前列腺癌3.0T MR动态增强扫描特征及DWI、MRS的相关性研究

发布时间：2018-06-22 23:26

本文选题：前列腺癌 + LAVA动态增强　；参考：《苏州大学》2014年硕士论文

【摘要】：第一部分前列腺癌3.0T MR动态增强扫描特征目的：分析前列腺癌3.0T MR动态增强扫描特征，探讨动态增强检查对前列腺癌的诊断价值及其与Gleason评分的相关性。材料和方法：前瞻性纳入我院2012年8月至2013年8月的85例临床拟诊前列腺癌（Prostate cancer，PCa）患者，年龄47-83岁，平均70岁。所有病例均采用GESigna HDx3.0T磁共振扫描仪及心脏相控线圈。行常规扫描（横断面T1WI、T2WI、T2WI FS、冠状面T2WI、矢状面T2WI）和LAVA多期动态增强扫描。分析信号强度-时间（SI-T）曲线类型，并进一步计算到达峰值时间（Tmax）、最大强化程度（SImax%）和最快强化率（Rmax）。对前列腺进行标准化分区，，比较穿刺证实阳性组（癌区）与阴性组（非癌区）各参数之间的差异，并评价其与Gleason分级的相关性。结果：活检发现前列腺癌59例，26例未检出肿瘤证据，共有507个分区得到组织学证实，阳性组250个（Gleason评分2-6分者36个，Gleason评分7-10分者214个），阴性组257个。阳性组SI-T曲线以廓清型为主，阴性组SI-T曲线以上升型和平台型为主。阳性组的Tmax、SImax%、Rmax分别为（69.49±22.53）s、1.74±0.43、7.83±3.80，阴性组的Tmax、SImax%、Rmax分别为（175.61±52.64）s、1.05±0.35、1.86±1.10，差异均具有统计学意义（t=-24.24、16.34、17.75，P均＜0.01）。前列腺癌中高分化腺癌组（Gleason评分2-6分）的Tmax、SImax%、Rmax分别为（89.19±31.72）s、1.58±0.46、5.21±3.34，中低分化腺癌组（Gleason评分7-10分）的Tmax、SImax%、Rmax分别为（64.25±14.68）s、1.76±0.43、8.25±3.70，二者间差异均具有统计学意义（t=7.09、-8.74、-7.83，P均＜0.01）。前列腺癌的Tmax与Gleason评分呈负相关关系（r=-0.471，P＜0.01），SImax%、Rmax均与Gleason评分呈正相关关系（r=0.472、0.537，P均＜0.01）。结论：LAVA多期动态增强扫描在前列腺癌的诊断中具有重要价值，多表现为早期明显强化，动态增强扫描参数与Gleason分级具有相关性，能够无创性评估PCa的生物学特性，有助于临床治疗方案的选择及评估预后。第二部分前列腺癌3.0T MRS与DWI扫描的相关性研究目的：分析前列腺癌的（Cho+Cre）/Cit比值与ADC值，研究二者的相关性，并与病理结果对照，探讨其对前列腺癌的诊断价值。材料和方法：前瞻性纳入我院2012年8月至2013年8月的29例临床拟诊前列腺癌患者，年龄52-79岁，平均68岁。所有病例均采用GE Signa HDx3.0T磁共振扫描仪及心脏相控线圈。分别行常规扫描（横断面T1WI、T2WI、T2WI FS、冠状面T2WI、矢状面T2WI）和MRS、DWI扫描。MRS扫描采用PRESS序列，扫描完成后用本机自带软件进行数据后处理；DWI采用EPI序列，自动生成ADC图。对前列腺进行标准化分区，得到阳性组（癌区）与阴性组（非癌区）的（Cho+Cre）/Cit比值与ADC值，应用ROC曲线下面积评价其准确性，并对二者进行相关性分析。结果：活检发现前列腺癌16例，13例未检出肿瘤证据，共有174个分区得到组织学证实，阳性组73个，阴性组101个。穿刺阳性组与阴性组的平均（Cho+Cre）/Cit比值分别为2.59±1.89、0.71±0.15，二者差异具有显著的统计学意义（t=3.56，P＜0.01），将（Cho+Cre）/Cit值作为预测穿刺阳性的指标，利用SPSS19.0绘制ROC曲线，曲线下面积为0.93（P=0.000），最佳临界值为（Cho+Cre）/Cit=1.04，此时预测穿刺阳性的敏感度为87.5%，特异度为92.3%。穿刺阳性组与阴性组的平均ADC值分别为（0.86±0.20）×10-3mm2/s、（1.13±0.12）×10-3mm2/s，二者差异有统计学意义（t=-6.02，P＜0.01），将ADC值作为预测疑诊前列腺癌患者穿刺阳性率的指标，并绘制ROC曲线，曲线下面积为0.89（P=0.000），最佳临界值为1.06×10-3mm2/s，此时预测穿刺阳性的敏感度为87.5%，特异度为77.3%。前列腺癌的（Cho+Cre）/Cit比值与ADC值呈负相关关系（r=-0.71，P＜0.01）。结论：3.0T磁共振MRS及DWI扫描有助于前列腺癌的诊断及鉴别诊断，本研究中（Cho+Cre）/Cit比值高于1.04、ADC值低于1.06×10-3mm2/s是诊断前列腺癌较适宜的界值，且（Cho+Cre）/Cit比值和ADC值二者间具有相关性。
[Abstract]:Part one features of 3.0T MR dynamic enhanced scan for prostate cancer
Objective: to analyze the characteristics of 3.0T MR dynamic contrast-enhanced scan in prostate cancer, and to explore the diagnostic value of dynamic enhanced examination for prostate cancer and its correlation with Gleason score.
Materials and methods: We prospectively included 85 patients with Prostate cancer (PCa) from August 2012 to August 2013, aged 47-83 years old, with an average of 70 years of age. All cases were treated with GESigna HDx3.0T MRI scanner and cardiac controlled coil. Routine scan (cross section T1WI, T2WI, T2WI FS, coronary T2WI, sagittal T2WI) And LAVA multi-phase dynamic enhanced scan. Analysis of signal intensity time (SI-T) curve type, and further calculate the peak time (Tmax), maximum intensification degree (SImax%) and the fastest intensification rate (Rmax). The standard partition of the prostate is carried out to compare the differences between the parameters of the positive group (cancer area) and the negative group (non cancer area), and evaluate the difference between the parameters of the positive group and the negative group (non cancer area). Correlation with Gleason classification.
Results: 59 cases of prostate cancer were detected by biopsy, and 26 cases had no evidence of tumor. A total of 507 zoning were confirmed by histology. The positive group was 250 (36 Gleason score 2-6, 214 of 7-10 scores) and 257 in the negative group. The SI-T curve in the positive group was mainly the clearance type, and the SI-T curve above the SI-T curve in the negative group was the dominant group. Tm of the positive group was Tm. Ax, SImax%, and Rmax were (69.49 + 22.53) s, 1.74 + 0.43,7.83 + 3.80, Tmax in the negative group, SImax%, and Rmax were (175.61 + 52.64) s and 1.05 + 0.35,1.86 + 1.10 respectively. The difference was statistically significant (t=-24.24,16.34,17.75, P < 0.01). 1.58 + 0.46,5.21 + 3.34, Tmax, SImax%, and Rmax of middle and low differentiated adenocarcinoma group (Gleason score 7-10) were (64.25 + 14.68) s and 1.76 + 0.43,8.25 + 3.70 respectively. The differences among two were statistically significant (t=7.09, -8.74, -7.83, P < 0.01). On score was positively correlated (r=0.472,0.537, P < 0.01).
