前列腺IVIM-DWIb值优化及其参数的一致性分析

发布时间：2018-06-18 13:26

本文选题：前列腺癌 + 体素内不相干运动成像　；参考：《苏州大学》2016年硕士论文

【摘要】：第一部分前列腺IVIM-DWI的b值优化探讨目的对前列腺IVIM-DWI的b值组合进行优化,探讨IVIM-DWI定量参数在前列腺癌诊断中的作用。方法回顾性分析本院2015年2月至11月间行前列腺常规MRI和IVIM-DWI扫描并经穿刺病理证实的47例前列腺病例资料,其中前列腺癌23例,良性前列腺增生24例。纳入标准:(1)同时行前列腺常规MRI和IVIM-DWI检查,检查技术符合本研究要求,检查参数保持一致;(2)经超声引导下穿刺活检证实为前列腺癌或良性前列腺组织;(3)前列腺MRI检查前1月内均未进行前列腺穿刺活检;(4)前列腺MRI检查前未进行任何针对前列腺疾病的治疗;(5)前列腺MRI检查和病理检查的间隔时间小于6周。排除标准:(1)MRI扫描图像资料不完整,图像质量不符合本研究的要求;(2)肿瘤体积过小,瘤灶在IVIM-DWI图像上边界不清,无法准确设置ROI;(3)病理结果描述区域与MRI图像不匹配。IVIM-DWI检查设置四组b值进行扫描,具体为:(1)0,10,100,200,1000;(2)0,10,50,100,200,1000;(3)0,10,20,50,100,200,1000;(4)0,10,20,50,100,200,500,1000。在所获IVIM-DWI图像上根据穿刺病理报告结合PI-RADS v2评分标准在活检取材相对应部位分别设置前列腺癌区、中央腺体非癌区和外周带非癌区的ROI,分别测量四组不同b值的IVIM-DWI定量参数,包括扩散系数D、灌注分数f和伪扩散系数D*。采用方差分析比较各组b值的前列腺癌区、中央腺体非癌区和外周带非癌区测得参数间的差异,两两间差异性检验采用LSD-t检验,P0.05,为具有统计学差异。结果第(1)组b值(0,10,100,200,1000)前列腺癌区的D值、f值、D*值分别为(0.67±0.11)×10-3mm2/s、(26.95±4.75)%、(12.88±4.93)×10-3mm2/s,中央腺体非癌区的D值、f值、D*值分别为(1.35±0.16)×10-3mm2/s、(27.79±3.47)%、(15.6±2.82)×10-3mm2/s,外周带非癌区的D值、f值、D*值分别为(1.79±0.29)×10-3mm2/s、(25.19±4.3)%、(13.47±4.84)×10-3mm2/s;第(2)组b值(0,10,50,100,200,1000)前列腺癌区的D值、f值、D*值分别为(0.68±0.14)×10-3mm2/s、(26.45±4.73)%、(13.1±4.44)×10-3mm2/s,中央腺体非癌区的D值、f值、D*值分别为(1.36±0.17)×10-3mm2/s、(27.3±4.06)%、(15.41±3.46)×10-3mm2/s,外周带非癌区的D值、f值、D*值分别为(1.85±0.29)×10-3mm2/s、(23.9±3.54)%、(12.22±4.61)×10-3mm2/s;第(3)组b值(0,10,20,50,100,200,1000)前列腺癌区的D值、f值、D*值分别为(0.68±0.12)×10-3mm2/s、(25.59±4.84)%、(13.75±5.08)×10-3mm2/s、,中央腺体非癌区的D值、f值、D*值分别为(1.38±0.16)×10-3mm2/s、(26.78±3.86)%、(15.55±2.82)×10-3mm2/s,外周带非癌区的D值、f值、D*值分别为(1.8±0.31)×10-3mm2/s、(23.98±5.2)%、(13.55±5.27)×10-3mm2/s;第(4)组b值(0,10,20,50,100,200,500,1000)前列腺癌区的D值、f值、D*值分别为(0.67±0.13)×10-3mm2/s、(28.58±5.93)%、(12.43±5.55)×10-3mm2/s,中央腺体非癌区的D值、f值、D*值分别为(1.33±0.16)×10-3mm2/s、(28.2±3.16)%、(14.38±3.15)×10-3mm2/s,外周带非癌区的D值、f值、D*值分别为(1.81±0.35)×10-3mm2/s、(28±6.93)%、(11.41±5.64)×10-3mm2/s。各组癌区的D值均低于非癌区,差异有统计学意义(P0.05),且中央腺体非癌区的D值低于外周带非癌区的D值,差异有统计学意义(P0.05)。f值和D*值在前列腺癌区、中央腺体非癌区和外周带非癌区间的差异无统计学意义(P0.05)。结论在本研究部分选择的四组b值行3.0T前列腺IVIM-DWI扫描所获的IVIM参数(D值、f值和D*值)中,仅D值在前列腺癌区与非癌区间的差异具有统计学意义,可用于前列腺癌与非癌区的诊断与鉴别诊断;且第(1)组b值(0,10,100,200,1000)所选的b值数最少,扫描时间最短,建议在前列腺IVIM-DWI扫描中推荐使用。第二部分前列腺IVIM-DWI成像的一致性分析目的评价在不同时间、不同设备和重复测量时前列腺IVIM-DWI所测定量参数值(D值、f值和D*值)间的一致性,以明确其作为前列腺多中心研究评价指标的可行性。方法2015年12月在我院招募健康成年男性志愿者15例,进行前列腺IVIM-DWI定量参数测值的一致性研究,年龄23-30岁。纳入标准:(1)健康成年男性,无前列腺疾病史,无前列腺疾病相关临床症状;(2)前列腺IVIM-DWI检查技术符合本研究要求,检查参数保持一致。排除标准:(1)IVIM-DWI图像质量不佳,影响观察和分析;(2)严重幽闭恐惧症患者;(3)磁共振成像禁忌症;(4)前列腺IVIM-DWI检查显示前列腺有异常信号改变者。本研究获得本院伦理委员会批准并在其监督下进行,所有研究对象均已签署知情同意书。所有志愿者在同一天采用3.0T(Ingenia,Philips)MR成像系统行前列腺IVIM-DWI检查,在间隔16天后由同一操作者分别采用3.0T(Ingenia,Philips)(与前次检查为同一设备)和3.0T(TX,Philips)MR成像系统重复上述IVIM-DWI检查,扫描参数相同。b值采用第一部分研究所推荐的组合(0,10,100,200,1000)。在每次IVIM-DWI检查所获前列腺轴位图像上,对前列腺最大面积层面的前列腺中央腺体和外周带区域设置ROI(每例设置ROI的位置和大小尽量保持一致),分别测量IVIM参数(包括扩散系数D、灌注分数f和伪扩散系数D*),且在3.0T(Ingenia,Philips)MR成像系统第一次IVIM-DWI扫描所获前列腺图像上按照上述ROI设置方法对IVIM参数(D值、f值和D*值)进行重复测量。上述IVIM-DWI检查及IVIM参数测量均由同一研究者完成。采用配对样本t检验比较不同时间、不同设备及重复测量所获IVIM各参数值间的差异,P0.05,为差异有统计学意义。计算组内相关系数(ICC),其值介于0~1之间,0表示不可信,1表示完全可信,一般认为低于0.4表示相关性低,大于0.75表示信度好,相关性高。