本文選題：子宮肌瘤 + 病理�。� 參考：《浙江大學》2017年碩士論文

【摘要】：目的探討Extended Tofts和Exchange兩種血流動力學模型的動態(tài)對比增強MRI(DCE-MRI)參數(shù)在子宮肌瘤病理分型中的應用。資料與方法2015年10月至2016年6月經(jīng)手術病理證實的35例子宮肌瘤患者,術前行盆腔多期動態(tài)增強磁共振成像(DCE-MRI),選擇Extended Tofts和Exchange血流動力學模型分別計算子宮肌瘤的定量灌注參數(shù)Ktrans(對比劑從血管(血漿)間隙滲漏到血管外細胞外間隙轉運系數(shù))、PS(毛細血管表面通透性)、Fp(血漿灌流量)、Kep(對比劑從血管外細胞外間隙返回血管(血漿)間隙的速率常數(shù))、Ve(血管外細胞外間隙容積分數(shù))、Vp(血管(血漿)間隙容積分數(shù))。術后按病理分型分為細胞型(7例)、普通型(18例)、退變型(10例)三組,采用單因素方差分析子宮肌瘤三組間的組間差異,采用LSD檢驗分別分析兩組間(普通型與細胞型、細胞型與退變型、普通型與退變型)的血流動力學參數(shù)差異,P0.05有統(tǒng)計學意義;篩選出有統(tǒng)計學意義的參數(shù),繪制鑒別細胞型子宮肌瘤的ROC曲線;使用Pearson相關性分析觀察兩個模型間的參數(shù)有無相關性。結果一:在三組子宮肌瘤間,Extended Tofts模型中的Ktrans、Kep、Vp及Exchange模型中的Fp、Kep、Vp值差異有統(tǒng)計學意義(P0.05),其中細胞型子宮肌瘤 Extended Tofts 模型中 Ktrans(p0.001)、Kep(p =0.001)、Vp(p =0.003),Exchange模型中Kep(p =0.035)、Fp(tp0.001)值高于普通型子宮肌瘤;細胞型子宮肌瘤 Extended Tofts 模型中 Ktrans(p0.001)、Kep(p =0.019)、Vp(p =0.001),Exchange模型中Vp(p=0.017)、Fp(p0.001)值高于退變型子宮肌瘤;普通型子宮肌瘤ExtendedTofts模型中Ktrans(p=0.037)高于退變型子宮肌瘤,余定量灌注參數(shù)無明顯統(tǒng)計學意義。二:Extended Tofts模型中的Ktrans、Kep、Vp及Exchange模型中的Fp、Kep、Vp值在鑒別細胞型子宮肌瘤的ROC曲線下面積分別為1.000、0.923、0.827、1.000、0.702、0.738;三:Extended Toft 模型中的 Ktrans 與 Exchange模型中的 PS 和 Fp相關(r=0.365,P=0.034,r=0.968,P=0.000),Kep、Vp 在 2 種模型中呈正相關(r=0.454,P=0.007,r=0.479,P=0.004),兩種模型間的Ve值無相關性。結論 Extended Tofts 模型中的Ktrans、Kep、Vp 及 Exchange 模型中的 Fp、Kep、Vp值在鑒別子宮肌瘤病理分型中的應用價值較高,特別是Extended Tofts模型中的Ktrans值和Exchange模型中的Fp值診斷效能最高,且兩者具有明顯的相關性;同時Extended Tofts模型的Kep、Vp值診斷效能優(yōu)于Exchange模型。
[Abstract]:Objective to investigate the application of dynamic contrast enhanced MRICE-MRI parameters in the pathological classification of uterine leiomyoma in Extended Tofts and Exchange hemodynamic models.Materials and methods from October 2015 to June 2016, 35 patients with hysteromyoma confirmed by surgery and pathology,Extended Tofts and Exchange hemodynamic models were used to calculate the quantitative perfusion parameters of uterine leiomyoma by dynamic enhanced pelvic magnetic resonance imaging (DCE-MRI) before operation.The rate constant of the return of the extracellular space to the vascular (plasma) space from the extracellular space of the contrast agent and the VpV volume fraction of the extracellular space of the vessel (plasma).According to the pathological classification, the patients were divided into three groups: 7 cases of cytomegaloid type, 18 cases of common type, 10 cases of degenerative type). The differences among the three groups of uterine leiomyoma were analyzed by univariate analysis of variance. LSD test was used to analyze the difference between the two groups (common type and cell type, respectively).The difference of hemodynamic parameters between cell type and degeneration type, common type and degenerative type (P0.05) was statistically significant. The parameters with statistical significance were screened out and the ROC curve was drawn to distinguish the cell type uterine leiomyoma.Pearson correlation analysis was used to observe the correlation between the two models.Results: there were significant differences between the three groups in the KtransP KepP of extended Tofts model and the Exchange model in the Exchange model (P 0.05). The value of Ktransp0.001VepP 0.001VpP in the Extended Tofts model was higher than that in the normal type of uterine myoma (P < 0.05). The results showed that the value of KTP in the model of extended Tofts was higher than that in the model of normal uterine leiomyoma (P < 0.05). The results showed that the value of KTP in the model of Extended Tofts was higher than that in the model of normal type of uterine myoma (P < 0.05), and the value of KTP was higher than that in the model of normal type of uterine leiomyoma (P < 0.05).In Extended Tofts model, the value of Ktransp0. 001 + KepP in the model of Extended Tofts was higher than that in the model of degenerative uterine leiomyoma, and the value of Ktransp0. 037 in ExtendedTofts model of normal uterine leiomyoma was higher than that of degenerative uterine leiomyoma, and there was no significant difference in the parameters of residual quantitative perfusion.There was no correlation between the two models.Conclusion Extended Tofts model and Exchange model have higher application value in differentiating the pathological types of uterine leiomyoma, especially the Ktrans value in Extended Tofts model and the FP value in Exchange model.At the same time, the diagnostic efficiency of Extended Tofts model was better than that of Exchange model.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R737.33

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