体素内不相干运动、扩散峰度成像和超高b值扩散加权成像在前列腺癌诊断和鉴别诊断中的应用

发布时间：2018-06-09 06:06

本文选题：扩散加权成像 + 体素内不相干运动　；参考：《中国人民解放军医学院》2017年博士论文

【摘要】：目的:评价体素内不相干运动(intravoxel incoherent motion, IVIM)模型的参数鉴别前列腺移行带和外周带中癌和非癌组织的可行性以及参数在短期内和观察者内的可重复性。材料和方法:采用3.0T GE磁共振(magnetic resonance MR)扫描仪对23例前列腺患者行两次12个b值(0-3000s/mm2) IVIM扫描。计算IVIM模型生成的参数Dslow、Dfast、f和表观扩散系数(apparent diffusion coefficient, ADC12b)。采用方差分析比较移行带中癌灶和良性前列腺增生(benign prostatic hyperplasia, BPH)和腺体BPH之间、外周带中癌灶和良性外周带和正常外周带之间的参数的差异。短期内两次检查IVIM参数的可重复性评价采用变异系数(coefficient of variation, CV)、Bland-Altman分析法,观察者内一致性分析采用组内相关系数(intraclass correlation coefficient,ICC)评价。结果:移行带中前列腺癌灶的Dslow、ADC12b和f值比基质和腺体BPH的低(P均为0.000);外周带中癌灶的Dslow、ADC12b和f值比良性和正常外周带的低(P均为0.000)。两次检查移行带中癌灶和非癌组织的Dslow(CV2.1-5.8%,BA-LA-21-21%)和 ADC12b 的可重复性好(CV 3.1-6.1%, BA-LA -23-23%),f 次之(CV 4.4-10.3%,BA-LA -42-41 %), Dfast 的可重复性差(CV 12.8-24.5%,BA-LA -101 -89%)。外周带中前列腺癌和非癌组织的可重复性顺序与移行带中的一样。在移行带中,Dslow和ADC12b在癌灶中的可重复性最好。在外周带中,Dslow在癌灶中可重复性最好,ADC12b在正常外周带中的可重复性最好。观察者内一致性移行带中癌灶、外周带中癌和非癌组织所有的参数的一致性极好。结论:初步结果表明前列腺移行带和外周带中癌灶的Dslow、ADC12b和f值与非癌组织的显著不同。前列腺移行带和外周带中癌和非癌组织的Dslow和 ADC12b的可重复性好,f次之,Dast的可重复性差。目的:评价扩散峰度成像(diffusion kurtosis imaging, DKI)参数鉴别前列腺移行带和外周带中癌和非癌组织的可行性以及参数在短期内和观察者内的可重复性。材料和方法:采用3.0T GE MR扫描仪对23例前列腺患者行两次3个b值(0-3000s/mm2)DKI扫描。计算DKI的参数K和D值。采用方差分析比较移行带前列腺癌与良性前列腺增生(BPH)和腺体BPH之间、外周带前列腺癌和良性外周带和正常外周带之间的参数的差异。短期内两次检查DKI参数的可重复性评价采用变异系数(coefficient of variation, CV)、Bland-Altman分析法,观察者内重复测量一致性分析采用组内相关系数(intraclass correlation coefficient, ICC)评价。结果:在前列腺移行带中,癌灶的K值显著高于基质BPH和腺体BPH(P0.001),D值明显低于基质和腺体BPH(P0.001);在外周带中,癌灶的K值比良性外周带和正常外周带高,D值比良性和正常外周带低(P0.001)。两次检查移行带中癌灶和非癌组织K值和D值的可重复性(CV 3.5-4.3%,BA-LA-17-24%; CV 5.2-5.5%,BA-LA-20-20%)和外周带中癌和非癌组织K和D值的可重复性都较好(CV5.1-6.3%,BA-LA-24-21%; CV3.8-5.4%,BA-LA-21-23%)。在移行带中,K值在癌灶的可重复性最好,D值在癌和基质BPH和腺体BPH中相似。在外周带中,K值在癌灶中的可重复性最好;D值在正常外周带中的可重复性最好。观察者内一致性前列腺移行带和外周带中癌和非癌组织所有的参数的一致性极好。结论:初步结果表明前列腺移行带和外周带中癌与非癌组织的K值和D值显著不同。前列腺移行带和外周带中癌和非癌组织K和D值都具有较好的可重复性。目的:比较超高b值扩散加权成像(DWI)、体素内不相关运动成像(IVIM)和扩散峰度(DKI)鉴别移行带前列腺癌和基质、腺体良性前列腺增生(BPH)的价值。材料和方法:回顾性分析14例移行带前列腺癌(22个癌灶)和23例BPH患者(22个基质BPH和22个腺体BPH)穿刺活检前的超高b值DWI、IVIM和DKI检查的影像资料。计算所有癌灶、基质BPH和腺体BPH的ADC3000、K、Dk、Dslow、Dfast、f和ADC12b。计算每个参数的平均值和标准差。采用方差分析比较移行带前列腺癌和基质BPH和腺体BPH之间的参数的差异。受试者工作特性(receiver operating characteristic, ROC)曲线分析各参数的诊断效能。结果:移行带前列腺癌中的K值比基质BPH和腺体BPH中的高(P值都为0.000)。移行带前列腺癌中的ADC3000、Dk、Dslow、f和ADC13b比基质BPH和腺体BPH中的低(P值都为0.000)。移行带前列腺癌与基质BPH和腺体BPH之间的Dfast无统计学意义(P0.05)。ADC3000、K、Dk、Dslow、f和ADC12b鉴别移行带前列腺癌与基质BPH的曲线下面积分别为0.957、0.926、0.942、0.867、0.793和0.894。ADC3000、K、Dk和ADC13b鉴别移行带与腺体BPH的曲线下面积都为1。结论:ADC3000和Dk分别在移行带前列腺癌和基质BPH和腺体BPH之间显著不同,使用它们可以提高鉴别诊断移行带前列腺癌和基质BPH和腺体BPH的效能。
