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研究生:劉明承
研究生(外文):LIU, MING-CHENG
論文名稱:多參數磁振造影診斷小腎臟腫塊- 台灣中部某醫學中心的經驗
論文名稱(外文):Multiparametric MRI in the Diagnosis of Small Renal Mass A Medical Center Experience in Taiwan
指導教授:潘忠煜潘忠煜引用關係
指導教授(外文):PAN, CHUNG-YU
口試委員:莊秀文陳南松潘忠煜
口試委員(外文):ZHUANG,XIU-WENCHEN,NAN-SONGPAN, CHUNG-YU
口試日期:2020-04-24
學位類別:碩士
校院名稱:東海大學
系所名稱:工業工程與經營資訊學系
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:英文
論文頁數:51
中文關鍵詞:小腎臟腫塊多參數磁振造影腎細胞癌血管平滑肌脂肪瘤
外文關鍵詞:Small renal massmultiparametric MRIRenal cell carcinoma
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小腎臟腫塊定義為直徑小於四公分之腎臟腫瘤,於臨床上盛行率越來越高。針對良性之小腎臟腫塊,像是血管平滑肌脂肪瘤和嗜酸粒细胞腺瘤,只要密切追蹤即可。但是,透明細胞腎細胞癌、乳突型腎細胞癌、嫌色細胞腎細胞癌,和其他類型的腎細胞癌,需要手術切除治療。手術前運用多參數磁振造影,包含常規磁振造影、動態對比度增強圖像,和擴散加權圖像,在決策步驟中扮演了關鍵的角色。本研究利用多參數磁振造影,區分何者為良性小腎臟腫塊或腎細胞癌亞型。
再進一步確認高度或低度惡性之腎細胞癌的關鍵圖像特徵。本研究採用回溯性資料,擷取中部某醫療中心從 2014 年至 2019 年間,曾施行手術前多參數磁振造影,並切除小腎臟腫塊的資料進行分析。結果發現,四種主要小腎臟腫塊的圖像特徵存在顯著差異。其中有關透明細胞腎細胞癌部分,
1. T2 加權信號強度高於血管平滑肌脂肪瘤、乳突型腎細胞癌和其他腎細胞癌;2. 動脈洗入指數和表觀擴散係數高於血管平滑肌脂肪瘤和乳突型腎細胞癌;3. 所有透明細胞腎細胞癌均表現出 plateau 或 washout 型動態曲線。與腎細胞癌相比,血管平滑肌脂肪瘤的細胞內脂肪含量更高。一半的血管平滑肌脂肪瘤含有大量脂肪。與血管平滑肌脂肪瘤以及其他腎細胞癌相比,乳突型腎細胞癌表現出更多的 progressive 型動態曲線。高度惡性腎細胞癌和低度惡性腎細胞癌相比,有著較高的年齡層以及較低的表觀擴散係數。
The small renal masses (SRMs), defined as renal tumors less than 4 cm in diameter, are becoming progressively prevailing. Active surveillance is indicated for benign SRMs such as angiomyolipoma (AML) and oncocytoma, with renal cell carcinoma (RCC); including clear cell (ccRCC), papillary (pRCC), chromophobe, and other type RCC; need to be surgically removed. Preoperative multiparametric MRI, which contained conventional MRI parameter, dynamic contrast enhanced (DCE) images, and diffusion weighted images (DWI), play a key role in decision making. In this study, we used the multiparametric MRI in classifying benign SRMs with RCC subtypes, and determine the key image feature between high-grade and low-grade malignancy.
We reviewed medical records in a Medical Center in Central Taiwan to identify patients who underwent surgical resection of SRM from 2014 to 2019 and who had a presurgical multiparametric MRI study available for analysis. SPSS 22.0 software was used for data processing. The results were considered statistically significant when p value was < 0.05.
There are significant differences in the image feature of four major subgroups (ccRCC, pRCC, AML and Other type RCC) of SRMs in our hospital, where ccRCC showed higher T2 weighted signal intensity than AML, pRCC, and other type RCC; AMLs exhibited more intravoxel fat than ccRCC, pRCC and other type RCC; half AMLs (6 in 12 AMLs) contained bulk fat; ccRCC showed higher Arterial Wash-in Index (AWI) and ADC than AML and pRCC; all ccRCC manifested plateau(n=9, 25%) or washout(n=27, 75%) type dynamic curve; and pRCC demonstrated more progressive(n=3, 60%) type dynamic curve than AMLs and other type RCCs. The age of high-grade RCCs were significantly higher than the low-grade RCCs, and the ADC value of high-grade RCCs were significantly lower than the low-grade RCCs.
Table of Contents
摘要 ................................................................................................................................. i
ABSTRACT .................................................................................................................. ii
誌謝 ...............................................................................................................................iii
Table of Contents .......................................................................................................... iv
List of Tables ................................................................................................................ vi
List of Figures .............................................................................................................. vii
Chapter 1 Introduction............................................................................................. 1
1.1 Research background and motivation ........................................................ 1
1.2 Research purposes ...................................................................................... 3
1.3 Research Process ........................................................................................ 3
Chapter 2 Literature Review ................................................................................... 5
2.1 Small renal mass (SRM) ............................................................................ 5
2.2 Renal cell carcinoma (RCC) and subtype .................................................. 7
2.3 Benign renal tumor .................................................................................... 9
2.4 MRI advantage for small renal mass (SRM) ........................................... 10
Chapter 3 Research Method .................................................................................. 26
3.1 Research design and object ...................................................................... 26
3.2 Measuring tools ........................................................................................ 26
3.3 Analytical method .................................................................................... 29
Chapter 4 Research Result ..................................................................................... 30
4.1 Basic Characteristic of SRMs .................................................................. 30
4.2 Subtype Tumor Comparison .................................................................... 32
4.3 Tumor Grading Comparison .................................................................... 40
Chapter 5 Conclusion and Discussion ................................................................... 44
5.1 Conclusion ............................................................................................... 44
5.2 Limitation ................................................................................................. 44
Reference .................................................................................................................... 44
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