功能MR成像在直肠癌新辅助放化疗疗效评估以及预后评估中的应用价值

发布时间：2018-03-09 10:56

本文选题：磁共振成像　切入点：扩散加权成像　出处：《南京医科大学》2017年博士论文　论文类型：学位论文

【摘要】：第一部分功能MR成像在直肠癌新辅助放化疗疗效评估中的运用及临床价值研究一目的:评估扩散峰度成像(DKI)在评估局部晚期直肠癌患者新辅助放化疗治疗反应中的可行性和价值。材料方法:本研究纳入41名患者,所有患者在新辅助放化疗前以及新辅助治疗后均行MR检查。后处理得到定量参数Dapp、Kapp以及ADC值,同时计算上述定量参数新辅助治疗前后的变化值(AX)以及变化率(rΔX)。病理学肿瘤回归分数参考Mandard标准:疗效好的为pTRG1-2;疗效差者为pTRG3-5。运用ROC分析比较诊断性能。结果:新辅助治疗前的定量值pre-Dapp-10th在疗效好的组低于疗效差的组(p等于0.036)。ROC实验得到pre-Dapp-10th的AUC为0.753(p等于0.036),敏感性为66.67%,特异性为77.78%。上述所有定量值中,Dapp值的前后变化率(rΔDapp)有相对最高的AUC(0.859)及敏感性(100%)。结论:DKI可以用于筛选出新辅助放化疗疗效好的局部晚期直肠癌患者。研究二目的:探索DCE-MRI评估局部晚期直肠癌患者新辅助放化疗得到病理性完全缓解的价值。材料方法:35名局部晚期接受新辅助放化疗的直肠癌患者纳入研究。DCE-MRI后处理得到定量参数Ktrans、K以及Ve值,并计算新辅助放化疗前后Ktrans的变化率:ΔKtrans=(post-Ktrans-pre-Ktrans)/pre-Ktrans。ROC 诊断实验分析 DCE-MRI的预测价值以及敏感性、特异性。结果:Ktrans值新辅助放化疗前后的变化值在病理完全缓解组显著高于未缓解组(45.437%±10.703%vs.34.063%±15.856%,p 等于 0.022)。ΔKtrans的 AUC 为 0.777,敏感性为80%,以及特异性为75%。结论:DCE-MRI能够评估局部晚期直肠癌新辅助放化疗后的病理性完全缓解。第二部分功能MR成像与直肠癌远处转移相关性的临床研究研究一目的:探索常规弥散成像(DWI)及弥散峰度成像(DKI)与直肠腺癌远处转移之间的相关性。材料与方法:58名直肠腺癌患者(其中27名发生远处转移,31名没有发生远处转移)纳入研究。常规弥散后处理得到ADC值(b值为0以及1000 sec/mm2),DKI后处理得到Dapp以及Kapp值(b值为0,700,1400以及2000 sec/mm2)。上述定量参数基于整体肿瘤分析(感兴趣区域ROI包括整体肿瘤)。组间定量参数的比较使用独立t检验,运用ROC诊断实验评价定量参数鉴别远处转移的效能。结果:定量参数Dapp直方图分析得到百分位数值百分之十(Dapp-10th),ADC值最小值(ADC-min)在转移组显著低于对照组(0.972±0.119 vs 1.121±0.134及0.486±0.228 vs 0.596±0.086×10-3 mm2/s,p 值小于 0.05);Kapp最大值(Kapp-max)在转移组显著高于对照组(1.407±0.337vs1.215±0.147;P值等于0.014)。ROC诊断实验发现Dapp-10th较ADC-min有更高的曲面下面积(0.856 vs.0.677),更高的特异性(100%vs 60%)。结论:与常规DWI相比,DKI能更好得区分直肠腺癌是否发生远处转移。研究二目的:探索DCE-MRI定量参数与直肠癌远处转移以及临床病理学指标的相关性。材料与方法:63名患者纳入研究(其中发生远处转移31名,未发生远处转移者32名)。定量参数(Ktrans、Kep以及Ve值)的比较运用t检验或者ANOVA检验;ROC诊断实验用于评估DCE-MRI定量参数区分直肠腺癌是否发生远处转移的效价。结果:Ktrans、Kep以及Ve值在转移组显著高于对照组(0.536±0.242vs0.299±0.118 min-1,p小于 0.001;1.598±0.477 vs 1.341±0.390 min-1,p等于 0.022;0.324±0.173 vs 0.249±0.091,p 等于 0.034)。定量参数中Ktrans值得 AUC 为 0.788(p小于 0.001),敏感性为61.29%,特异性为87.5%。结论:DCE-MRI定量参数有望成为预测直肠癌发生远处转移的有效指标。
[Abstract]:The first part of the study on the application of functional MR imaging in evaluation of chemotherapy efficacy and clinical value of neoadjuvant rectal cancer Objective: To evaluate the diffusion kurtosis imaging (DKI) in the assessment of patients with locally advanced rectal cancer neoadjuvant chemotherapy in the treatment of the feasibility and value of reaction. Materials and methods: the study included 41 patients, all patients before chemotherapy and neoadjuvant therapy in neoadjuvant were examined by MR and postprocessing quantitative parameters of Dapp, Kapp and ADC, and calculate the changes before and after neoadjuvant therapy for the quantitative values of the parameters (AX) and the rate of change (R X). The pathological tumor regression score Mandard standard reference: good curative effect for pTRG1-2; poor effect to pTRG3-5. using ROC analysis to compare the diagnostic performance of neoadjuvant therapy. Results: the quantitative values before pre-Dapp-10th was lower than that of poor outcome group in the curative group (P = 0.036).ROC pre-Dapp-10th AUC experiment 0.753 (P = 0.036), the sensitivity was 66.67%, specificity was 77.78%. all of the above quantitative value, before and after the change rate of Dapp value (R Dapp) had the highest relative AUC (0.859) and sensitivity (100%). Conclusion: DKI can be used for the screening of new adjuvant chemotherapy has good curative effect of local advanced study on two patients with rectal cancer. Objective: To explore the DCE-MRI evaluation of locally advanced rectal cancer patients with neoadjuvant chemotherapy and get pathological complete remission value. Materials and methods: 35 women with locally