采用Bland-Altman法对上述不同时间、不同设备及重复测量所获IVIM各参数值间的差异进行一致性分析。结果3.0T(Ingenia,Philips)MR成像系统第一次前列腺IVIM-DWI检查测得的中央腺体D值、f值、D*值分别为(1.35±0.22)×10-3mm2/s,(33.33±7.28)%,(14.28±4.05)×10-3mm2/s,外周带D值、f值、D*值分别为(1.32±0.14)×10-3mm2/s,(34.15±7.34)%,(13.09±3.20)×10-3mm2/s;第二次检查测得的中央腺体D值、f值、D*值分别为(1.34±0.16)×10-3mm2/s,(31.67±5.34)%,(14.21±3.53)×10-3mm2/s,外周带D值、f值、D*值分别为(1.35±0.09)×10-3mm2/s,(34.05±8.36)%,(12.94±4.41)×10-3mm2/s;3.0T(TX,Philips)MR成像系统测得的中央腺体D值、f值、D*值分别为(1.42±0.19)×10-3mm2/s,(33.81±5.77)%,(33.81±5.77)×10-3mm2/s,外周带D值、f值、D*值分别为(1.31±0.28)×10-3mm2/s,(32.83±10.34)%,(12.43±3.80)×10-3mm2/s;3.0T(Ingenia,Philips)MR成像系统所获前列腺IVIM-DWI图像进行重复测量所测得的中央腺体D值、f值、D*值分别为(1.31±0.11)×10-3mm2/s,(34.64±7.70)%,(13.98±4.01)×10-3mm2/s,外周带D值、f值、D*值分别为(1.32±0.16)×10-3mm2/s,(33.20±5.41)%,(13.46±2.67)×10-3mm2/s。前列腺IVIM-DWI检查在不同时间、不同设备及重复测量所测得的D值、f值及D*值间的差异均无统计学意义(P0.05)。不同时间中央腺体测得的D值、f值、D*值的ICC分别为(0.823,0.460,0.520),外周带测得的D值、f值、D*值的ICC分别为(0.934,0.601,0.630);不同设备中央腺体测得的D值、f值、D*值的ICC分别为(0.910,0.462,0.735),外周带测得的D值、f值、D*值的ICC分别为(0.836,0.523,0.662);重复测量中央腺体测得的D值、f值、D*值的ICC分别(0.794,0.769,0.566),外周带测得的D值、f值、D*值的ICC分别为(0.849,0.803,0.871),上述测得的D值间(ICC大于0.75)的相关性最好。Bland-Altman散点图显示D值分布较D*值和f值更集中,提示在3.0T MR设备前列腺IVIM-DWI检查时,D值在不同时间、不同设备和重复测量所获IVIM定量参数各测量值间的一致性区间较小,可重复性较好。结论本部分研究结果显示在3.0T MR设备前列腺IVIM-DWI检查时不同时间、不同设备及重复测量所测得的前列腺IVIM定量参数值间差异没有统计学意义,D值间(ICC大于0.75)的相关性最好,各参数间的一致性较好,其中D值较D*和f值的一致性好,由此表明在3.0T MR设备前列腺IVIM-DWI检查时不同时间、不同设备及重复测量所测得的前列腺IVIM定量参数值间的一致性较好,IVIM定量参数可作为前列腺多中心研究的评价指标。
[Abstract]:Part one optimization of the b value of the prostate IVIM-DWI objective to optimize the b value combination of the prostate IVIM-DWI and to explore the role of IVIM-DWI quantitative parameters in the diagnosis of prostate cancer. Methods a retrospective analysis of 47 cases of prostate cases from February 2015 to November with routine prostate MRI and IVIM-DWI scan and pathologically confirmed prostate cases were analyzed retrospectively. Materials, of which 23 cases of prostate cancer and 24 cases of benign prostatic hyperplasia were included. (1) routine MRI and IVIM-DWI examination of prostate were performed simultaneously. The examination technique accorded with the requirements of this study, the examination parameters remained consistent; (2) the ultrasound guided biopsy confirmed the prostate cancer or benign prostatic tissue; (3) the MRI examination of the prostate was not carried out in January. Prostate biopsy; (4) no treatment for prostate disease before prostate MRI examination; (5) the interval between MRI and pathological examination of the prostate is less than 6 weeks. (1) the image data of the MRI scan is incomplete and the image quality does not meet the requirements of this study; (2) the tumor size is too small and the tumor range is not on the IVIM-DWI image boundary. In Qing, ROI can not be set accurately; (3) the pathology result description area and the MRI image mismatch.IVIM-DWI examination set four groups of B values to scan, specifically: (1) 0,101002001000; (2) 0,10,501002001000; (3) 0,10,20,501002001000; (4) 0,10,20,501002005001000. in the obtained IVIM-DWI image according