不同模型DWI成像技术在宫颈癌及淋巴结转移诊断中的应用价值研究

发布时间：2018-01-06 00:27

本文关键词：不同模型DWI成像技术在宫颈癌及淋巴结转移诊断中的应用价值研究　出处：《郑州大学》2017年博士论文　论文类型：学位论文

【摘要】：第一部分宫颈癌不同b值体素内不相干运动成像研究目的:评价体素内不相干运动成像不同b值范围应用单指数及双指数模型所得参数对宫颈癌的诊断价值。材料与方法:对120例宫颈癌患者和21例正常志愿者行3.0 T盆腔MRI检查,DWI采用多b值成像(0,50,100,150,200,300,500,800,1000,1500,1700和2000 s/mm2)。对于两种b值范围:0-1000 s/mm2和0-2000 s/mm2,采用单指数模型计算宫颈癌病灶和正常宫颈内膜的平均表观弥散系数(ADC),采用双指数衰减模型计算D,D*,f值。比较两种b值范围所得参数在宫颈癌患者和正常志愿者中的差异、宫颈癌不同病理分级和分期中的差异,并且通过ROC曲线评价不同b值范围单指数及双指数模型各参数的诊断价值,并确定最佳阈值。结果:两种b值范围单指数和双指数模型所得参数ADC,D和f值在宫颈癌患者和正常志愿者中均存在差异(p0.01)。D2000,ADC2000和D1000对于宫颈癌和正常宫颈的鉴别显示了相似的诊断价值,其曲线下面积(AUC)分别为0.923,0.909和0.907。ADC2000,D2000,ADC1000和D1000在宫颈癌不同浸润深度间存在差异(p0.05)。结论:D2000和ADC2000在宫颈癌和正常宫颈中的鉴别诊断价值稍优于D1000,但三者间没有统计学差异。ADC值和D值低的宫颈癌患者浸润深度较大。第二部分不同模型扩散加权成像用于鉴别宫颈癌盆腔淋巴结转移的可行性研究目的:探讨弥散加权成像单指数模型、双指数模型和拉伸指数模型对宫颈癌盆腔淋巴结转移的鉴别诊断价值。材料与方法:回顾性分析行子宫切除及盆腔淋巴结清扫术的50例宫颈癌患者,包括39例直接手术早期患者和11例放化疗后手术患者。患者均行术前盆腔MRI平扫和多b值DWI成像(13个b值:分别为0,50,100,150,200,300,500,800,1000,1300,1500,1700和2000 s/mm2)。发现157个DWI上呈高信号的淋巴结,测量其长径、短径和短长径比值,单指数模型参数ADC值,双指数模型参数慢扩散系数(D)值、灌注分数(f)值和快扩散系数(D*)值,拉伸指数模型参数DDC和α值。采用独立样本t检验或Mann-Whitney U检验比较转移淋巴结和非转移淋巴结两组间各参数值的差异,和Spearman相关分别分析淋巴结大小参数与各弥散参数与转移之间的相关性,以及大小参数与各弥散参数之间的相关性。并绘制诊断淋巴结转移差异有统计学意义的各参的ROC曲线,比较曲线下面积(AUC)和相应的敏感性、特异性、PPV和NPV。结果:157个淋巴结中有41个病理确诊为转移淋巴结。转移淋巴结的平均D值和α值高于非转移淋巴结,而f值低于非转移淋巴结;转移淋巴结的长径,短径和短长径比值均高于非转移淋巴结组(p0.05)。Spearman相关分析显示淋巴结D值与ADC、DDC、α、淋巴结长径和短径间均存在正相关性(p0.01)。ROC曲线分析显示淋巴结短径对鉴别转移价值最大(AUC=0.844),之后是短长径比值(AUC=0.726)和长径(AUC=0.694)。D和f鉴别淋巴结转移的价值有限,AUC不超过0.7。大小参数诊断淋巴结转移的敏感性不超过80%,弥散参数诊断淋巴结转移的敏感性低于50%。结论:双指数和拉伸指数模型扩散加权成像能够对鉴别宫颈癌淋巴结转移提供帮助;转移和非转移淋巴结间D值、f值和α值存在差异,弥散参数D值、f值和α值的曲线下面积低于大小参数,其对淋巴结转移的判断效能不如大小参数。
[Abstract]:The b value of intravoxel incoherent motion imaging to study different part of cervical cancer: evaluation of intravoxel incoherent motion imaging diagnostic value of different b value range of parameters using single index and double exponential model is obtained for cervical cancer. Materials and methods: 120 cases of cervical cancer patients and 21 normal volunteers underwent 3 T pelvic MRI examination, the b value of DWI imaging (0,50100150200300500800100015001700 and 2000 s/mm2). In the two B range: 0-1000 s/mm2 and 0-2000 s/mm2, the average apparent diffusion coefficient calculation table for cervical cancer lesions and normal cervical endometrium using the single index model (ADC), using double exponential attenuation model to calculate D, D*, f comparison of two b value range of the parameters in cervical cancer patients and normal volunteers in the differences, differences in different pathological grading and staging of cervical cancer, and through the ROC curve to evaluate the different b value range of single and double index Diagnostic value of exponential model parameters, and to determine the optimal threshold. Results: two b values of single index and double exponential model parameters obtained from ADC, D and F in cervical cancer patients and normal volunteers were different (P0.01).D2000, ADC2000 and D1000 showed a similar diagnostic value for differential diagnosis of cervical cancer and the normal cervix, the area under the curve (AUC) were 0.923,0.909 and 0.907.ADC2000, D2000, ADC1000 and D1000 in cervical cancer differed between the depth of invasion (P0.05). Conclusion: D2000 and ADC2000 in cervical carcinoma and normal cervical in the differential diagnosis is slightly better than that of D1000, but no