在胰腺癌靶区勾画中磁共振弥散加权成像（MR-DWI）与增强电子计算机断层扫描（CT）的对比研究
发布时间：2018-09-03 08:29
【摘要】：【目的】旨在进一步研究探讨胰腺癌、肝脏与区域淋巴结转移瘤在增强电子计算机增强扫描(Computed tomography,CT)及磁共振弥散加权成像(Magnetic Resonance Diffusion Weighted Imaging,MR-DWI)上的区别,使胰腺癌放疗靶区勾画更具精确性,为指导临床放疗提供理论依据,指导临床放疗实践。【方法】入组患者为38例,入组条件:KPS(Karnofsky Performance Status,功能状态评分)评分60分;未行针对胰腺癌的相关治疗;患者体内无金属异物,可行磁共振检查;患者对增强造影剂不过敏且知情并同意;经组织病理学或者临床确诊为胰腺癌患者。所有患者均行增强CT及MRI定位扫描。依据不同图像进行逐层靶区体积勾画(表示为:GTVCT、GTVDWI),测量肿瘤最大截面长径测量(表示为:d CT、dDWI)、肝转移瘤(表示为:NCT肝、NMRI肝)及5-8mm、8mm淋巴结转移瘤(表示为:NCT5-8淋巴、NMRI5-8淋巴、NCT8淋巴、NMRI8淋巴)。将相应数据进行统计分析,采用配对t检验或秩和检验对计量资料进行统计学分析。【结果】1、患者特征:入组患者38例,男、女分别为20/18人。入组患者平均年龄59.1岁。肿瘤位于胰腺头颈部20例,胰腺体尾部18例。19例为局部进展期,19例伴有肝脏等转移。行增强CT和MR-DWI的平均检查间隔时间为4.3天。2、胰腺原发肿瘤比较:基于增强CT、MR-DWI所勾画的肿瘤靶区体积大小,分别为54.95cm3(12.41cm3-266.29cm3)、41.67cm3(5.66cm3-235.41cm3),均值差值13.28cm3(8.26cm3-18.29cm3),使用配对wilcoxon检验分析得出两组数据有统计学差异。依据增强CT及MR-DWI所测量的肿瘤最大界面长径分别为4.18cm(1.76cm-7.3cm)、3.94cm(1.48cm-7.33cm),均值差值为0.24cm(0.18cm-0.30cm)。配对t检验分析得出p0.001,结果有统计学差异。表明MR-DWI所测量的肿瘤靶区体积及肿瘤最大界面长径较增强CT小。3、胰腺癌肝脏转移比较:有肝脏转移患者19例,占比50%。依据增强CT与MR-DWI图像分别检出肝脏转移瘤为83vs112枚,CT检出只量占MR-DWI检出量的74%,MR-DWI检出可覆盖全部增强CT检出。经配对wilcoxon秩和检验分析得出p0.001,二者之间有显著统计学差异,表明DWI对胰腺癌肝转移有更高检出率。4、区域淋巴结转移比较:依据增强CT与MR-DWI图像,分别检出8mm区域淋巴结转移者46vs56枚,增强CT检出量只有MR-DWI检出量的82%。依据增强CT与MR-DWI图像分别检出5-8mm区域淋巴结为103vs200枚,增强CT检出量只有MR-DWI检出量的52%,且MR-DWI检出可覆盖全部增强CT检出。使用配对wilcoxon检验得p值均小于0.001。N_(CT5-8淋巴)、N_(DWI5-8淋巴)与N_(CT8淋巴)、N_(DWI8淋巴)之间均有统计学差异,表明MR-DWI对区域淋巴结检出有较高敏感性,但临床诊断特异性还有待深入研究。【结论】基于MR-DWI所测量的肿瘤靶区体积及肿瘤最大界面长径较增强CT小,肝转移及区域淋巴结检出较增强CT敏感。在制定胰腺癌放疗计划时,参考MR-DWI可使得靶区边界更加清晰,对于肝脏及区域淋巴结转移检出敏感性显著高于CT检查,有助于临床治疗方案的确定和放疗计划的修正,当然还需要进一步深入研究MR-DWI检出率的特异性。参照病理的进一步对照研究是有必要的。
[Abstract]:[Objective] To investigate the difference between enhanced computed tomography (CT) and magnetic Resonance Diffusion Weighted Imaging (MR-DWI) in pancreatic cancer, liver and regional lymph node metastases, so as to make the target area delineation more accurate and guide the clinical practice. [Methods] 38 patients with KPS (Karnofsky Performance Status) score of 60 points, no treatment for pancreatic cancer, no metallic foreign body in the body, feasible magnetic resonance imaging, and no sensitivity to contrast agents, were enrolled in the study. All patients underwent enhanced CT and MRI localization scan. The target volume was delineated layer by layer according to different images (GTVCT, GTVDWI), the maximum cross-sectional length of the tumor was measured (expressed as: D CT, dDWI), hepatic metastases (expressed as: NCT liver, NMRI liver) and lymph node metastasis of 5-8 mm, 8 mm. Tumor metastasis (expressed as NCT 5-8 lymph node, NMRI 5-8 lymph node, NCT 8 lymph node, NMRI 8 lymph node). Statistical analysis of the corresponding data was carried out by paired t test or rank sum test. [Results] 1. Patient characteristics: 38 patients in the study group, 20/18 men, women respectively. The average age of the patients in the study group was 59.1 years. The mean interval between contrast-enhanced CT and MR-DWI was 4.3 days.2. Compared with primary pancreatic tumors, the size of the tumor target area based on contrast-enhanced CT and MR-DWI was 54.95 cm 3 (12.41 cm 3-266.29 cm 3), 41.67 cm 3 (5.66 cm 3-235.41 cm 3), respectively. The maximum tumor interface length measured by enhanced CT and MR-DWI was 4.18 cm (1.76 cm-7.3 cm), 3.94 cm (1.48 cm-7.33 cm), and the mean difference was 0.24 cm (0.18 cm-0.30 cm). Compared with contrast-enhanced CT, MR-DWI showed that the tumor target volume and the maximum tumor interface length were smaller. 