磁共振扩散张量成像在前列腺癌中的临床应用研究

发布时间：2018-05-24 10:06

本文选题：前列腺 + 磁共振成像　；参考：《滨州医学院》2014年硕士论文

【摘要】：目的本研究采用单次激发自旋平面回波成像(SE-EPI)技术对前列腺行磁共振扩散张量成像(DTI)扫描,探讨外周带前列腺癌DTI参数表观扩散系数(ADC)值和各向异性(FA)值的变化与病理Gleason评分水平的相关性。方法本研究为回顾性研究,已获得本单位伦理委员会批准可免除患者知情同意权。回顾性分析行常规MRI和DTI检查并经穿刺活检或手术病理结果证实的65例外周带前列腺癌患者进行统计分析,患者年龄范围为53～81周岁,平均年龄为65.6周岁。在西门子后处理软件上将前列腺癌患者的DTI图与常规T2WI解剖图融合,由两位有经验的MR诊断医师参照病理结果,在融合图像上画取与之对应的前列腺癌癌灶区,并测量其ADC值和FA值,经三次测量后取其平均值作为最终的ADC值和FA值,与病理结果Gleason评分相比较,分析两者的相关性。根据Gleason评分将前列腺癌分为低、中、高级别癌三组：Gleason评分7者为低级别癌；=7者为中级别癌；7者为高级别前列腺癌。对三组进行统计学分析,分别测量每组的平均ADC值和FA值,并在三组间进行方差分析。结果外周带前列腺癌癌灶区ADC值和FA值均随评分的升高呈降低趋势,两者均Gleason与评分呈负相关关系(r=-0.731,p0.05；r=-0.606,p0.05)。结论前列腺癌低、中、Gleason高级别三组中ADC值分别为：(9值和FA值进行方差分析发现均具有差异,且该差异具有统计学意义(p0.05)。61±103)×10-6mm2/s、(770±152)×10-6mm2/s.(652±111) ×10-6mm2/s；FA值为(395±60)×10-3、(313±93)×10-3.(235±64)×10-3。三组间ADC结论前列腺癌区ADC值和FA值与评分具有相关性,均呈负相关关系,ADC值和GleasonFA值定量诊断前列腺癌具有可能性,对前列腺癌的分级和预后的判断具有重要价值。目的探讨扩散张量成像(diffusion tensor imaging, DTI)相关参数表观扩散系数(apparent diffusion coefficient, ADC)值和各向异性(fractional anisotropy, FA)值及扩散张量纤维束成像(Diffusion tensor tractography, DTT)对中央腺体(central gland, CG)区前列腺癌(prostate cancer, PCa)和良性前列腺增生(benign prostate hyperplasia, BPH)的鉴别诊断价值。方法分析行MRI和DTI检查并经病理证实的CG-PCa 16例和PH30例,测量两组病变区的ADC值和FA值,比较其间是否存在差异。运用种子点法对病灶最大层面对前列腺进行纤维追踪,得出DTT图,由两名资深放射科医生采用四级评分制对其进行评分,比较两组病变区纤维的走行、密度及连续性的差异。结果BPH组ADC值为(1273±163)×10-6 mm2/s, FA值为(356±116)×10-3；CG-PCa组ADC值和FA值分别为(1037±±196)×10-6mm2/s、(407±132)×10-3。两组间ADC值差异有统计学意义（p0.05)；FA值间差异无统计学意义(p0.05)。两名医师对两组DTT图评分一致性较好(k=0.723),CG-PCa组评分分别为2.9±0.9,2.8±1.0；BPH组为1.8±0.7；1.7±0.8。两组差异具有统计学意义(p均0.05)。结论DTI相关参数ADC值在鉴别CG-PCa口BPH中具有重要价值,但FA值的意义不大。DTT图对前列腺的描述更加直观,对两者的鉴别具有一定的价值。
[Abstract]:Objective to investigate the correlation between the apparent diffusion coefficient (ADC) values and the changes of the anisotropy (FA) values of the DTI parameters of the peripheral prostate cancer and the correlation between the changes of the anisotropy (FA) value and the level of the pathological Gleason score by using single excitation spin plane echo imaging (SE-EPI) technique, and to investigate the correlation between the changes of the values of the apparent diffusion coefficient (ADC) and the value of the anisotropy (FA) of the prostate cancer of the peripheral zone. Methods the study was a retrospective study. A retrospective analysis of 65 patients with prostate cancer confirmed by routine MRI and DTI examination and confirmed by biopsy or surgical pathology were analyzed retrospectively. The age range of the patients was 53~81 years old and the average age was 65.6 years old. The post-processing software of SIEMENS will be analyzed. The DTI map of the prostate cancer patients was combined with the conventional T2WI anatomic map. Two experienced MR diagnostics refer to the pathological results, draw the corresponding prostate cancer area on the fusion image, and measure their ADC and FA values. After three measurements, the average value is taken as the final ADC value and the FA value, compared with the Gleason score of the pathological results, The correlation between the two was analyzed. According to the Gleason score, the prostate cancer was divided into three groups: low, middle, and high grade