扩散张量成像评估子宫内膜癌浅肌层浸润的研究

发布时间：2018-05-16 06:26

本文选题：扩散张量成像 + 子宫内膜癌　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：初探1.5T磁共振扩散张量成像（Diffusion tensor imaging，DTI）对子宫内膜癌浅肌层浸润的诊断效能评估。材料与方法：回顾性研究行MR扫描子宫内膜癌浅肌层浸润患者35例。分析分别采用DTI参数（ADC值、FA值）、T2WI、动态增强扫描评估子宫内膜癌浅肌层浸润的敏感性。每例患者以T2WI-DWI融合图定位，在DTI同一层面上选取感兴趣区（regionof interest，，ROI）：子宫腔内癌组织(ROI1)、癌区浅肌层(ROI2)、非癌区浅肌层(ROI3)、癌区相应的深肌层(ROI4)、非癌区相应的深肌层(ROI5)；获得ADC值、FA值及所选层面的纤维示踪图(FT)。分别比较ROI1和ROI2、ROI2和ROI3、ROI4和ROI5的ADC值、FA值，两两间比较采用Wilcoxon signed-rank test（经Bonferroni法校正）。并采用受试者工作特征曲线（receiver operatingcharacteristic curves，ROC）评估DTI参数（ADC值、FA值）的诊断效能，并对T2WI、动态增强评估子宫内膜癌浅肌层浸润的敏感性与DTI参数评估的敏感性进行比较。结果：子宫内膜癌癌区浅肌层（ROI2）ADC值显著低于非癌区浅肌层（ROI3）ADC值[中位数（median）：1.16*e-9vs.1.48*e-9, P 0.001]，相应的癌区浅肌层（ROI2）FA值显著高于非癌区浅肌层（ROI3）FA值[中位数（median）：0.41vs.0.27;P 0.001]。对浅肌层癌区、非癌区(ROI2vs. ROI3)ADC值、FA值分别行ROC曲线分析，得到ADC值、FA值评估浅肌层浸润的敏感性、特异性、阳性预测值、阴性预测值分别为74.3%,88.6%,86.7%,77.5%和88.6%,97.1%,96.9%,89.5%。相应FT图均显示癌区浸润的肌层对比健侧肌层可见纤维颜色不均，走行、分布紊乱。分别单独采用T2WI及增强扫描评估子宫内膜癌浅肌层浸润的敏感性为80%、77.4%，与DTI参数评估的敏感性进行比较，可见FA值评估子宫内膜癌浅肌层浸润的敏感性最高（88.6%）。结论：DTI参数中ADC值、FA值均能很好地评估子宫内膜癌侵及浅肌层，FA值较ADC值更加敏感、准确；且FA值评估子宫内膜癌浅肌层浸润的敏感性均优于ADC值、T2WI及动态增强扫描； FT图可以直观地显示子宫肌层纤维受侵、排列紊乱的情况。
[Abstract]:Objective: to evaluate the diagnostic efficacy of 1.5T diffusion Zhang Liang imaging tensor imaging in the diagnosis of superficial myometrium invasion of endometrial carcinoma. Materials and methods: 35 patients with superficial myometrial invasion of endometrial carcinoma were studied retrospectively. The sensitivity of DTI parameters and FA value to evaluate the superficial myometrium invasion of endometrial carcinoma was evaluated by dynamic contrast enhanced scanning. Each patient was located by T2WI-DWI fusion map. At the same level of DTI, the region of interest was selected as follows: intrauterine carcinoma tissue, superficial muscular layer, non-cancerous superficial muscle layer, and the corresponding deep muscle layer, and the corresponding depth muscle layer, and the ADC value and the fiber tracer of the selected layer were obtained. The ADC value and FA value of ROI1 and ROI2, ROI2, ROI3, ROI4 and ROI5 were compared respectively, and Wilcoxon signed-rank testwas used in the comparison. The diagnostic efficacy of DTI parameters was evaluated by receiver operatingcharacteristic curvessroc. The sensitivity of T2WI, dynamic enhanced evaluation of superficial myometrium invasion of endometrial carcinoma was compared with that of DTI parameters. Results: the ADC value of superficial muscle layer in endometrial carcinoma area was significantly lower than that of superficial muscle layer in non-cancerous area [median value was 1.16e-9vs.1.48e -9, P 0.001]. The corresponding value of ROI2FFA in superficial muscular layer of carcinoma area was significantly higher than that in non-cancerous superficial muscle layer (median medianine: 0.41vs.0.27P 0.001). To the superficial muscle layer cancer area, not the cancer area, the ROI 2 vs. The ROI3)ADC value and FA value were analyzed by ROC curve, and the sensitivity, specificity, positive predictive value and negative predictive value of ADC value and FA value to evaluate superficial muscle invasion were obtained. The negative predictive values were 77.5% and 86.7% respectively. The corresponding FT images showed that the muscle layer infiltrated in the cancer area showed that the color of the fibers in the contralateral myometrium was uneven, and the distribution of the fibers was disordered. The sensitivity of T2WI alone and enhanced scanning in assessing superficial myometrium invasion of endometrial carcinoma was 80 ~ 77.4, which was compared with that of DTI. The sensitivity of FA in assessing superficial myometrium invasion of endometrial carcinoma was 88.6T. Conclusion the FA value of ADC in the ratio of 1: DTI is more sensitive and accurate than that of ADC in evaluating the invasion of endometrial carcinoma into the superficial muscle layer of endometrial carcinoma. The sensitivity of FA in assessing superficial myometrium invasion of endometrial carcinoma was superior to that of ADC and dynamic enhanced scanning. FT images could visualize the invasion and disarrangement of myometrium fibers.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

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