MRI对前列腺癌骨及精囊转移的诊断价值

发布时间：2018-04-25 23:34

本文选题：前列腺癌 + 扩散加权成像　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的：骨是否发生转移对前列腺癌的临床分期非常重要，目前用于骨转移诊断的成像方式有MRI，骨扫描，CT、PET/CT等，分析MRI诊断前列腺癌骨转移的价值，并对MRI与核素骨扫描诊断前列腺癌骨转移进行比较，进而选择最优的成像手段，明确前列腺癌的分期，利于治疗方式的合理选择，提高病人的预后。材料与方法：收集我院2011年1月-2013年6月经病理证实为前列腺癌病人252例，全部患者均行常规MRI、DWI、增强MRI和全身骨扫描。分析盆腔影像，分别获得MRI、骨扫描对前列腺骨转移诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果：80%的前列腺癌骨转移病人的PSA50ng/ml，而92%的前列腺癌无骨转移病人的PSA50ng/ml。磁共振诊断前列腺癌骨转移的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值(NPV)分别为96.2%,100%,99.2%,100%,99%；全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为85.1%,84.3%,84.5%,60%,95.4%。结论： 1、 MRI诊断前列腺癌骨转移的特异度及阳性预测值高，对盆腔骨转移灶的显示优于骨扫描。 2、骨扫描显示范围广，有利于评估全身骨转移的情况。 3、 MRI与骨扫描可以实现优势互补，利于前列腺癌的准确临床分期。 4、 MRI冠状位与矢状位图像的补充可以有效提高病灶的检出率。目的：通过常规MRI与功能磁共振成像，探讨MRI对前列腺癌精囊腺侵犯与否的诊断价值，主要通过分析精囊腺的ADC值的差异对精囊侵犯与否的鉴别价值及常规磁共振，增强磁共振及扩散加权磁共振成像对精囊侵犯的诊断价值。材料与方法：收集我院2011年1月-2013年6月经病理证实为前列腺癌病人252例504个精囊腺，全部患者均行常规、DWI和增强MR成像。分别获取前列腺癌灶及双侧精囊腺的ADC值，并进行独立样本t检验；并计算常规MRI、常规+增强MRI,常规+DWI-MRI及综合应用常规+增强+DWI诊断前列腺癌精囊腺侵犯的特异度、敏感度及准确度。结果：受侵犯精囊腺（SVI）、受侵犯精囊腺所在前列腺癌灶、强化且未受侵犯侧精囊腺及强化且未受侵犯侧精囊腺所在前列腺癌灶的ADC值分别为(0.98±0.02)x10-3mm2/s,(0.81±0.14)x10-3mm2/s,(1.59±0.04)x10-3mm2/s,(1.01±0.12)x10-3mm2/s。受侵犯精囊腺的ADC值明显低于非受侵强化精囊腺的ADC值（P0.05），，受侵犯精囊所在前列腺癌灶ADC值低于有强化但未受侵犯精囊所在前列腺癌灶的ADC值（P0.05），受侵犯精囊所在前列腺癌灶的ADC值低于受侵犯精囊腺的ADC值（P0.05）。常规MRI、磁共振增强、扩散加权成像以及两者的联合对前列腺癌精囊腺转移的特异度分别为93.1%、97.8%、99.7%、99.7%；诊断敏感度分别为100%、100%、94.5%、100%；准确度分别为93.6%、98%、99.4%,99.8%。阳性预测值分别为54%，78.7%，97.2%，97.3%，阴性预测值分别为100%，100%，99.5%，100%。结论： 1、精囊腺的ADC值的差异有助于判断前列腺癌是否有精囊腺侵犯。 2、磁共振各序列联合应用更有利于对前列腺癌精囊转移的准确诊断。
[Abstract]:Objective: the metastasis of bone is very important for the clinical staging of prostate cancer. At present, the imaging modalities of bone metastasis are MRI, bone scan, CT, PET/CT and so on. The value of MRI in the diagnosis of bone metastasis of prostate cancer is analyzed, and the comparison of MRI and nuclide bone scan in the diagnosis of prostate cancer is made and the best imaging method is selected. The staging of prostate cancer is conducive to the rational choice of treatment and the prognosis of patients.
Materials and methods: 252 cases of prostate cancer confirmed by pathology in our hospital in January 2011 -2013 6 period were confirmed as 252 cases of prostate cancer. All patients underwent routine MRI, DWI, enhanced MRI and whole body bone scan. The pelvic images were analyzed to obtain MRI and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scan on the diagnosis of prostate bone metastasis.
Results: the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the PSA50ng/ml. magnetic resonance imaging (PPV) and negative predictive value (NPV) were 96.2%, 100%, 99.2%, 100%, 99% of the patients with prostate cancer without bone metastases in the diagnosis of bone metastases of the prostate cancer. The bone metastases of the prostate cancer were diagnosed by PSA50ng/ml. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 85.1%, 84.3%, 84.5%, 60%, 95.4%. respectively.
Conclusion:
