【作者】 张东方；

【导师】 郑静晨； 黎功；

【作者基本信息】 河北医科大学 ， 肿瘤学， 2010， 硕士

【摘要】 恶性肿瘤是严重危害人们健康和生命的常见疾病之一,早期、明确的诊断对治疗恶性肿瘤起着关键性的指导作用。影像学检查是诊断恶性肿瘤的重要手段,其结果往往直接影响到临床治疗方法的选择及预后的判断。目前的影像学检查(超声、X片、CT、MRI等)都是通过形态学的影像来实现的,无法反映肿瘤组织的微观变化,从而导致了治疗开展的滞后性和盲目性。近年来快速发展的MR功能成像突破了常规影像学检查只反映形态改变的限制,从人体组织器官的生物学、生理和生化代谢功能角度出发,获得动态的定量资料,从而在软组织肿瘤定性、判断肿瘤的恶性程度及术后疗效判定等方面逐渐显现出优势。而弥散加权成像(Diffusion-Weighted Imaging,DWI)是MR功能影像的一种,它可以通过检测活体组织内部水分子无规则的扩散运动,反映机体组织微观空间的组成变化和病理生理状态下各组织成分之间水分子交换的功能状况,从而为肿瘤的诊断提供更多的信息,进而更好的指导治疗,提高患者的生存质量和延长生存期。目前利用DWI及表观弥散系数(Apparent Diffusion Coefficient, ADC值)协助肿瘤诊断,较多地是应用于颅脑肿瘤、直肠肿瘤的研究。在鉴别肝脏良恶性肿瘤方面,国内外学者也进行了相对较多的研究,但对于鉴别不同病理类型的肝脏恶性肿瘤的研究鲜有报道。目的:本实验通过应用磁共振弥散加权成像技术,探讨肝组织以及不同病理类型的肝脏恶性肿瘤病灶的平均ADC值、变化规律,从而为临床早期诊断肝脏恶性肿瘤提供有价值的依据。方法:肝脏恶性肿瘤患者26例,男21例,女5例,中位年龄54岁(28～65岁),所有病例均经肝穿刺活检病理组织学检查证实。其中肝细胞癌14例,胆管细胞癌5例,肝转移癌7例。所有患者均在治疗前1天行常规MRI扫描(T1WI、T2WI)及弥散加权成像扫描(弥散敏感因子b值取50,400,1000)。在由相应层面DWI图像通过影像后处理工作站自动拟合而成的ADC图上,随机选取五个感兴趣区( region of interest, ROI),利用计算机软件直接测量肿瘤组织的表观弥散系数(ADC值),取其平均值。如1个病例有多个病灶,只选取病理结果所对应的病灶进行测量。感兴趣区为避免测量误差,注意避开瘤内原有坏死区、血管、胆管等部位。同样的方法获得肝组织的ADC值。应用配对样本T检验(Paired-Sample T Test ),对不同病理类型肝脏恶性肿瘤患者病灶与周围正常肝组织的ADC值进行比较,以P <0. 05认为差异有显著性意义;应用单因素方差分析,对不同病理类型肝脏恶性肿瘤病灶的ADC值进行组间两两比较,以P<0.05认为差异有显著性意义。结果:1图像的分析当b=50、400、1000 s/mm2时,所见肝癌病灶在DWI图像上均为高信号或中高信号,提示DWI图像是显示病灶的敏感方法。2 ADC值的比较2.1不同类型肝癌病灶与周围肝组织的比较在b值为50、400和1000 s/mm2时,肝细胞癌患者病灶平均ADC值是(0.85±0.13)×10-3mm2/s,肝组织的平均ADC值是(1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05,结果显示两者之间差异有统计学差异;胆管细胞癌患者病灶平均ADC值是(0.88±0.12)×10-3mm2/s,肝组织的平均ADC值是(0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05,结果显示两者之间有统计学差异;肝转移瘤患者病灶平均ADC值是(0.93±0.07)×10-3mm2/s,肝组织的平均ADC值是(0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05,结果显示两者之间有统计学差异;2.2不同类型肝癌病灶之间的比较肝细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);胆管细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);肝细胞性癌与胆管细胞癌在同一b值下的ADC值之间差异无统计学意义(P=0.276)。结论:不同病理类型的肝脏恶性肿瘤在DWI中具有不同的特征,结合ADC值的量化特征,对肝脏恶性肿瘤的鉴别有一定的参考价值。通过对病灶的ADC值进行量化分析,能为肝脏恶性肿瘤的定性诊断提供重要依据。更多还原