Conclusion: LAVA multiphase dynamic enhanced scan is of important value in the diagnosis of prostate cancer. It is characterized by early obvious enhancement. The dynamic enhanced scan parameters are correlated with the Gleason classification. It can not be used to evaluate the biological characteristics of PCa, and help to select and evaluate the prognosis of the clinical treatment.
The second part of prostate cancer 3.0T MRS and DWI scan correlation study
Objective: to analyze the (Cho+Cre) /Cit ratio and ADC value of prostate cancer, and to study the correlation between these two factors and to compare with pathological findings and to explore their diagnostic value for prostate cancer.
Materials and methods: 29 cases of clinically diagnosed prostate cancer were prospectively included in our hospital from August 2012 to August 2013, aged 52-79 years old, with an average of 68 years of age. All cases were treated with GE Signa HDx3.0T magnetic resonance scanner and cardiac controlled coil. Routine scanning (cross section T1WI, T2WI, T2WI FS, coronary T2WI, sagittal T2WI) and MRS, DWI sweep were performed respectively. The.MRS scan uses the PRESS sequence, and after the scanning is completed, the data is processed with the software of the machine, and the ADC map is automatically generated by the EPI sequence. The standard partition of the prostate is carried out. The ratio of the positive group (cancer area) to the negative group (Cho+Cre) /Cit ratio and ADC value is obtained. The accuracy is evaluated with the area under the ROC curve, and the two are entered into the two. Correlation analysis.
Results: 16 cases of prostate cancer were detected by biopsy, and 13 cases had no evidence of tumor. A total of 174 zoning were confirmed by histology, 73 positive groups and 101 negative groups. The average (Cho+Cre) /Cit ratio of the positive group and negative group was 2.59 1.89,0.71 + 0.15 respectively. The difference of the two was statistically significant (t=3.56, P < 0.01), and (Cho+Cre) /Cit As the target of predicting the positive puncture, the ROC curve was plotted by SPSS19.0, the area under the curve was 0.93 (P=0.000), the best critical value was (Cho+Cre) /Cit=1.04, and the sensitivity of the positive puncture was 87.5%. The average ADC value of the 92.3%. puncture positive group and the negative group was (0.86 + 0.20) x 10-3mm2/s and (1.13 + 0.12) x 10-3mm2/s, respectively. The difference between the two was statistically significant (t=-6.02, P < 0.01). The ADC value was used as an index to predict the positive rate of prostate cancer, and the ROC curve was drawn, the area under the curve was 0.89 (P=0.000), the best critical value was 1.06 x 10-3mm2/s, at this time the sensitivity of the positive puncture was 87.5%, and the specificity was the /Cit ratio of the 77.3%. prostate cancer (Cho+Cre). There is a negative correlation between the value and the ADC value (r=-0.71, P < 0.01).
Conclusion: 3.0T MRI MRS and DWI scan are helpful for the diagnosis and differential diagnosis of prostate cancer. In this study (Cho+Cre), the ratio of /Cit is higher than 1.04, and the value of ADC is less than 1.06 * 10-3mm2/s is a better boundary value for the diagnosis of prostate cancer, and the (Cho+Cre) /Cit ratio and ADC value two have a correlation between them.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25;R445.2

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