發(fā)布時(shí)間：2018-05-23 13:03

  本文選題：釓塞酸二鈉 + 磁共振��； 參考：《南方醫(yī)科大學(xué)》2017年博士論文

【摘要】：肝纖維化和肝硬化在我國(guó)的發(fā)病率非常高,隨著病情的進(jìn)展,肝纖維化可以向肝硬化發(fā)展,最終演變?yōu)楦渭?xì)胞肝癌(hepatocellular carcinoma HCC)。目前對(duì)肝纖維化和肝硬化的評(píng)估主要依靠肝穿刺組織的病理檢查,HCC病理結(jié)果需依靠術(shù)后檢查,肝穿刺有一定的缺點(diǎn)。因此需尋找一種無(wú)損傷的檢查方法來(lái)預(yù)測(cè)肝纖維化、肝硬化和HCC的病理學(xué)分級(jí),并且能精確評(píng)估肝功能的情況。因此本實(shí)驗(yàn)進(jìn)行了以下方面的研究:(1)分析Gd-EOB-DTPA增強(qiáng)MRI預(yù)測(cè)HCC的病理學(xué)分級(jí);(2)分析大鼠Gd-EOB-DTPA增強(qiáng)MRI預(yù)測(cè)肝硬化的病理學(xué)分級(jí);(3)分析Gd-EOB-DTPA增強(qiáng)MRI與不同病變程度肝臟的病理學(xué)相關(guān)性;(4)Gd-EOB-DTPA 增強(qiáng) MRI 在評(píng)估功能性肝體積(functional liver volume,FLV)與肝功能Child-Pugh分級(jí)相關(guān)性中的作用。方法:1.分析Gd-EOB-DTPA增強(qiáng)MRI癌灶信號(hào)絕對(duì)增強(qiáng)強(qiáng)度(absolute enhancement value,AEV)和對(duì)比增強(qiáng)率(contrast enhancement ratio,CER),及癌灶對(duì)肝臟的對(duì)比增強(qiáng)率(CERtl,CERtumor to liver)與病理分級(jí)的相關(guān)性。2.分析大鼠肝臟Gd-EOB-DTPA增強(qiáng)MRI的AEV和CER。根據(jù)Laennec分級(jí)系統(tǒng)對(duì)肝硬化進(jìn)行分級(jí)。分析AEV和CER與肝硬化病理分級(jí)的相關(guān)性。3.定量分析Gd-EOB-DTPA增強(qiáng)MRI癌灶周?chē)�肝臟的AEV和CER。分析AEV和CER與不同病變程度肝臟病理分級(jí)的相關(guān)性。4.計(jì)算肝段的CER和解剖性肝體積(anatomical liver volume,ALV)。利用Ⅰvol×ⅠCER+Ⅱvol×ⅡCER+……+Ⅷvol×ⅧCER.計(jì)算 FLV。分析 ALV 和 FLV 與肝功能Child-Pugh分級(jí)的相關(guān)性。結(jié)果:1.CERtl與肝癌的分化程度有最顯著的負(fù)相關(guān)性。ROC曲線中,CERd在肝癌分化程度Ⅰ和Ⅱ級(jí),Ⅱ和Ⅲ級(jí),Ⅲ和Ⅳ級(jí)間的臨界值為分別為0.535,0.40,0.295。CERtl與病理分級(jí)的一致性檢驗(yàn)的kappa值為0.62。2.肝硬化的病理分級(jí)和CER之間存在更顯著的負(fù)相關(guān)。肝硬化病理分級(jí)之間的差異性通過(guò)ROC曲線下面積來(lái)分析。輕和中度肝硬化,中和重度肝硬化之間的CER臨界值分別為0.535和0.335。CER和病理分級(jí)之間的一致性檢驗(yàn),kappa 值為 0.73。3.不同病變肝臟的病理分級(jí)與CER有最顯著的負(fù)相關(guān)性。通過(guò)ROC曲線的分析,正常肝臟和肝纖維化,肝纖維化和肝硬化間的CER臨界值分別為0.76和0.46。分析CER和不同病變程度肝臟病理分級(jí)之間的一致性檢驗(yàn),kappa值為0.41。在輕和中度肝硬化組,中和重度肝硬化之間CER臨界值分別為0.425和0.325。分析CER和肝硬化病理分級(jí)之間的一致性檢驗(yàn),kappa值為0.60。4.肝功能Child-Pugh分級(jí)與ALV的相關(guān)性(r =-0.792,p0.001);肝功能Child-Pugh 分級(jí)與 FLV 的相關(guān)性(r=-0.911,p0.001)。FLV 與肝功能 Child-Pugh分級(jí)有更顯著的負(fù)相關(guān)性。結(jié)論:1.CERtl與HCC的分化程度之間有比較顯著的相關(guān)性。分析Gd-EOB-DTPA增強(qiáng)MRI可以預(yù)測(cè)病理分級(jí)。2.CER與肝硬化的病理分級(jí)存在比較顯著的相關(guān)性,CER在區(qū)別不同病變程度肝臟病理學(xué)分級(jí)的能力較差,但可以預(yù)測(cè)肝硬化的病理分級(jí)。3.結(jié)合CER和ALV計(jì)算肝臟的FLV實(shí)現(xiàn)區(qū)域性肝功能的整合,較ALV能更好的反映肝臟的功能。項(xiàng)目創(chuàng)新性:1.定量分析Gd-EOB-DTPA增強(qiáng)MRI,創(chuàng)新性的使用公式CER=SIth-SItu/SIlh-SIlu 預(yù)測(cè) HCC 的病理學(xué)分級(jí)。2.創(chuàng)新性的利用定量分析釓塞酸二鈉增強(qiáng)MRI,并通過(guò)計(jì)算CER預(yù)測(cè)肝硬化的病理學(xué)分級(jí)。3.創(chuàng)新性的結(jié)合Gd-EOB-DTPA增強(qiáng)MRI和ALV計(jì)算肝臟的FLV,并實(shí)現(xiàn)區(qū)域性肝功能的計(jì)算和整合。
[Abstract]:The incidence of liver fibrosis and cirrhosis in our country is very high. With the progress of the disease, liver fibrosis can develop to liver cirrhosis and eventually become liver cell liver cancer (hepatocellular carcinoma HCC). The evaluation of liver fibrosis and liver cirrhosis depends mainly on the pathological examination of liver puncture tissue, and the pathological results of HCC need to be checked by postoperative examination, Liver puncture has some shortcomings. Therefore, it is necessary to find a noninvasive method to predict the pathological grading of liver fibrosis, liver cirrhosis and HCC, and to evaluate the liver function accurately. Therefore, the following studies have been carried out in this experiment: (1) analysis of the pathological grade of Gd-EOB-DTPA enhanced MRI prediction of HCC; (2) analysis of Gd-EOB-DTPA in rat The histopathological classification of liver cirrhosis was predicted by enhanced MRI; (3) the pathological correlation between Gd-EOB-DTPA enhanced MRI and the liver of different pathological changes was analyzed; (4) the role of Gd-EOB-DTPA enhanced MRI in evaluating the correlation between functional hepatic volume (functional