磁敏感加权成像(swi)、灌注加权成像(pwi)及其联合应用在颅内肿瘤诊断中的价值

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1、《中国图书资料分类法》分类号：R445单位代码：10660学号：S100490贵阳医学院2013届临床医学硕士专业学位材料(临床论文部分)磁敏感加权成像（SWI）、灌注加权成像（PWI）及其联合应用在颅内肿瘤诊断中的价值研究生：赵艳蕊导师：沈桂权年级：2010级专业：影像医学与核医学2013年5月1日贵阳医学院2013届硕士研究生论文目录摘要„„„„„„„„„„„„„„„„„„„„2略缩词表„„„„„„„„„„„„„„„„„„„3前言„„„„„„„„„„„„„„„„„„„„4材料与方法„„„„„„„„„„„„„„„„„„5结果„„„„„„„„

2、„„„„„„„„„„„„7讨论„„„„„„„„„„„„„„„„„„„„15结论„„„„„„„„„„„„„„„„„„„„21不足与展望„„„„„„„„„„„„„„„„„„21参考文献„„„„„„„„„„„„„„„„„„„21附图„„„„„„„„„„„„„„„„„„„„24致谢„„„„„„„„„„„„„„„„„„„„30英文摘要„„„„„„„„„„„„„„„„„„„31论文原创性声明„„„„„„„„„„„„„„„„33综述„„„„„„„„„„„„„„„„„„„„34附：临床能力考核有关材料：临床轮转考核表学术活动情况表临床能力考试及学位答辩情况-

3、1-贵阳医学院2013届硕士研究生论文磁敏感加权成像（SWI）、灌注加权成像（PWI）及其联合应用在颅内肿瘤诊断中的价值专业：影像医学与核医学研究生：赵艳蕊导师：沈桂权教授中文摘要目的：应用磁敏感加权成像（SWI）和灌注加权成像（PWI）分析研究肿瘤内部细微结构、出血灶、微静脉及肿瘤血管增生、通透性等情况，探讨磁敏感加权成像、灌注加权成像及其联合应用对颅内肿瘤的诊断价值。材料与方法：收集2012年5月—2013年2月经病理证实的脑膜瘤31例、高级别胶质瘤16例、转移瘤11例。术前均行常规MRI、SWI及PWI检查；将PWI原始数据经工作站软件

4、获得灌注伪彩图，测量并分析不同颅内肿瘤间实性成分和周围水肿区rCBV值及差异；对所获得SWI图像病灶内低信号进行评分，将肿瘤内低信号评分分为1分(无明显低信号)、2分(1～10个聚集的点状结构或细线状结构)、3分(大于10个聚集的点状结构或细线状结构）。结果：脑膜瘤共31例，其中WHO分级Ⅰ级18例、Ⅱ级10例、Ⅲ级3例，肿瘤实质区最大rCBV值分别为7.352.05、9.351.74、9.811.23，肿瘤水肿区最大rCBV值分别为2.392.55、3.371.45、4.110.99，单因素方差分析差异均有统计学意义。据ROC曲

5、线分析肿瘤实质区最大rCBV诊断恶性脑膜瘤的最佳诊断阈值为8.015，其敏感度为92.3%，特异度为77.8%；肿瘤水肿区rCBV诊断阈值为2.76，其敏感度和特异度分别为100%和66.7%。16例胶质瘤（Ⅲ-Ⅳ级）及11例转移瘤肿瘤实质区最大rCBV值分别为9.872.76和10.972.12，单因素方差分析，差异无统计学意义；肿瘤水肿区最大rCBV值分别为1.990.50和1.120.23，差异有统计学意义。Ⅰ、Ⅱ、Ⅲ级脑膜瘤在SWI低信号程度评分中恶性脑膜瘤高于良性脑膜瘤，差异具有统计学意义（P<0.05）。胶质瘤与转移瘤在S

6、WI序列低信号程度评分中差异具有统计学意义，胶质瘤明显高于转移瘤。诊断效能：MRI＋PWI（肿瘤实质区rCBV）诊断恶性脑膜瘤的敏感性84.62%，特异性83.33%，准确度83.87%；MRI＋PWI（肿瘤水肿区rCBV）诊断恶性脑膜瘤的敏感性92.31%，特异性88.89%，准确度90.32%；MRI＋PWI＋SWI联合应用诊断恶性脑膜瘤的敏感性100%，特异性88.89%，准确度93.55%；常规MRI诊断胶质瘤和转移瘤的准确率分别为81.25%和72.73%，MRI＋PWI＋SWI联合应用诊断胶质瘤和转移瘤的准确率分别为87.50%-

7、2-贵阳医学院2013届硕士研究生论文和81.8%。结论：PWI及SWI有助于分析颅内肿瘤的细微结构、反应肿瘤的血流动力学信息。联合应用PWI和SWI的诊断效能优于单独应用PWI或SWI，MRI＋PWI＋SWI的敏感度、准确度和特异度最高，有助于脑膜瘤分级及胶质瘤、转移瘤鉴别诊断。关键词：颅内肿瘤，磁共振成像(MRI)，磁共振灌注加权成像(PWI)，磁敏感加权成像（SWI）-3-贵阳医学院2013届硕士研究生论文缩略词中英文对照表英文缩写英文全称中文全称MRImagneticresonanceimaging磁共振成像PWIperfusionw

8、eightedimaging灌注加权成像SWIsusceptibilityweightedimaging磁敏感加权成像CBVcerebralbloodvolume脑