to the biopsy pathology report combined PI-RADS v2. The scoring criteria set the prostate cancer area, the central glandular non cancer area and the peripheral ROI of the peripheral zone, respectively, to measure the IVIM-DWI quantitative parameters of four groups of different b values, including the diffusion coefficient D, the perfusion fraction f and the pseudo diffusion coefficient D*., which were compared with the b value of the prostate cancer area and the central glandular non cancer area. The difference between the parameters measured in the non cancer zone and the peripheral zone, the 22 difference test using LSD-t test, P0.05, was statistically different. Results (1) the D value of the b value (0,101002001000), F value, D* value was (0.67 + 0.11) x 10-3mm2/s, (26.95 + 4.75)%, (12.88 + 4.93) x 10-3mm2/s, D value, F value of the central gland non cancer area, D*. The values were (1.35 + 0.16) x 10-3mm2/s, (27.79 + 3.47)%, (15.6 + 2.82) x 10-3mm2/s, D value, F value of non cancer zone, D* value (1.79 + 0.29) x 10-3mm2/s, (25.19 + 4.3)%, (13.47 + 4.84) x 10-3mm2/s, b value (0,10,501002001000) in group B (0,10,501002001000) of prostate cancer area, F value, D* values were respectively. (13.1 + 4.44) * 10-3mm2/s, the D value, F value of the central glandular non cancerous region, D* value (1.36 + 0.17) * 10-3mm2/s, (27.3 + 4.06)%, (15.41 + 3.46) x 10-3mm2/s, F value, D* value (1.85 + 0.29) * 10-3mm2/s, (23.9 + 3.54)%, (12.22 +) * 10-3mm2/s; D value, F value, and D* value were (0.68 + 0.12) x 10-3mm2/s, (25.59 + 4.84)%, (13.75 + 5.08) x 10-3mm2/s, D value, F value of central glandular non cancer area, D* value (1.38 + 0.16) x 10-3mm2/s, (26.78 + 3.86)%, (15.55 + 2.82) * 10-3mm2/s, F value, F values, respectively, F values, respectively 0-3mm2/s; (4) group B value (0,10,20,501002005001000), D value, F value, D* value (0.67 + 0.13) x 10-3mm2/s, (28.58 + 5.93)%, (12.43 + 5.55) x 10-3mm2/s, D value, F value, D* value of the central glandular region (1.33 + 0.16) * 10-3mm2/s, (28.2 + 3.16)%, (14.38 + 3.15) * *, peripheral band non cancer value, values, values, values, values, The values of D* were (1.81 + 0.35) x 10-3mm2/s, (28 + 6.93)% and (11.41 + 5.64) x 10-3mm2/s., and the D values were lower than those in non cancerous regions. The difference was statistically significant (P0.05), and the D value of the central glandular non cancerous region was lower than the D value in the non cancerous region of the peripheral zone. The difference was statistically significant (P0.05).F value and D* value in the prostate cancer area, the central glandular non cancerous region and the outer region. There was no significant difference in the difference between the non cancer interval and the non cancerous interval (P0.05). Conclusion in the four groups of B values selected in this study, the IVIM parameters (D, F and D*) of the 3.0T prostate IVIM-DWI scan were statistically significant in the difference between the prostate cancer and the non cancer areas, and could be used for the diagnosis and differential diagnosis of the prostate