【Abstract】 Cancer is one of the common diseases which harm people’s health and lives seriously. Early and clear diagnosis plays a critical role in guiding treatment of malignant tumor. Imaging examination is an important means for diagnosis of malignant tumors. The result is often a direct impact on the choice of clinical treatment and prognosis. The current imaging studies(ultrasound, X-ray, CT, MRI, etc.) through morphological image to achieve, which can not reflect micro-changes in tumor tissue. So developing the treatment is delayed and blindness. MR functional imaging break through the constraint of the conventional images and show up ascendancy in qualitation, the judgement of malignant degree and curative effect of tumors from biology, physiology and biochemistry. DWI is one of the MR functional imaging and show physiological and pathological changes through measuring the microscopic molecular movement of water in the tissues. This technique can provide more information for guiding the continued treatment plans and lasting life time. At present, most of the researches in diagnosis of tumor using DWI and ADC value is major of brain and rectal tumors. Many scholars has studied in differentiating benign and malignant tumors in liver through DWI, but the research of identification different pathological types of liver cancer using DWI and ADC is rare.Objective: In this experiment, we discuss the changes and significance of mean apparent diffusion coefficient(ADC) value in and provid valuable evidences for judgement effect of diagnoses of liver cancer in the early stage. Methods: 26 patients ( 21 male patients and 5 female patient, aged 28 to 65 years, mean 54 years) with liver malignant Tumor.All these were confirmed by pathological examination. 14 patients with hepatocellular carcinoma,5 patients with cholangiocellular carcinoma,7 patients with hepatatic metastatic neoplasms.Before treatment conventional MRI and DWI were performed in 26 patients, respectively. To choose five(region of interests, ROIs) in ADC map randomly and measure the ADC values of tumor tissue. If there are multiple lesions in a case, only selected the results corresponding to the pathological lesions to measure.ROIs get out of zone of necrosis, blood vessel, bile vessel in order to avoid error of measurement. The ADC values of liver were obtained in the same method. T2WI image were loaded in Argus browser and compute tumor volume through the software. To compare ADC values of patients with different pathological types of liver lesions and the surrounding normal liver tissue using Paired-Sample T Test. If P<0.05, the difference was significant. Application of single-factor analysis of variance, for different types of liver pathology of ADC values of malignant lesions in pairwise comparison between groups.If P<0.05, the difference was significant. Results:2.1 Different types of liver lesions compared with the surrounding liver tissueThe average ADC value of tumor tissue of the patients with hepatocellular carcinomathe(0.85±0.13)×10-3mm2/s,if the value b denfined 50、400和1000 s/mm2. The average ADC value of liver tissue i(s1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with cholangiocellular carcinoma is (0.88±0.12)×10-3mm2/s, The average ADC value of liver tissue is (0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with hepatatic metastatic neoplasms is (0.93±0.07)×10-3mm2/s, The average ADC value of liver tissue i(s0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05. The results showed that they had significant statistically between them.2.2 comparison with the different types of liver cancerThe average ADC value in Hepatocellular carcinoma and liver metastases have significant statistically at the same value b. Conclusion:Different pathological types of liver cancer have different feature at different DWI. It is helpful for Identification in liver malignant tumors. through quantitative analysis of the ADC values, it can Provide an important basis for Qualitative diagnosis of liver cancer.更多还原