3. Compared with contrast-enhanced CT, 19 patients with hepatic metastasis had hepatic metastasis, accounting for 50%. According to contrast-enhanced CT and MR-DWI, 83 vs 112 hepatic metastases were detected, only 74% of them were detected by CT, and the detection of MR-DWI could cover all of them. Strong CT was detected. The paired Wilcoxon rank sum test showed that p0.001 was significantly different between the two, indicating that DWI had a higher detection rate of liver metastasis of pancreatic cancer. 4. Regional lymph node metastasis was compared. According to enhanced CT and MR-DWI images, 46 vs56 lymph node metastases were detected in 8 mm region, and only 82% of enhanced CT was detected by MR-DWI. According to contrast-enhanced CT and MR-DWI images, 103 vs 200 lymph nodes were detected in 5-8 mm region, only 52% of them were detected by contrast-enhanced CT, and the detection of MR-DWI could cover all the enhanced CT. The p value of matched Wilcoxon test was less than 0.001.N_ (CT5-8 lymph), N_ (DWI 5-8 lymph) and N_ (CT8 lymph), N_ (DWI 8 lymph) were statistically significant. The difference shows that MR-DWI is more sensitive to regional lymph node detection, but the specificity of clinical diagnosis remains to be further studied. [Conclusion] The volume of tumor target and the maximum diameter of tumor interface measured by MR-DWI are smaller than that by contrast-enhanced CT, and the detection of liver metastasis and regional lymph node is more sensitive than that by contrast-enhanced CT. WI can make the target boundary clearer, and the sensitivity of detection of liver and regional lymph node metastasis is significantly higher than that of CT. It is helpful to determine the clinical treatment plan and revise the radiotherapy plan. Of course, further study on the specificity of MR-DWI detection rate is needed.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R735.9
本文编号：2219438
[Abstract]:[Objective] To investigate the difference between enhanced computed tomography (CT) and magnetic Resonance Diffusion Weighted Imaging (MR-DWI) in pancreatic cancer, liver and regional lymph node metastases, so as to make the target area delineation more accurate and guide the clinical practice. [Methods] 38 patients with KPS (Karnofsky Performance Status) score of 60 points, no treatment for pancreatic cancer, no metallic foreign body in the body, feasible magnetic resonance imaging, and no sensitivity to contrast agents, were enrolled in the study. All patients underwent enhanced CT and MRI localization scan. The target volume was delineated layer by layer according to different images (GTVCT, GTVDWI), the maximum cross-sectional