carcinoma: 7 were low grade cancer; =7 was intermediate grade carcinoma; the 7 was high grade prostate cancer. The three groups were analyzed statistically to measure the average ADC value and FA value of each group and to analyze the variance between the three groups. The results were analyzed. The results were analyzed. The results were analyzed in the three groups. The result was the analysis of variance. The result was out of analysis. The result was the result of variance analysis. The result was the result of analysis of variance. The ADC value and FA value of the carcinoma area of the prostate cancer were decreased with the increase of the score. Both Gleason and score were negatively correlated (r=-0.731, P0.05; r=-0.606, P0.05). Conclusion the ADC values in the three groups of high grade prostate cancer were respectively: (9 value and FA value were analyzed by variance analysis, and the difference was unified. Study significance (P0.05).61 + 103) x 10-6mm2/s, (770 + 152) x 10-6mm2/s. (652 + 111) x 10-6mm2/s, FA value of (395 + 60) x 10-3, (313 + 93) x 10-3. (235 + 64) * 10-3. three group ADC conclusion, ADC value and FA value of prostate cancer area are correlated with scores, both have negative correlation, ADC value and quantitative diagnosis of prostate cancer are possible. It is of great value for judging the classification and prognosis of prostate cancer. Objective to explore the apparent diffusion coefficient (apparent diffusion coefficient, ADC) and anisotropy (fractional anisotropy, FA) and diffusion tensor fiber beam imaging (fractional anisotropy, DTI) for diffusion tensor imaging (DTI). DTT) the value of the differential diagnosis of prostate cancer (prostate cancer, PCa) and benign prostatic hyperplasia (benign prostate hyperplasia, BPH) in the central gland (central gland, CG). Methods 16 cases of MRI and pathology confirmed by pathology were analyzed and the values and values of the two groups were measured, and the difference between them was compared. The seed point method was used to track the prostate for fiber tracking on the largest layer of the lesion. The DTT map was obtained by two senior radiologists using a four grade score system. The difference between the fiber walking, density and continuity of the two groups was compared. Results the ADC value of group BPH was (1273 + 163) x 10-6 mm2/s, FA value was (356 + 116) x 10-3; CG-PCa Group ADC value and FA value were (1037 + 196) x 10-6mm2/s and (407 + 132) x 10-3. two groups with statistically significant difference (P0.05), and there was no statistical difference between FA values (P0.05). Two physicians had good agreement on the two groups of DTT graph (k=0.723), CG-PCa group score was 2.9 + 0.9,2.8 1, 1.8 + 0.7, 1.7 + two groups. The difference has statistical significance (P 0.05). Conclusion the ADC value of DTI related parameters is of great value in the identification of CG-PCa mouth BPH, but the value of FA value is not much more intuitive to the description of the prostate, which is of certain value for the identification of the two.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R737.25

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