liver volume, FLV) and liver function Child-Pugh classification. Method: 1. analysis Gd-EOB-DTPA enhanced MRI cancer Absolute enhancement value (AEV) and contrast enhancement (contrast enhancement ratio, CER), and the correlation of the contrast enhancement of the liver (CERtl, CERtumor to liver) and pathological grading. Analysis of the correlation between AEV and CER and the pathological classification of liver cirrhosis by.3. quantitative analysis of the AEV and CER. analysis of the liver surrounding the MRI carcinoma and the correlation between AEV and CER and the pathological grade of liver with different pathological changes;.4. for the CER and anatomical liver volume of the liver segment. The correlation between ALV and FLV and liver function Child-Pugh classification was calculated by FLV.. Results: the degree of differentiation between 1.CERtl and liver cancer was the most significant negative correlation.ROC curve. CERd was in the degree of differentiation of liver cancer I and II, grade II and grade III, and the critical value between grade III and grade IV was the consistency of 0.535,0.40,0.295.CERtl and pathological grading, respectively. The kappa value of the test was a more significant negative correlation between the pathological grades of 0.62.2. cirrhosis and CER. The difference between the pathological grades of liver cirrhosis was analyzed under the ROC curve. The critical value of CER between mild and moderate cirrhosis, and severe cirrhosis was 0.535 and 0.335.CER, and the consistency test between pathological grades, kappa The pathological grading of the liver of 0.73.3. with different lesions was the most significant negative correlation with CER. Through the analysis of the ROC curve, the critical values of normal liver and liver fibrosis, liver fibrosis and liver cirrhosis were 0.76 and 0.46., respectively, and the consistency test between CER and the pathological grade of different pathological changes, the kappa value was 0.41. in light and middle. The critical value of CER between the liver cirrhosis and the severe cirrhosis was 0.425 and 0.325., respectively, for the consistency test between CER and the pathological grading of liver cirrhosis. The kappa value was the correlation between the 0.60.4. liver function Child-Pugh grading and ALV (R =-0.792, p0.001); the correlation between the liver function Child-Pugh classification and FLV, and the liver function Ild-Pugh classification has a more significant negative correlation. Conclusion: there is a significant correlation between the differentiation degree of 1.CERtl and HCC. The analysis of Gd-EOB-DTPA enhanced MRI can predict a significant correlation between pathological grade.2.CER and the pathological grading of liver cirrhosis, and CER is less capable of differentiating the pathological grade of liver from different pathological changes, but it can be less effective. To predict the pathological grade.3. of liver cirrhosis combined with CER and ALV to calculate the integration of liver function in the liver, which can better reflect the liver function than ALV. Project innovation: 1. quantitative analysis of Gd-EOB-DTPA enhanced MRI, innovative use formula CER=SIth-SItu/SIlh-SIlu to predict the innovative utilization of HCC's pathological grade.2.. The MRI was enhanced by the analysis of two sodium gadolinium acid, and the pathological grading of liver cirrhosis was calculated by CER to predict the MRI and ALV to calculate the FLV of the liver, and to realize the calculation and integration of the regional liver function.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.7;R575.2

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