1, the specificity and positive predictive value of MRI in diagnosing bone metastases of prostate cancer is high.
Bone scan.
2, bone scan shows a wide range and helps to assess bone metastases in the whole body.
3, MRI and bone scan can complement each other and facilitate the accurate clinical staging of prostate cancer.
4, MRI coronal and sagittal images can effectively improve the detection rate of lesions.
Objective: To explore the diagnostic value of MRI on the adenocarcinoma of the seminal vesicle by conventional MRI and functional magnetic resonance imaging (fMRI), and to evaluate the value of the differential value of the ADC value of the seminal vesicle on the differentiation of the seminal vesicle and the conventional magnetic resonance (MRI), and to enhance the diagnostic value of magnetic resonance and diffusion-weighted magnetic resonance imaging on the encroachment of the seminal vesicle.
Materials and methods: 252 cases of 504 seminal vesicles were collected from 252 cases of prostate cancer confirmed by pathology in 6 period of -2013 January 2011. All patients underwent routine, DWI and enhanced MR imaging. The ADC values of prostate cancer and bilateral seminal vesicles were obtained respectively. The independent sample t test was performed, and routine MRI, routine + enhanced MRI, conventional +DWI-MRI and heald were calculated. The specificity, sensitivity and accuracy of routine and enhanced +DWI in the diagnosis of prostate cancer seminal vesicle invasion were compared.
Results: the invasive seminal vesicle gland (SVI), the prostate cancer in the encroachment of the seminal vesicle, the ADC value of the enhanced and unencroached seminal vesicle and the enhanced and unencroached side seminal vesicle of the prostate cancer were (0.98 + 0.02) x10-3mm2/s, (0.81 + 0.14) x10-3mm2/s, (1.59 + 0.04) x10-3mm2/s, and (1.01 + 0.12) x10-3mm2/s. (1.01 +) x10-3mm2/s. by the ADC of the encroachment of the seminal vesicle The value of the ADC value (P0.05) was lower than that of the non invaded seminal vesicle. The ADC value of the prostate cancer area in the encroachment seminal vesicle was lower than that of the enhanced but unencroached seminal vesicle ADC (P0.05). The ADC value of the prostate cancer lesion located in the encroachment seminal vesicle was lower than the ADC value of the encroached seminal vesicle (P0.05). The specificity of the combination of the images and the two was 93.1%, 97.8%, 99.7%, 99.7%, respectively, and the diagnostic sensitivity was 100%, 100%, 94.5%, 100% respectively, and the accuracy was 93.6%, 98%, 99.4%, respectively, and the predictive values of 99.8%. were respectively 54%, 78.7%, 97.2%, and negative predictive values respectively, 100%.
Conclusion:
1, the difference in ADC value of seminal vesicle helps to determine whether there is a seminal vesicle invasion in prostate cancer.
2, combined application of MRI sequences is more conducive to accurate diagnosis of prostate cancer seminal vesicle metastasis.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25;R445.2

【参考文献】