磁共振功能成像在喉及下咽癌诊断及放化疗疗效评估中的应用研究

发布时间：2017-12-28 05:33

本文关键词：磁共振功能成像在喉及下咽癌诊断及放化疗疗效评估中的应用研究　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：第一部分喉及下咽癌MR体素内不相干运动扩散加权成像(IVIM-DWI)特征目的:分析喉及下咽癌MR体素内不相干运动扩散加权成像(IVIM-DWI)特征,探讨IVIM-DWI对喉及下咽癌的诊断价值。材料与方法:分析2014年11月-2015年8月经我院诊治并病理证实的32例喉及下咽癌患者,治疗前行MR扩散加权成像(IVIM-DWI)序列检查。IVIM序列扫描采用12个b值(0、10、20、30、50、70、100、150、200、400、800和1000s/mm2)。IVIM-DWI扫描所得原始数据经双指数模型处理,生成对应参数图。分别测量原发癌、正常咽壁及不同病理分级原发癌的纯扩散系数D值、伪扩散系数D*值及灌注分数f值,比较及分析其差异。结果:D、f值在喉与下咽癌组间无显著差异(P0.903、0.223),D*值在组间有显著差异(P=0.028)。原发癌D、D*及f值分别为(0.84±0.22)×10-3mm2/s、(65.71± 19.66)X 10-3mm2/s和44.90%± 14.49%;正常咽壁组织D、D*及f分别为(1.48± 1.04)×10-3mm2/s、(37.85±14.04)× 10-3mm2/s 和35.88%±11.51%。原发癌与正常咽壁D、D*及f值比较,D值较正常咽壁低(P=0.001),D*、f值较正常咽壁高(P=0.000、0.006)。ROC曲线分析D值诊断效能最佳,以D=0.949×10-3mm2/s为阈值,鉴别原发癌与正常咽壁,敏感度、特异度和准确度分别为91.2%、88.2%和85.5%。不同病理分级原发癌比较,D、f在各组间无显著差异(P=0.558、0.809),D*值有显著差异(P=0.001)。D*值在高分化组与中、低分化组间比较差异具有显著性(P=0.027、0.000),在中分化与低分化组间无显著性差异(P==0.110)。结论:喉及下咽癌与正常咽壁IVIM参数存在显著差别,D值的诊断价值最高。D*值在不同病理分级的喉及下咽癌中存在差异,可以在一定程度上反映肿瘤的分化程度。第二部分IVIM-DWI预测下咽癌诱导化疗疗效价值研究目的:探讨MR扩散加权成像(IVIM-DWI)预测进展期下咽癌诱导化疗疗效的价值。材料与方法:搜集2014年12月-2015年10月经我院诊治并病理证实的28例下咽癌患者,在治疗前及诱导化疗后3周内分别行IVIM-DWI检查。IVIM序列设置12个b值(b=0、10、20、30、50、70、100、150、200、400、800 和 1000 s/mm2)。分析 IVIM双指数模型D*、D、f值,并与单指数模型ADC值进行比较,诱导化疗结束后进行疗中评价。根据RECIST标准,将患者分为治疗有效组(CR和PR)和无效组(SD和PD)。根据肿瘤的病理分级,将患者分为高分化组(G1)、中分化组(G2)和低分化组(G3)。有预测价值的IVIM参数及阈值通过独立样本t检验、单因素方差分析和受试者特征曲线(ROC)分析和确定。结果:接受诱导化疗的下咽癌患者中,18例治疗有效,10例治疗无效。诱导化疗后,IVIM参数中ADC、D值均升高,D*值降低(P均0.05),f值改变不明显(P0.05)。与治疗无效组比较,治疗有效组中疗前ADC、D、疗后D*值较低,疗后ADC、D、AADC、△D和△D*较高,而△f变化不显著。ROC曲线分析治疗前D值预测疗效最佳,以D值为0.847×10-3 mm2/s为阈值,对应的AUC、敏感度和特异度分别为0.806、75.0%和88.9%。尽管治疗前IVIM各参数在不同病理分化组的下咽癌间无显著差异,但随着病理分级的增高(低分化到高分化),D*值有逐渐降低的趋势。结论:IVIM-DWI有助于预测下咽癌诱导化疗疗效,可以为后续临床治疗提供有价值信息。第三部分MR动态增强(DCE-MRI)半定量预测喉及下咽癌放化疗近期疗效研究目的:分析及探讨MR动态增强(DCE-MR)半定量参数预测喉及下咽癌放化疗近期疗效的价值。材料与方法:搜集2013年12月-2015年10月经病理确诊的62例喉癌及下咽癌患者,分别于治疗前及治疗后3周内行DCE-MRI检查。治疗结束后根据RECIST标准,将患者分为治疗有效组(包括CR和PR)和治疗无效组(包括SD和PD)。分析时间信号曲线(TIC曲线)相关的半定量参数:达峰时间(TTP),最大上升斜率(MSI),最大下降斜率(MSD)和正性增强积分(PEI),比较其在两组间的差异,建立预测治疗有效的阈值。结果:放化疗结束三周内评价,54例治疗有效,8例治疗无效。与治疗前相比,治疗后的MSI、MSD和PEI均显著降低(P0.05)。与治疗无效组比较,治疗有效组疗前MSI、MSD和PEI值较高(P0.05),疗后MSI、MSD和PEI均较低(P0.05),而TTP在治疗前后均无明显改变(P0.05)。ROC曲线分析,治疗前MSI为预测疗效有效的最佳指标,其阈值为154.81时,对应的曲线下面积(AUC)、敏感度和特异度分别为0.882、89.3%和 73.5%。结论:DCE-MRI半定量参数有助于预测喉及下咽癌早期放化疗疗效。第四部分MR动态增强(DCE-MRI)定量预测喉及下咽癌同步放化疗敏感性研究目的:探讨MR动态增强扫描(DCE-MRI)定量参数预测喉及下咽癌对同步放化疗敏感性的价值。材料与方法:搜集2014年12月-2015年12月经本院喉镜活检病理证实并行同步放化疗治疗的喉及下咽癌患者36例。所有患者于治疗前行DCE-MRI检查,放疗剂量累积达50Gy时行疗中MRI复查。根据治疗结束后肿瘤缓解情况,分为完全缓解组(CR)及部分缓解组(PR)。测量DCE-MRI定量参数包括:容积转移常数(Ktrans)、速率常数(Kep)和血管外细胞外容积分数(Ve)值,比较三者在CR组与PR组间的差异,并绘制ROC曲线评估各定量参数预测喉及下咽癌同步放化疗近期疗效的效能。结果:36例喉及下咽癌,同步放化疗后达CR20例,PR 16例。喉癌和下咽癌组间疗前DCE-MRI各定量参数比较均未见显著差异(P均0.05)。疗前CR组Ktrans、Kep和Ve值分别为(0.307±0.055)/min、(0.527±0.114)/min和0.587±0.045,疗前PR组Ktrans、Kep和Ve值分别为(0.234±0.049)/min、(0.390±0.090)/min和0.602±0.037。疗前CR组和PR组比较,Ktrans和Kep差异均有统计学意义(P均0.05),Ve差异无统计学意义(P0.05)。ROC曲线分析,以Ktrans=0.283/min为阈值,预测同步放化疗后达CR,相应的AUC、敏感度及特异度分别为0.839、70.0%和81.2%;以Kep=0.446/min为阈值,预测同步放化疗后达CR,相应的AUC、敏感度及特异度分别为0.809、75.0%和75.0%。结论:疗前DCE-MRI定量参数有助于预测喉及下咽癌同步放化疗敏感性。
[Abstract]:The first part of larynx and hypopharynx carcinoma is MR intra body incoherent motion diffusion-weighted imaging (IVIM-DWI). Purpose: to analyze the characteristics of MR voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in larynx and hypopharyngeal carcinoma, and to explore the diagnostic value of IVIM-DWI for laryngeal and hypopharyngeal carcinoma. Materials and methods: 32 patients with laryngopharyngeal and hypopharyngeal carcinoma confirmed by pathology in our hospital in November 2014 8, -2015, were treated by MR diffusion-weighted imaging (IVIM-DWI) sequence. The