and non cancer areas. And the b value (0,101002001000) of group (1) group (0,101002001000) is the least and the shortest scanning time. It is recommended to be used in the IVIM-DWI scan of the prostate. The consistency analysis of IVIM-DWI imaging in part second of the prostate is used to evaluate the parameter values (D, F, and D*) at different time, different equipment and repeated measurements of the prostatic gland in the prostatic gland. Conformance, to determine the feasibility of the prostatic multicenter study. Methods 15 healthy adult male volunteers were recruited in our hospital in December 2015 to conduct a conformance study of the quantitative parameters of the prostate IVIM-DWI parameters, aged 23-30 years. (1) a healthy adult male, a history of no prostate disease, and no prostate disease related Clinical symptoms; (2) the IVIM-DWI examination of the prostate coincide with the requirements of this study, and the examination parameters remain consistent. Exclusion criteria: (1) poor IVIM-DWI image quality, influence observation and analysis; (2) patients with severe claustrophobia; (3) contraindications to magnetic resonance imaging; (4) prostate IVIM-DWI examination showed abnormal signal changes in the prostate. All the subjects had signed the informed consent. All the volunteers used the 3.0T (Ingenia, Philips) MR imaging system for the prostate IVIM-DWI examination on the same day, and the same operator used 3.0T (Ingenia, Philips) (the same device with the previous examination) and 3 at the same day after 16 days. The T (TX, Philips) MR imaging system repeats the above IVIM-DWI examination with the same.B value of the scan parameters recommended by the first part of the study (0,101002001000). ROI on the central prostate gland and the peripheral zone of the prostate at the maximum area of the prostate (each set of ROI locations) on the prostate axis image obtained at each IVIM-DWI examination. The IVIM parameters (including diffusion coefficient D, perfusion fraction f and pseudo diffusion coefficient D*) were measured respectively, and repeated measurements were carried out on the IVIM parameters (D values, values and values) in the prostate images obtained by the first IVIM-DWI scan of the 3.0T (Ingenia, Philips) MR imaging system. M parameters are measured by the same researchers. Using paired sample t test, the difference between different time, different equipment and repeated measurements of IVIM parameters, P0.05, is statistically significant. The correlation coefficient within the computing group (ICC) is between 0~1, 0 is unbelievable, 1 is fully credible, generally believed to be less than 0.4. The correlation was low and greater than 0.75 indicated that the reliability was good and the correlation was high. The Bland-Altman method was used to make a consistent analysis of the differences between the values of IVIM parameters obtained at different times, different equipment and repeated measurements. Results the value of D, F, D* values of the first IVIM-DWI examination of the 3.0T (Ingenia, Philips) MR imaging system was (1.), and the value of D* was (1.). 