[Abstract]:Objective: To evaluate the feasibility of the parameters of intravoxel incoherent motion (IVIM) model to identify the prostate transitional zone and the noncancerous tissue in the peripheral zone and the reproducibility of the parameters in the short term and in the observer. Materials and methods: using the 3.0T GE magnetic resonance (magnetic resonance MR) scanner for 23 cases of prostate The patients were treated with 12 b values (0-3000s/mm2) IVIM scan. The parameters Dslow, Dfast, F, and apparent diffusion coefficient (apparent diffusion coefficient, ADC12b) generated by the IVIM model were calculated. The cancer foci and benign prostatic hyperplasia (benign) and glands were compared by variance analysis. The cancer foci and good in the peripheral zone were compared. The difference between the parameters of the peripheral zone and the normal peripheral zone. The reproducibility evaluation of the IVIM parameters in the two time examination was evaluated by the coefficient of variation (coefficient of variation, CV), Bland-Altman analysis, and the intra group correlation analysis was evaluated by the intra group correlation coefficient (intraclass correlation coefficient, ICC). The values of Dslow, ADC12b and F in the adenocarcinoma of the adenocarcinoma were lower than that of the matrix and BPH (P was 0); the Dslow, ADC12b and F values in the peripheral zone were lower than those of the benign and normal peripheral zones (P were 0). Two times for the examination of the Dslow (CV2.1-5.8%, BA-LA-21-21%) and the repeatability of the non cancerous tissues in the transitional zone. F (CV 4.4-10.3%, BA-LA -42-41%), Dfast's repeatability (CV 12.8-24.5%, BA-LA -101 -89%). The repeatability of prostate and noncancerous tissues in the peripheral zone is the same as that in the transitional zone. The reproducibility of C12b in the normal peripheral zone is the best. The consistency of all the cancer and noncancerous tissue in the consistent transitional zone of the observer is excellent. Conclusion: the preliminary results show that the Dslow, ADC12b, and F values of the prostate transitional zone and the peripheral zone are significantly different from those in the non cancer group. The reproducibility of Dslow and ADC12b in medium and noncancerous tissues is good, f times, and Dast repeatability. Objective: To evaluate the feasibility of the diffusion kurtosis imaging (diffusion kurtosis imaging, DKI) parameters to identify the prostate transitional zone and the noncancerous tissue in the peripheral zone, and the reproducibility of the parameters in the short term and in the observer. Two times 3 B (0-3000s/mm2) DKI scans were performed on 23 cases of prostate patients with the 3.0T GE MR scanner. The parameters K and D of DKI were calculated. The variance analysis was used to compare the differences between the transitional zone prostate cancer and benign prostatic hyperplasia (BPH) and gland BPH, the difference between the peripheral zone prostate cancer and the benign peripheral zone and the normal peripheral zone. The reproducibility of the two examination of the DKI parameters was evaluated by the coefficient of variation (coefficient of variation, CV), Bland-Altman analysis, and the intra observation consistency analysis was evaluated by the intra group correlation coefficient (intraclass correlation coefficient, ICC). Results: the K value of the cancer was significantly higher than