IVIM sequence scan uses 12 b values (0, 10, 20, 30, 50, 70, 100, 150, 200, 400, 800, and 1000s/mm2). The original data obtained by IVIM-DWI scan are processed by double exponential model, and the corresponding parameters are generated. The pure diffusion coefficient D value, pseudo diffusion coefficient D* value and perfusion fraction f value of primary carcinoma, normal pharyngeal wall and different pathological grades of primary carcinoma were measured and compared. Results: there was no significant difference between the D and F values in the larynx and hypopharyngeal cancer groups (P0.903, 0.223), and there was a significant difference between the groups of D* (P=0.028). The values of D, D* and F in primary carcinoma were (0.84 + 0.22) x 10-3mm2/s, (65.71 + 19.66) X 10-3mm2/s and 44.90% + 14.49%, respectively, and D, D* and F in normal pharyngeal tissues were (1.48 + 1.04) x 10-3mm2/s, 37.85 37.85 14.04, 35.88% and 35.88% 35.88%, respectively. Compared with normal pharyngeal wall D, D* and F, the value of D was lower than that of normal pharynx wall (P=0.001), and the value of D* and F was higher than that of normal pharynx wall (P=0.000, 0.006). ROC curve analysis D value has the best diagnostic efficiency. The sensitivity, specificity and accuracy of D=0.949 value 10-3mm2/s as the threshold value are 91.2%, 88.2% and 85.5%, respectively. There was no significant difference between D and f (P=0.558, 0.809), and significant difference in D* (P=0.001). There was a significant difference in the D* value between the highly differentiated group and the moderately differentiated group (P=0.027, 0), but there was no significant difference between the moderately differentiated and the poorly differentiated group (P==0.110). Conclusion: there is a significant difference between the IVIM parameters of laryngeal and hypopharyngeal carcinoma and the normal pharyngeal wall, and the value of D is the highest. The difference of D* value in different pathological grades of larynx and hypopharyngeal carcinoma can reflect the degree of differentiation of the tumor to a certain extent. The second part is the value of IVIM-DWI in predicting the efficacy of induction chemotherapy for hypopharyngeal carcinoma. Objective: To explore the value of MR diffusion weighted imaging (IVIM-DWI) in predicting the efficacy of induction chemotherapy for advanced hypopharyngeal carcinoma. Materials and methods: a total of 28 hypopharyngeal cancer patients diagnosed and pathologically confirmed in our hospital in December 2014 10, -2015, were collected for IVIM-DWI examination before treatment and 3 weeks after induction chemotherapy. The IVIM sequence sets 12 b values (b=0, 10, 20, 30, 50, 70, 100, 150, 200, 400, 800, and 1000 s/mm2). The values of D*, D, and F of IVIM double index model were analyzed and compared with the ADC value of single index model, and the evaluation was made in the treatment of chemotherapy after chemotherapy. According to the RECIST standard, the patients were divided into effective treatment group (CR and PR) and ineffective group (SD and PD). According to the pathological grade of tumor, the patients were divided into high differentiation group (G1), middle differentiation group (G2) and low differentiation group (G3). The predictive value of IVIM parameters and thresholds was analyzed and determined by independent sample t test, single factor variance analysis and subject characteristic curve (ROC). Results: of the patients with hypopharyngeal carcinoma receiving induction chemotherapy, 18 cases were treated effectively and 10 cases were not effective. After induction chemotherapy, the