advanced rectal cancer patients received neoadjuvant chemotherapy were included in the study of.DCE-MRI postprocessing quantitative parameters of Ktrans, K and Ve, and calculate the rate of Ktrans neoadjuvant chemotherapy the change before and after chemotherapy: a Ktrans= (post-Ktrans-pre-Ktrans) /pre-Ktrans.ROC diagnosis experimental analysis of DCE-MRI predictive value and sensitivity, specificity. Results: the Ktrans value of neoadjuvant chemotherapy before and after chemotherapy in pathological changes completely The remission group was significantly higher than non remission group (45.437% + 10.703%vs.34.063% + 15.856%, P = 0.022). Ktrans AUC was 0.777, the sensitivity was 80%, and the specificity was 75%. conclusion: DCE-MRI can assess the pathological of locally advanced rectal cancer after neoadjuvant chemoradiotherapy in complete remission. Clinical research of second functional MR imaging and rectal cancer distant metastasis Objective: To explore the correlation between the conventional diffusion weighted imaging (DWI) and diffusion kurtosis imaging (DKI) and the correlation between rectal adenocarcinoma metastasis. Materials and methods: 58 patients with rectal cancer (including 27 metastasis, 31 without metastasis) were enrolled in the study. The conventional diffusion by postprocessing the ADC value (b value of 0 and 1000 sec/mm2), DKI Dapp postprocessing and Kapp value (b value of 07001400 and 2000 sec/mm2). The quantitative analysis based on the parameters of the whole tumor (region of interest including ROI The whole tumor.) using quantitative parameters between groups using independent t test, performance evaluation of ROC diagnosis of experimental quantitative parameter identification of distant metastasis. Results: the quantitative parameters of Dapp histogram analysis percentile ten percent (Dapp-10th), the ADC value of the minimum value (ADC-min) in the metastasis group was significantly lower than the control group (0.972 + 0.119 vs 1.121 + 0.134 and 0.486 + 0.228 vs 0.596 + 0.086 * 10-3 mm2/s, P value is less than 0.05); the maximum value of Kapp (Kapp-max) in the metastasis group was significantly higher than the control group (1.407 + 0.337vs1.215 + 0.147; P = 0.014).ROC diagnosis test showed that Dapp-10th is ADC-min higher surface area (0.856 vs.0.677), higher specificity (100%vs 60%). Conclusion: compared with conventional DWI, DKI can better distinguish whether rectal adenocarcinoma metastasis. Two research objective: To explore the quantitative parameters of DCE-MRI and colorectal cancer metastasis and clinical pathology refers to Subject correlation. Materials and methods: 63 patients (including distant metastasis occurred in 31, without the occurrence of distant metastasis 32). Quantitative parameters (Ktrans, Kep and Ve) comparison by t test or ANOVA test; ROC diagnostic tests for DCE-MRI quantitative parameters to evaluate the distinction of rectal adenocarcinoma is titer distant metastasis. Results: Ktrans, Kep and Ve value in metastasis group was significantly higher than the control group (0.536 + 0.242vs0.299 + 0.118 min-1, P is less than 0.001; 1.598 + 0.477 vs 1.341 + 0.390 min-1, P = 0.022; 0.324 + 0.173 vs 0.249 + 0.091, P = 0.034). The quantitative parameters of Ktrans AUC is worth 0.788 (p less than 0.001), the sensitivity was 61.29%, specificity was 87.5%. conclusion: DCE-MRI quantitative parameters prediction is expected to become the effective index of distant metastasis of rectal cancer.

【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R735.37;R445.2

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