磁共振弥散加权成像表观弥散系数预测胃肠道癌肝转移化疗疗效的临床研究

发布时间：2018-02-02 21:18

本文关键词： 肝转移瘤化疗表观扩散系数磁共振　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的评估表观弥散系数（ADC)在胃肠道癌肝脏转移化疗疗效预测和早期评价中的临床应用价值。材料与方法研究对象：收集2012年1月到2014年1月年我院20例胃、结直肠癌肝脏转移患者的完整临床及影像资料，其中胃癌肝脏转移8位患者22个病灶，结直肠癌肝转移12例患者43个病灶，共计65个病灶。检查方法：采用荷兰Philips Pulsar HP1.5T磁共振扫描仪，应用腹部8通道相控阵线圈。图像分析：在化疗前、化疗后2周、12周行磁共振（magnetic resonance,MR）检查；将原始图像传到Philips EWS2.6.3.2工作站进行分析和后处理，利用自带软件生成ADC图并测量ADC值，分别测量转移瘤化疗前、化疗后2周、12周ADC值及最大直径，根据化疗12周后转移瘤最大直径的变化，把所有转移瘤分成对化疗敏感的有效组和不敏感的无效组，评判两组化疗前、化疗后2周、12周三个时间点的ADC值及转移瘤最大直径的差异。统计学分析：使用SPSS18.0软件包进行统计学分析。首先对两组数据进行正态分布性检验；然后比较两组转移瘤治疗前、后ADC值及最大直径和年龄的差异；采用Spearman秩相关性分别对治疗前转移瘤ADC值与治疗前最大直径、治疗后转移瘤ADC值与治疗后最大直径、治疗前转移瘤ADC值与直径减少率、ADC变化率与转移瘤直径减少率、治疗前的转移瘤最大直径与转移瘤减少率进行相关性分析，确定其相关性；使用接受者工作特征（ROC））曲线确定化疗前最适的ADC值，以确定预测胃肠道癌肝转移瘤对化疗无效的敏感性及特异性，及预测的阳性及阴性值。结果在65个病灶中对化疗有效的30个病灶，，无效的35个病灶，化疗前敏感组ADC值（1.05±0.07×10-3mm2/s）与不敏感组（1.26±0.09×10-3mm2/s）对比有明显统计学的差异(P0.001)，化疗敏感组在2周后ADC值明显上升(1.30±0.02×10-3mm2/s,P0.001),与此同时不敏感的ADC值与治疗前对比无显著差异（1.29±0.10×10-3mm2/s,P=0.128)；化疗后12周后有效组上升至1.35±0.06×10-3mm2/s(P0.001），而无效组亦无明显变化1.27±0.06×10-3mm2/s（P=0.146）；在治疗前ADC值与肿瘤最大直径无明显相关性（r=0.191,P=0.127）；治疗后ADC值与肿瘤最大直径无明显相关性亦无相关性（r=0.067,P=0.597）；而治疗前平均ADC值与胃肠道癌肝转移瘤减少率呈明显负相关性（r=-0.670,P0.001）；治疗后平均ADC值增加率与肿瘤最大直径减小率呈明显正相关性（r=0.685,P0.001）；肿瘤的减小率与治疗前肿瘤的最大直径无明显相关性（r=-0.112,P=0.374）；ROC曲线下面积为0.913，以治疗前ADC值=1.17×10-3mm2/s断定转移灶对化学治疗无效的敏感性和特异性分别为80%和90%，判断胃肠道癌肝转移瘤对化疗无效结果的阳性与阴性值为90.0%和91.4%。结论（1）胃肠癌肝转移瘤化疗前平均ADC值高的病例对化疗不敏感；（2）化疗后ADC值早期增加的胃、结直肠癌肝转移瘤对化学治疗敏感；（3）ADC值能够预测胃、结直肠癌肝转移瘤对化疗是否敏感，以治疗前ADC值等于1.17×10-3mm2/s作为化疗无效的临界值断定转移瘤对化学治疗无效的敏感性和特异性分别为80%和90%。
[Abstract]:Objective to evaluate the clinical value of apparent diffusion coefficient (ADC) in the prediction and early evaluation of the curative effect of liver metastasis chemotherapy for gastrointestinal cancer.
Materials and methods
Participants: a total of 20 patients with liver metastases from stomach and colorectal cancer from January 2012 to January 2014 were collected. The clinical data and imaging data of 8 patients with liver metastases from gastric cancer, 22 patients with liver metastases from colorectal cancer, 12 patients with 43 lesions, 65 lesions were included.
Examination method: using the Holland Philips Pulsar HP1.5T magnetic resonance scanner, the 8 channel phased array coil of the abdomen is applied.
Image analysis: before chemotherapy, 2 weeks after chemotherapy, 12 weeks underwent magnetic resonance (magnetic resonance, MR); the original image to Philips EWS2.6.3.2 workstation for analysis and postprocessing, the use of software to generate ADC and ADC measurements, respectively measuring metastases before chemotherapy, 2 weeks after chemotherapy, 12 weeks ADC value and maximum diameter, the maximum diameter of the tumor metastasis according to the change of chemotherapy after 12 weeks, all metastases into effective chemotherapy sensitive and insensitive to the invalid group, evaluation of two groups before chemotherapy, 2 weeks after chemotherapy, the difference between the 12 Wednesday time ADC and the maximum diameter of the metastases.