length of the tumor was measured (expressed as: D CT, dDWI), hepatic metastases (expressed as: NCT liver, NMRI liver) and lymph node metastasis of 5-8 mm, 8 mm. Tumor metastasis (expressed as NCT 5-8 lymph node, NMRI 5-8 lymph node, NCT 8 lymph node, NMRI 8 lymph node). Statistical analysis of the corresponding data was carried out by paired t test or rank sum test. [Results] 1. Patient characteristics: 38 patients in the study group, 20/18 men, women respectively. The average age of the patients in the study group was 59.1 years. The mean interval between contrast-enhanced CT and MR-DWI was 4.3 days.2. Compared with primary pancreatic tumors, the size of the tumor target area based on contrast-enhanced CT and MR-DWI was 54.95 cm 3 (12.41 cm 3-266.29 cm 3), 41.67 cm 3 (5.66 cm 3-235.41 cm 3), respectively. The maximum tumor interface length measured by enhanced CT and MR-DWI was 4.18 cm (1.76 cm-7.3 cm), 3.94 cm (1.48 cm-7.33 cm), and the mean difference was 0.24 cm (0.18 cm-0.30 cm). Compared with contrast-enhanced CT, MR-DWI showed that the tumor target volume and the maximum tumor interface length were smaller. 3. Compared with contrast-enhanced CT, 19 patients with hepatic metastasis had hepatic metastasis, accounting for 50%. According to contrast-enhanced CT and MR-DWI, 83 vs 112 hepatic metastases were detected, only 74% of them were detected by CT, and the detection of MR-DWI could cover all of them. Strong CT was detected. The paired Wilcoxon rank sum test showed that p0.001 was significantly different between the two, indicating that DWI had a higher detection rate of liver metastasis of pancreatic cancer. 4. Regional lymph node metastasis was compared. According to enhanced CT and MR-DWI images, 46 vs56 lymph node metastases were detected in 8 mm region, and only 82% of enhanced CT was detected by MR-DWI. According to contrast-enhanced CT and MR-DWI images, 103 vs 200 lymph nodes were detected in 5-8 mm region, only 52% of them were detected by contrast-enhanced CT, and the detection of MR-DWI could cover all the enhanced CT. The p value of matched Wilcoxon test was less than 0.001.N_ (CT5-8 lymph), N_ (DWI 5-8 lymph) and N_ (CT8 lymph), N_ (DWI 8 lymph) were statistically significant. The difference shows that MR-DWI is more sensitive to regional lymph node detection, but the specificity of clinical diagnosis remains to be further studied. [Conclusion] The volume of tumor target and the maximum diameter of tumor interface measured by MR-DWI are smaller than that by contrast-enhanced CT, and the detection of liver metastasis and regional lymph node is more sensitive than that by contrast-enhanced CT. WI can make the target boundary clearer, and the sensitivity of detection of liver and regional lymph node metastasis is significantly higher than that of CT. It is helpful to determine the clinical treatment plan and revise the radiotherapy plan. Of course, further study on the specificity of MR-DWI detection rate is needed.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R735.9
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