that of the matrix BPH and gland in the anterior gland migrating zone. BPH (P0.001), D value was significantly lower than matrix and BPH (P0.001); in the peripheral zone, the K value of the cancer was higher than that of the benign peripheral zone and normal peripheral zone, and the D value was lower than that of the benign and normal peripheral zone (P0.001). The repeatability of the K and D values of the cancer and non cancerous tissues in the transitional zone was examined by two times (CV 3.5-4.3% The reproducibility of K and D values in both middle and non cancer tissues is better (CV5.1-6.3%, BA-LA-24-21%; CV3.8-5.4%, BA-LA-21-23%). In the transitional zone, the K value is the best repeatability in the cancer, and the D value is similar in the cancer and matrix BPH and the gland BPH. In the peripheral zone, the K value in the cancer is best; the repeatability of the D value in the normal peripheral zone is the best. Good consistency of all the parameters of the carcinoma and noncancerous tissues in the consistent prostate transitional zone and the peripheral zone. Conclusion: the preliminary results show that the K and D values of the cancer and non cancerous tissues in the prostate transitional zone and the peripheral zone are significantly different. The values of K and D in the carcinoma and non cancer tissues of the prostate transitional zone and the peripheral zone are both good repeatable. Objective: To compare the value of ultra high B diffusion weighted imaging (DWI), voxel unrelated motion imaging (IVIM) and diffusion kurtosis (DKI) in the differential diagnosis of transitional prostate cancer and matrix, and the value of benign prostatic hyperplasia (BPH). Materials and methods: retrospective analysis of 14 cases of transitional zone prostate cancer (22 cancer foci) and 23 cases of BPH patients (22 matrix BPH and 22 glands. Body BPH) the imaging data of the ultra high b value DWI, IVIM and DKI before biopsy. Calculate the average and standard deviation of all the cancer foci, the ADC3000 of the matrix BPH and the BPH of the gland, K, Dk, Dslow, Dfast, and the difference between the parameters of each parameter. Diagnostic efficacy of receiver operating characteristic (ROC) curve analysis. Results: the K value in transitional zone prostate cancer is higher than that in matrix BPH and gland BPH (P value is 0). ADC3000, Dk, Dslow, F and basal mass and glands in transitional zone prostate cancer (0). Transitional zone prostate The Dfast between cancer and matrix BPH and gland BPH was not statistically significant (P0.05).ADC3000, K, Dk, Dslow, F and ADC12b, respectively. The area under the curve of prostate cancer and matrix BPH was 1. There is a significant difference between the transitional zone prostate cancer and the matrix BPH and the glandular BPH. The use of them can improve the effectiveness of the differential diagnosis of transitional prostate cancer and matrix BPH and BPH.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R737.25

【参考文献】