statistically significant difference between the three.ADC value and low D value in patients with cervical cancer invasive depth is larger. Second different models of diffusion weighted imaging for the purpose of the feasibility study of pelvic lymph node metastasis of cervical cancer: identification of diffusion weighted imaging and single index model, double The exponential model and the tensile index model for differential diagnosis of pelvic lymph metastasis of cervical carcinoma. Materials and methods: a retrospective review of 50 cases of cervical cancer patients were analyzed for hysterectomy and pelvic lymph node dissection, including 39 cases of patients with early surgery and 11 cases of chemotherapy after surgery. Patients underwent preoperative pelvic MRI scan and b value of DWI imaging (13 b values: 0,501001502003005008001000130015001700 and 2000 s/mm2 respectively). 157 DWI showed high signal of lymph node, measurement of the long diameter, short diameter and short diameter ratio, single index model parameters ADC value, slow diffusion coefficient parameter double exponential model (D) value of perfusion fraction (f) and fast diffusion coefficient (D*) value, tensile index model parameters DDC and alpha value. By using independent sample t test or Mann-Whitney U test to compare the difference of metastasis lymph nodes and the value of parameters between two groups of non metastatic lymph node, and Sp Earman were correlation analysis between lymph node size parameters and the diffusion parameters and metastasis, and the correlation between the size parameters and the dispersion parameters. And draw a statistically significant difference in diagnosis of lymph node metastasis of the ROC curve, compare the area under the curve (AUC) and the corresponding sensitivity, specificity, PPV and NPV. results: 157 lymph nodes in 41 pathologically confirmed lymph node metastasis of lymph node metastasis. The average D value and a value higher than non metastatic lymph nodes, and the F value is lower than the non lymph node metastasis; lymph node metastasis of long diameter, short diameter and short diameter ratio was higher than that in non metastatic lymph nodes (P0.05).Spearman correlation analysis showed that lymph node value of D and ADC, DDC, alpha, lymph node of long diameter and short diameter have positive correlation between (P0.01).ROC curve analysis showed that lymph node metastasis in the differential diagnosis of short diameter (AUC=0.844), the maximum value is short diameter ratio (AUC=0. 726) and long diameter (AUC=0.694) of.D and F in the differential diagnosis of lymph node metastasis of limited value, AUC does not exceed the size parameter sensitivity of 0.7. diagnosis of lymph node metastasis is less than 80%, lower than the 50%. conclusion in diagnosis of lymph node metastasis sensitivity parameters: double diffusion index and tensile index model of diffusion weighted imaging of lymph node can identify cervical cancer transfer help; metastatic and non metastatic lymph nodes, D value, F value and the difference value of alpha, dispersion parameter D value, F value and the area under the curve below the value of the size parameter, the judgment of the lymph node metastasis efficiency as the size parameter.

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R737.33

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