Statistical analysis: statistical analysis was performed using SPSS18.0 software package. The data of the two groups were tested for normal distribution; and then compare the two groups of metastatic tumor before treatment, the difference ADC and the maximum diameter and age; the Spearman rank correlation of ADC value before treatment of metastatic tumor before treatment with the maximum diameter, value and treatment after the maximum diameter of tumor metastasis of ADC after treatment, before the treatment of metastatic tumor ADC value and the diameter reduction rate, ADC rate and metastasis rate of decrease in diameter, the largest diameter of metastatic tumor before treatment and reduce the rate of metastasis by correlation analysis to determine the correlation; using the receiver operating characteristic (ROC) curve to determine the optimal chemotherapy before) the value of ADC to determine the sensitivity and specificity for prediction of tumor chemotherapy ineffective liver metastasis of gastrointestinal tract cancer, and the positive and negative predictive value.
Results 30 lesions in 65 lesions of effective chemotherapy, 35 lesions invalid, before chemotherapy sensitive group ADC (1.05 + 0.07 * 10-3mm2/s) and sensitive group (1.26 + 0.09 * 10-3mm2/s) had obvious statistical difference (P0.001), chemotherapy group at 2 weeks after the ADC value of Ming Dynasty significantly increased (1.30 + 0.02 * 10-3mm2/s, P0.001), at the same time is not sensitive to the ADC value had no significant difference compared with before treatment (1.29 + 0.10 * 10-3mm2/s, P=0.128); after 12 weeks after chemotherapy effective group increased to 1.35 + 0.06 * 10-3mm2/s (P0.001), and the ineffective group there was no obvious change of 1.27 + 0.06 * 10-3mm2/s (P=0.146); before treatment, ADC value and the maximum diameter of the tumor was no significant correlation (r=0.191, P=0.127); after treatment, ADC value and the maximum diameter of the tumor had no obvious correlation with no correlation (r=0.067, P=0.597); and before treatment the average ADC value decrease rate was significantly negative correlation with gastrointestinal cancer liver metastases (R =-0.670, P0.001); the average ADC value increased after treatment rate and maximum tumor diameter reduction rate was significantly correlated (r=0.685, P0.001); the maximum diameter of tumor reduction rate and tumor before treatment had no significant correlation (r=-0.112, P=0.374); the area under the ROC curve was 0.913, with the ADC value before treatment =1.17 * 10-3mm2/s concluded metastasis on chemical treatment is invalid. The sensitivity and specificity were 80% and 90%, the judgment of gastrointestinal cancer liver metastases results invalid to chemotherapy, the positive and negative values of 90% and 91.4%.
Conclusion (1) liver metastasis of gastrointestinal cancer chemotherapy before the average ADC value of high case is not sensitive to chemotherapy; (2) ADC increased early gastric value after chemotherapy for colorectal liver metastases are sensitive to chemotherapy; (3) the value of ADC can predict the stomach, liver metastases of colorectal cancer is sensitive to chemotherapy, to before treatment, ADC value is equal to the critical value of 1.17 * 10-3mm2/s as chemotherapy ineffective concluded that metastases were 80% and 90%. on chemical therapy sensitivity and specificity

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735;R445.2;R730.53

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