35 + 0.22) * 10-3mm2/s, (33.33 + 7.28)%, (14.28 + 4.05) x 10-3mm2/s, D value of peripheral zone, F value, D* value (1.32 + 0.14) x 10-3mm2/s, (34.15 + 7.34)%, (13.09 + 3.20) x 10-3mm2/s, D value of central gland, F value and D* value measured by second examination. Value, D* value is (1.35 + 0.09) x 10-3mm2/s, (34.05 + 8.36)%, (12.94 + 4.41) x 10-3mm2/s, 3.0T (TX, Philips) MR imaging system has measured D value of central gland, F value, D* value is (1.42 + 0.19) x 10-3mm2/s, (33.81 + 5.77)%, (33.81 + 5.77) * 10-3mm2/s, peripheral zone value, respectively. 3 + 3.80) * 10-3mm2/s; 3.0T (Ingenia, Philips) MR imaging system has measured the D value of the central gland, F value, D* value (1.31 + 0.11) x 10-3mm2/s, (34.64 + 7.70)%, (13.98 + 4.01) x 10-3mm2/s, peripheral band D value, respectively, (1.32 + 0.16)%, (33.20 + 5.41)%, (13.46 + 2.67) There was no significant difference between the values of D, F and D* values measured at different time, different equipment and repeated measurements for the prostate IVIM-DWI in X 10-3mm2/s. (P0.05). The D value, F value, D* value of the central gland at different time were respectively (0.823,0.460,0.520), and the D values measured in the peripheral zone were respectively. The D value, the F value and the D* value of the central glands of different equipment are (0.910,0.462,0.735), the D values of the peripheral zone, the F value and the D* value are respectively (0.836,0.523,0.662), and the D values measured by the central glands are repeated, the F values, the values and the values are respectively measured. The best correlation between the above D values (ICC greater than 0.75) is the best.Bland-Altman scatter plot, which shows that the D value distribution is more concentrated than the D* value and F value. It is suggested that the D value of the 3.0T MR equipment in the prostate IVIM-DWI examination is at different time, and the consistency interval between the measured values of the IVIM quantitative parameters obtained by different equipment and repeated measurements is smaller, and the repeatability is better. The results of this part of the study showed that there was no statistical difference between different time, different equipment and repeated measurements of the prostate IVIM quantitative parameters in the prostate IVIM-DWI examination of 3.0T MR equipment. The correlation between the D values (ICC greater than 0.75) was the best, and the consistency of the parameters was better, and the consistency of the D value was better than the D* and F values. It shows that the consistency of the quantitative parameters of the prostate IVIM parameters measured by different equipment and repeated measurements at different time in the prostate IVIM-DWI examination of 3.0T MR equipment is better. The quantitative parameter of IVIM can be used as an evaluation index for the study of prostate multi center.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R737.25;R697.3

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