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  本文關鍵詞： 膠質瘤 彌散峰度成像 病理分級 微觀結構　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討磁共振彌散峰度成像(diffusional kurtosis imaging,DKI)在腦膠質瘤分級中的應用價值,以及彌散峰度參數與腫瘤病理組織學參數的相關性,以明確DKI是否可以評估腦膠質瘤微觀結構的變化。方法:本研究使用3.0 T MR掃描儀,對37名經病理證實為腦膠質瘤的患者(男性23例,女性14例,年齡23歲-66歲,平均年齡47歲)行MRI常規(guī)序列及DKI序列掃描。經后處理軟件得到各項異性分數(fractional anisotropy,FA)、平均擴散系數(mean diffusivity,MD)以及平均擴散峰度(mean kurtosis,MK)參數圖,由一名經驗豐富的磁共振診斷醫(yī)師分別在瘤體、瘤周及對側正常腦白質(contralateral normal appearing white matter,NAWMc)色畫感興趣區(qū).(region of interest,ROI),以NAWMc為參照對瘤體及瘤周的各參數值進行標準化處理,最終得到標準化參數(nFA、nMD和nMK)。應用獨立樣本t檢驗比較標準化參數在高低級別膠質瘤瘤體中的差異。應用受試者工作特性曲線(receiver operating characteristic,ROC)分析標準化參數在鑒別高-低級別膠質瘤中的敏感性及特異性。采用配對t檢驗比較標準化參數在瘤體及瘤周中的差異。術中神經外科醫(yī)生根據常規(guī)MRI定位分別切取對應的瘤體及瘤周組織,并對其分別進行單克隆Ki-67、CD34 和微管相關蛋白(microtubule-associated protein 2,MAP2)抗體的免疫組化染色。采用Pearson相關分析檢測標準化DKI參數值(nFA、nMD及nMK)與病理組織學參數(腫瘤細胞密度,微血管總面積(total vascular area,TVA)以及Ki-67標記指數(labe1ingindex,LI))的相關性。結果:1.高級別膠質瘤瘤體nFA和nMK參數值明顯高于低級別膠質瘤(P=0.02和P0.001),而nMD參數值明顯低于低級別膠質瘤(P=0.001)。2.在鑒別高低級別膠質瘤ROC曲線分析中,nMK具有最大的曲線下面積(area underthecurve,AUC)(0.889),最高的靈敏度(80%)和特異度(100%),差異具有統(tǒng)計學意義(P值均0.05)。3.nFA和nMD參數值在膠質瘤瘤體及瘤周中有顯著性差異(P0.001和P=0.006),nMK參數值在兩者間無顯著性差異(P=0.28),然而,在低級別膠質瘤中,瘤體nMK值顯著低于瘤周(P0.001),在高級別膠質瘤中,瘤體nMK值顯著高于瘤周(P=0.002)。4.膠質瘤腫瘤實質nMK值與腫瘤細胞密度(r = 0.596,P=0.006)、TVA(r = 0.764,P0.001)以及Ki-67 LI(r = 0.766,P0.001)均存在顯著的正相關關系,然而nFA值僅與腫瘤細胞密度這一個指標存在顯著的正相關關系(r = 0.534,P=0.01),nMD 僅與腫瘤細胞密度(r =-0.467,P=0.03)和 Ki-67LI(r =-0.630,P=0.003)存在顯著的負相關關系。結論:1.DKI尤其是MK參數在高低級別膠質瘤中存在顯著性差異,而且具有較高的特異度和敏感度,與傳統(tǒng)的擴散成像參數(FA及MD)相比,可以更好地鑒別高-低級別膠質瘤。2.DKI尤其是MK參數與膠質瘤細胞的增殖活性、腫瘤內微血管密度和形態(tài)以及腫瘤細胞密度密切相關,可以作為無創(chuàng)性MRI技術來評估膠質瘤微觀結構的變化。
[Abstract]:Objective: to evaluate the value of diffusional kurtosis imaging (DKI) in the classification of gliomas. And the correlation between diffusion kurtosis parameters and tumor histopathological parameters to determine whether DKI can be used to evaluate the microstructural changes of gliomas. Methods: 3. 0 T Mr scanner was used in this study. Thirty-seven patients (23 males and 14 females, aged 23 to 66 years) with pathologically confirmed gliomas were enrolled. The average age was 47 years). MRI routine sequence and DKI sequence scanning were performed. After the post-processing software, the fractional anisotropic fractions were obtained. Mean diffusion coefficient and mean diffusion kurtosis mean kurtosism (MK). By an experienced magnetic resonance diagnostic physician in the tumor. Contralateral normal appearing white matter. The region of interest is drawn by NAW McC. The parameters of the tumor and its circumference are standardized with NAWMc as the reference. Finally, the standardized parameters (nFA) were obtained. NMD and nMK. The differences of standardized parameters in high and low grade gliomas were compared using independent sample t test. Receiver operating characteristic. Rock). The sensitivity and specificity of standardized parameters in differentiating high and low grade gliomas were analyzed. The difference of standardized parameters in tumor and surrounding tumor was compared by paired t test. Neurosurgeon's localization was based on conventional MRI during operation. The corresponding tumor and peri-tumor tissue were removed respectively. The monoclonal Ki-67mCD34 and microtubule-associated protein 2 were used respectively. Pearson correlation analysis was used to detect the normalized DKI parameters, nFA-nMD and nMK) and histopathological parameters (tumor cell density). Total vascular area (TVA) and Ki-67 labeling index (labe1ing index). Results the parameters of nFA and nMK in high grade gliomas were significantly higher than those in low grade gliomas (P 0. 02 and P 0. 001). NMD parameters were significantly lower than those of low grade gliomas (P < 0. 001). In the analysis of ROC curve for differentiating high and low grade gliomas. NMK has a maximum area under the curve (0.889), with the highest sensitivity (80) and specificity (100). The difference was statistically significant (P = 0.05nFA, P = 0.05nFA, P < 0.05) and nMD parameters were significantly different (P 0.001 and P ~ (0.006)) in glioma tumor and its peritumour (P ~ (0.001) and P ~ (0.006)). There was no significant difference in nMK parameter between the two groups. However, in the low grade glioma, the nMK value of the tumor was significantly lower than that of the surrounding tumor (P 0.001), and in the high grade glioma. The nMK value of the tumor was significantly higher than that of the surrounding tumor. The nMK value of the tumor parenchyma and the density of the tumor cell were significantly higher than that of the surrounding tumor (r = 0. 596 P0. 006). TVA(r = 0.764P0.001) and Ki-67 LI(r = 0.766P0.001). However, there was only a significant positive correlation between nFA value and tumor cell density (r = 0.534P0. 01). NMD was only associated with tumor cell density (r = -0.467) and Ki-67LI(r ~ (-0.630). Conclusion: 1. DKI, especially MK parameters, have significant differences in high and low grade gliomas, and have high specificity and sensitivity. Compared with the conventional diffusion imaging parameters (FA and MDD), DKI and MK parameters can be used to identify the proliferation of glioma cells. 2. DKI, especially MK parameters, can be used to differentiate glioma cells from high to low grade gliomas. 2. Microvessel density (MVD), morphology and tumor cell density are closely related to tumor cell density, and can be used as a noninvasive MRI technique to evaluate the microstructural changes of gliomas.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R739.41

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