【作者】 马霄虹；

【导师】 周纯武； 赵心明； 张红梅；

【作者基本信息】 中国协和医科大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 第一部分：3.0T MR动态增强扫描对正常胰腺及胰腺癌定量分析研究目的：利用3.0T MR快速三维动态增强扫描序列所得数据,对正常胰腺及胰腺癌的灌注过程进行定量分析研究,探讨其对胰腺癌诊断的临床应用价值。材料与方法：对43例经病理证实的胰腺癌患者(胰腺癌组)及37例非胰腺疾病患者(对照组)行全胰腺LAVA九期动态增强序列扫描,将所得数据传至ADW 4.2工作站处理,分别测量对照组胰腺的头、体、尾及胰腺癌组病变区域及非病变区域的30s强化率(SER30)、90 s强化率(SER90)、曲线下面积(PEI)、达峰时间(TTP)及最大强化斜率(MSI),并使用SPSS 11.5统计软件进行组内及组间各项参数的比较。结果：对照组胰腺头、体、尾的SER30、SER90、PEI、TTP及MSI差异均无统计学意义。胰腺癌组病变区与非病变区的SER30、PEI、TTP、MSI均有显著性差异,SER90不具有统计学差异。胰腺癌组非病变区与对照组对应区域的SER90及TTP有统计学差异,两组的SER30不具有统计学差异。结论：正常胰腺的不同部位间无灌注差异。胰腺癌病变区域与非病变区域的灌注差异可以反映癌组织浸润范围。胰腺癌非病变区域与正常胰腺间TTP的差异可能反映潜在病变的可能。第二部分：3.0 T MR在体氢质子波谱分析对正常胰腺及胰腺癌代谢特征的研究目的：利用3.0T MR在体氢质子波谱分析技术,分析正常胰腺及胰腺癌的代谢特征。材料与方法：选取29例经病理证实的胰腺癌患者(胰腺癌组；胰头癌19例,胰体尾癌10例),其中男14例,女15例,中位年龄55岁；27例非胰腺疾病患者(对照组),其中男15例,女12例,中位年龄56岁。采用GE公司的3.0 T磁共振扫描仪,分别对胰腺癌组的病变区与非病变区及对照组的胰头和胰体尾设定感兴趣区,并行单体素1H-MRS,将所得数据传至ADW 4.2工作站处理,分别测得胰腺癌组及对照组的各感兴趣区的脂肪酸(FA,5.4 ppm)、总胆碱复合物(t-Cho,3.2 ppm)、脂肪(Lip,1.3 ppm)及内生水(InW,4.7 ppm)的曲线下面积,并计算各感兴趣区的FA/InW、t-Cho/InW及Lip/InW的比值,使用SPSS 11.5统计软件对组内及组间所得各项比值进行比较。结果：①对照组胰头区和胰体尾区FA/InW及Lip/InW的比值差异无统计学意义,t-Cho/InW的比值胰头区小于胰尾区,且有显著差异。②胰腺癌组病变区与非病变区的FA/InW及Lip/InW的比值有显著差异；19例胰头癌的t-Cho/InW的比值,胰头病变区小于胰体尾非病变区,且有显著差异；10例胰尾癌的t-Cho/InW的比值差异无统计学意义。③胰腺癌组非病变区与对照组对应区域所有参数的比值的差异均无统计学意义。结论：3.0T MR1H-MRS正常胰腺及胰腺癌的代谢特点：①正常胰腺的代谢特征：t-Cho胰头区小于胰体尾区,FA及Lip无明显差异。②胰腺癌的代谢特征是：FA、t-Cho及Lip均在病变区减低。③胰腺癌非病变区与正常胰腺无明显代谢差异,提示非病变区相对正常,对外科手术范围有提示作用。更多还原

【Abstract】 Part I:Quantitative analysis of normal pancreas and pancreatic adenocarcinoma with dynamic contrast-enhanced MR imaging on a 3.0T systemPurpose:To quantify the perfusion parameters of normal pancreas and pancreatic carcinoma with three-dimension (3D) fast spoiled gradient echo dynamic contrast enhanced (DCE) MRI on 3.0T MR system, and to assess the value of 3D DCE-MRI in the diagnosis of pancreatic carcinoma.Materials and methods:Forty-three patients with pathology verified pancreatic carcinoma and thirty-seven control subjects with normal pancreas (without pancreatic diseases) underwent DCE-MRI with 3D LAVA sequence of ten phases. The data were processed on ADW4.2 workstation. The perfusion parameters of the head, body and tail of normal pancreas, together with lesion and non-lesion area of pancreatic carcinoma were measured and statistically analyzed, including signal enhancement ratio at 30 seconds after injection (SER30), signal enhancement ratio at 90 seconds after injection(SER9o), positive enhancement integral (PEI), time to peak (TTP) and maximum slope of increase (MSI).Results:There was no significant perfusion difference among head, body or tail of normal pancreas. The difference of SER30, PEI, TTP and MSI between lesion and non-lesion region of carcinous pancreas was significant. The TTP between normal pancreas and the non-lesion region of carcinous pancreas was significantly different.Conclusion:Normal pancreas has no regional perfusion difference. The data from DCE-MRI provide reliable information for the diagnosis of pancreatic cancer, and for the assessment of the invasion of pancreatic carcinoma. The difference in TTP between the normal pancreas and non-lesion region of carcinous pancreas suggest the existing of potential lesions. Part II:The metabolic analysis of normal pancreas and pancreatic adenocarcinoma by in vivo proton magnetic resonance spectroscopy at 3.0 TPurpose:To analyze metabolic features of normal pancreas and pancreatic adenocarcinoma by in vivo proton MRS at 3.0 T.Materials and methods:27 control subjects with normal pancreas (without pancreatic diseases) and 29 patients with pathology verified pancreatic adenocarcinoma and matching age and sex underwent single-voxel1H-MRS on a 3.0T MR system (GE Healthcare, HDxt) with 8-channel body coil. Breath-hold PRESS with TE/TR= 35ms/1500ms was used. The peaks area at 1.3 (lipid, Lip),3.2 (total choline, t-Cho) and 5.4 (fatty acids, FA) ppm of the head and body-tail in normal pancreas, together with lesion and non-lesion area in pancreatic carcinoma were measured by SAGE and their ratio to the peak area of none saturated (internal water, InW) at 4.7 ppm was calculated. Statistic analysis was made between different locations.Results:1) In normal pancreas, there were no statistical differences in the ratios of FA/InW and Lip/InW respectively, but t-Cho/InW of body-tail area was greater than that of head.2) In the pancreatic carcinoma, there was significant difference of the ratios in FA/InW and Lip/InW between lesion and non-lesion region respectively. There was no difference in the ratios of t-Cho/InW between lesion and non-lesion region in pancreatic body-tail cance. But in pancreatic head cancer, the ratio of t-Cho/InW in carcious region was smaller than that in non-lesion region.3) There were no statistical differences in the ratios of FA/InW、t-Cho/InWand Lip/InW between normal pancreas and non-lesion region in pancreatic cancer (head vs head, body-tail vs body-tail).Conclusion:The metabolic features of the pancreatic carcinoma including:a) in normal pancreas, t-Cho of body-tail was greater than that of head. b) the FA, t-Cho and Lip were decreased in the carcious region. c) no difference can be found between the normal pancrease and the non-leision region of pancreatic carcinoma.更多还原