC curve, can be found in collagen content of 15.39% can be used as the critical value of different texture. The tumor was found at the ADC / ADC value normal collagen and brainstem tumor in a certain correlation study, qualitative groups in collagen (+), (+ +), (+ + +), tumor / normal brain stem ADC value ADC value (rADC) were 1.5172,1.0998,1.0431, P=0.016, rADC value can be considered along with the increase of signal collagen content decreased, but the content of collagen and rADC and nonlinear correlation, R2=0.2175. imaging data of other groups including rTl, rT2 and rTl enhance the value and content of collagen within the tumor showed no significant correlation, while the clinical data such as age, gender, disease duration, tumor size, clinical features of tumor, tumor invasion There was no significant correlation between the classification of sex and pathological function and the content of tumor collagen.

【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R445.2;R736.4

【相似文獻】

相關期刊論文 前10條

1 陳素娟;;經(jīng)顯微鏡下鼻蝶垂體瘤切除術的療效分析[J];臨床合理用藥雜志;2014年13期

2 甘正凱,王貴富,冉啟山,蔣其俊,文遠超;垂體瘤術后并發(fā)癲癇原因探討[J];遵義醫(yī)學院學報;2003年03期

3 甘正凱,王貴富,冉啟山,蔣其俊,文遠超;垂體瘤術后并發(fā)癲癇原因探討[J];黔南民族醫(yī)專學報;2003年03期

4 顧磊,周紅葦,繆艷華;經(jīng)蝶垂體瘤切除術前去枕平臥位的訓練與護理[J];上海護理;2004年02期

5 張敏,齊麗莎;垂體瘤誤診1例[J];疑難病雜志;2004年03期

6 馬成;魏世輝;茅彥;劉陽;;垂體瘤多次復發(fā)侵及動眼神經(jīng)、外展神經(jīng)一例[J];眼科研究;2007年04期

7 張自發(fā);陳來照;李守緘;;垂體瘤的外科治療及進展[J];亞太傳統(tǒng)醫(yī)藥;2008年11期

8 馬逵;王富元;孫維曄;江偉;劉希光;周輝;顏士衛(wèi);;顯微神經(jīng)外科手術治療侵襲型垂體瘤[J];現(xiàn)代腫瘤醫(yī)學;2008年11期

9 馮斌;;顯微鏡下經(jīng)單鼻腔蝶竇入路垂體瘤切除術11例護理配合[J];福建醫(yī)藥雜志;2008年06期

10 王淑琴;;鼻內鏡經(jīng)蝶入路垂體瘤切除術的護理[J];吉林醫(yī)學;2008年08期

相關會議論文 前10條

1 徐永康;;經(jīng)蝶垂體瘤切除術的并發(fā)癥及處理[A];2008年浙江省神經(jīng)外科學學術年會論文匯編[C];2008年

2 王靜;;垂體瘤的診斷治療及術后替代[A];“聚焦內分泌疾病的診斷與治療”國家級繼續(xù)教育學習班論文匯編[C];2013年

3 陳陽;王偉;孫天虹;周淑芹;;經(jīng)蝶入路垂體瘤切除術及護理[A];中華護理學會第14屆全國手術室護理學術交流會議論文匯編（中冊）[C];2010年

4 李夏珍;;垂體瘤70例的眼部改變[A];浙江省中醫(yī)藥學會眼科分會2006繼續(xù)教育研討會論文集[C];2006年

5 宋文敬;趙超英;;鼻內鏡下經(jīng)蝶入路垂體瘤切除術中導航的應用及護理配合[A];全國眼耳鼻喉科護理學術交流會議論文匯編[C];2011年

6 閆長祥;劉寧;于春江;;垂體瘤復發(fā)因素及對策[A];全國中西醫(yī)結合圍手術期研究新進展學習班暨第三屆全國中西醫(yī)結合圍手術期醫(yī)學專題研討會論文集[C];2008年

7 宋洪珍;劉春紅;;經(jīng)鼻蝶垂體瘤切除術的圍手術期護理[A];全國五官科護理學術交流暨專題講座會議論文匯編[C];2002年

8 李芳;;經(jīng)單鼻碟入路腦垂體瘤切除術的手術配合[A];中華護理學會第16屆全國手術室護理學術交流會議論文匯編（下冊）[C];2012年

9 邵雯;謝莉;王昆;;經(jīng)蝶垂體瘤切除術后并發(fā)癥的護理[A];中華護理學會全國腫瘤護理新進展研討會論文匯編[C];2012年

10 李凌樂;;經(jīng)鼻蝶入路垂體瘤切除術后護理體會[A];2013年河南省神經(jīng)系統(tǒng)疾病護理新進展學術會議論文集[C];2013年

相關重要報紙文章 前1條

1 本報記者 余紅　李艷 通訊員 章枝柳;迅猛發(fā)展的微創(chuàng)技術[N];岳陽晚報;2011年

相關博士學位論文 前2條

1 陸逸平;預判垂體瘤質地：彌散加權成像—病理基礎對照研究[D];復旦大學;2014年

2 喬霓丹;基于視神經(jīng)傳導通路解剖形態(tài)、電生理特征和功能影像學表現(xiàn)的垂體瘤經(jīng)蝶入路手術后視力恢復相關因素研究[D];復旦大學;2012年

相關碩士學位論文 前10條

1 吳超;垂體瘤術后患者應對方式、希望水平與生活質量的相關研究[D];蘇州大學;2015年

2 何平;右美托咪定聯(lián)合硝酸甘油在經(jīng)鼻微創(chuàng)垂體瘤切除術的應用效果[D];蚌埠醫(yī)學院;2015年

3 張偉;內鏡經(jīng)鼻蝶垂體瘤切除術后患者視野的恢復及影響因素[D];新疆醫(yī)科大學;2014年

4 農勝德;垂體瘤的診斷和經(jīng)鼻蝶手術治療[D];廣西醫(yī)科大學;2012年

5 胡曉麗;垂體瘤的臨床病理診斷及分類診斷的價值評估[D];鄭州大學;2011年

6 甘偉雄;經(jīng)鼻蝶垂體瘤術后水電解質紊亂的相關因素分析[D];廣西醫(yī)科大學;2013年

7 單鈺棟;顯微鏡下單鼻孔入路經(jīng)蝶垂體瘤切除術臨床研究[D];浙江大學;2009年

8 邢澤剛;36例垂體瘤經(jīng)單鼻孔蝶竇人路切除術后的回顧性分析[D];華中科技大學;2011年

9 趙鵬;經(jīng)蝶入路顯微手術切除垂體瘤研究[D];浙江大學;2007年

10 李豪;單鼻孔經(jīng)蝶垂體瘤術后并發(fā)癥影響因素分析[D];山西醫(yī)科大學;2012年

，

本文編號：1658711