values of ADC and D in the IVIM parameters were all increased, the value of D* decreased (P 0.05), and the F value was not significantly changed (P0.05). Compared with group therapy, treatment group before treatment in ADC, D, D* after treatment was lower, after treatment of ADC, D, AADC, Delta D and delta D* is higher, but there was no significant change in F. ROC curve analysis showed that the best prediction value of D before treatment was D value of 0.847 * 10-3 mm2/s, and the corresponding AUC, sensitivity and specificity were 0.806, 75% and 88.9%, respectively. Although there was no significant difference in the parameters of IVIM between hypopharyngeal carcinoma of different pathological differentiation group before treatment, but with the increase of pathological grade (low differentiation to high differentiation), the D* value tended to decrease. Conclusion: IVIM-DWI is helpful to predict the curative effect of hypopharyngeal carcinoma induced chemotherapy and can provide valuable information for follow-up clinical treatment. The third part is MR dynamic enhancement (DCE-MRI) semi quantitative prediction of the short-term efficacy of radiotherapy and chemotherapy for laryngeal and hypopharyngeal carcinoma. Objective: to analyze and discuss the value of MR dynamic enhancement (DCE-MR) semi quantitative parameter in predicting the short-term efficacy of radiotherapy and chemotherapy for laryngeal and hypopharyngeal carcinoma. Materials and methods: 62 cases of laryngocarcinoma and hypopharyngeal carcinoma diagnosed in December 2013 10 menstrual period in -2015 were collected, and DCE-MRI examination was performed before and 3 weeks after treatment. After the treatment, the patients were divided into effective group (including CR and PR) and the treatment group (including SD and PD) according to the RECIST standard. The semi quantitative parameters related to time signal curve (TIC curve) were analyzed: peak to peak time (TTP), maximum ascending slope (MSI), maximum descending slope (MSD) and positive reinforcement integral (PEI). The difference between the two groups was compared, and an effective threshold for predicting treatment was established. Results: after three weeks of chemotherapy and chemotherapy, 54 cases were treated effectively and 8 cases were not effective. Compared with before treatment, MSI, MSD and PEI after treatment were significantly decreased (P0.05). Compared with the treatment ineffective group, the effective MSI, MSD and PEI values of the effective group were higher (P0.05). After treatment, MSI, MSD and PEI were all lower (P0.05), while TTP had no obvious change before and after treatment (P0.05). ROC curve analysis showed that MSI was the best index for predicting effective response before treatment. When the threshold value was 154.81, the corresponding area under the curve (AUC), sensitivity and specificity were 0.882, 89.3% and 73.5%, respectively. Conclusion: DCE-MRI semi quantitative parameters can be used to predict the early radiotherapy and chemotherapy of larynx and hypopharyngeal carcinoma. The fourth part is MR dynamic enhancement (DCE-MRI) to predict the sensitivity of concurrent chemoradiotherapy for laryngeal and hypopharyngeal carcinoma. Objective: To explore the value of MR dynamic enhanced scan (DCE-MRI) in predicting the sensitivity of laryngeal and hypopharyngeal carcinoma to concurrent chemoradiotherapy. Materials and methods: collection of laryngoscope biopsy pathology confirmed in our hospital in December 2014, -2015, -2015.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R739.63

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