ADC值及DCE-MRI定量分析在前列腺癌侵袭性评估中的应用

发布时间：2017-12-28 13:22

本文关键词：ADC值及DCE-MRI定量分析在前列腺癌侵袭性评估中的应用　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨前列腺癌表观弥散系数(ADC)值及动态对比增强磁共振扫描(DCE-MRI)定量参数转运常数.(Ktrans)、血管外细胞外间隙体积百分数(Ve)及数率常数(Kep)对前列腺癌侵袭性评估的价值。材料与方法:应用GE公司3.0 T HDX TWINSP设备对临床疑诊前列腺癌的154例患者行磁共振平扫、DWI及动态增强检查,将其中经病理证实的62例前列腺癌患者纳入本研究。根据MRI平扫及增强图像确定前列腺病变的形态、范围、强化特点及与周围组织的关系,在GE工作站经GE Function软件自动处理后获得ADC图,测量疑诊前列腺癌的感兴趣区ADC值。将所得动态增强数据刻盘,在另一台电脑将数据导入GE药业公司开发的专用动态增强分析软件Omni Kinetics Manual,选取疑诊前列腺癌的感兴趣区测量容积转运常数(Ktrans)、血管外细胞外间隙体积百分数(Ve)及数率常数(Kep)。所有患者在MRI检查1周内行超声引导下穿刺,除常规12个穿刺区外,对MRI提示的病灶区进行穿刺。根据穿刺病理结果分为GS=6分、GS=3+4分、GS=4+3分、GS=8分及GS=9～10五组,采用单因素方差分析对五组检查者的ADC、Ktrans、Ve及Kep值进行比较分析,应用Spearman相关性分析对ADC、Ktrans、Ve及Kep值与Gleason分级进行相关性研究。应用受试者工作特征(ROC)曲线分析,估计曲线下面积(AUC)分析ADC值联合Ktrans值评估前列腺癌侵袭性。结果:ADC值随Gleason评分的升高而降低,Ktrans值随Gleason评分的升高而升高,且各组之间具有统计学意义(F=20.462,F=13.560,P0.05),前列腺癌区的 ADC 值与 Gleason 呈负相关(r=-0.636,P0.05),Ktrans值与 Gleason 成正相关(r=0.562,P0.05),Kep及Ve在不同Gleason评分组间差异无统计学意义(r=0.116,r=0.179,P0.05),GS=3 + 3 与 GS≥7 之间、GS ≤ 3+4 与 GS≥4+3之间、GS≤4+3与GS≥8之间,ADC值与Ktrans值联合应用的AUC大于单独使用,差别有统计学意义(P0.05),在GS≤8与GS≥9的前列腺癌中联合ADC值及Ktrans值AUC大于单独使用两者且差别无统计学意义(P0.05)。结论:ADC值和Ktrans值都可以用来评估对前列腺癌的侵袭性,联合使用ADC和Krtn5值对前列腺癌侵袭性的评估产生更好的诊断性能。ADC值与Gleason评分呈中度负相关,Ktrans值与Gleason评分呈中度正相关。因此,ADC值及Ktrans具有预测前列腺癌恶性程度的潜力,有助于评估前列腺癌的侵袭能力,对于制定治疗方案及评价预后至关重要。
[Abstract]:Objective: To investigate the apparent diffusion coefficient (ADC) value of prostate cancer and the quantitative parameter transport constant of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), (Ktrans), the value of extravascular extracellular space volume fraction (Ve) and rate constant (Kep) in evaluating the aggressiveness of prostate cancer. Materials and methods: using GE 3 T HDX TWINSP equipment company of clinically suspected prostate cancer 154 patients underwent MRI, DWI and dynamic enhanced examination, which will be the 62 prostate cancer patients confirmed by pathology were enrolled in this study. According to the MRI scan and enhanced image to determine the shape and range of prostate diseases, strengthening characteristics and the relationship with the surrounding tissue, in the GE workstation by GE Function software automatically after ADC, measuring suspected prostate cancer region of interest ADC. The dynamic enhanced data Kepan, on another computer analysis software Omni Kinetics Manual special dynamic development data into the GE pharmaceutical company's enhancement, volume measurement of region of interest selection of suspected prostate cancer transfer constant (Ktrans), extravascular extracellular space volume fraction (Ve) and rate constant (Kep). All patients underwent ultrasound guided puncture in the MRI examination for 1 weeks. In addition to the conventional 12 puncture areas, the lesions were punctured by MRI. According to the pathological results were divided into GS=6 and GS=3+4, GS=4+3, GS=8 and GS=9 10 ~ five group, using the single factor analysis of variance of the examinations of the five groups of ADC, Ktrans, Ve and Kep value for comparative analysis, Spearman correlation analysis was used for ADC, Ktrans, Ve and Kep were associated with Gleason classification. The ROC curve analysis was used to estimate the area (AUC) of the under curve (AUC) to evaluate the ADC value combined with the value of Ktrans to evaluate the invasiveness of prostate cancer. Results: the ADC value increased with the Gleason score decreased, Ktrans value increased with the increase of Gleason score, and the difference was significant between the groups (F=20.462, F=13.560, P0.05), the ADC values of prostate cancer was negatively correlated with Gleason (r=-0.636, P0.05), Ktrans value is positively correlated with Gleason (r=0.562, P0.05), no statistically significant differences in Kep and Ve Gleason scores between groups (r=0.116, r=0.179, P0.05), GS=3 + 3 and GS = 7, GS = 3+4 and GS between 4+3 and GS, between GS = 4+3 = 8, the value of ADC combined with Ktrans value of AUC is greater than used alone, there are statistically significant difference (P0.05), in GS = 8, GS = 9 and prostate cancer combined with ADC and Ktrans values greater than AUC alone and there was no significant difference between the two (P0.05). Conclusion: both ADC and Ktrans values can be used to evaluate the aggressiveness of prostate cancer. Combined use of ADC and Krtn5 values can produce better diagnostic performance for invasive assessment of prostate cancer. The ADC value had a moderate negative correlation with the Gleason score, and the Ktrans value had a moderate positive correlation with the Gleason score. Therefore, ADC and Ktrans have potential to predict the malignancy degree of prostate cancer. It helps to evaluate the invasive ability of prostate cancer, and is essential for formulating therapeutic regimens and evaluating prognosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25;R445.2

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