磁共振功能成像诊断膀胱癌肌层浸润价值的研究

发布时间：2018-07-21 12:33

【摘要】：背景和目的膀胱癌是泌尿系统最常见的恶性肿瘤。临床上根据T分期不同将膀胱癌分为非肌层浸润性膀胱癌（Tis、Ta、T1期）和肌层浸润性膀胱癌（T2-T4期）。非肌层浸润性膀胱癌的治疗采用经尿道膀胱肿瘤电切术（transurethral resection ofbladder tumor，TURBT），肌层浸润性膀胱癌的治疗为根治性膀胱切除术。因此，术前正确判断膀胱癌是否浸润肌层对于临床治疗具有重要意义。MRI是判断膀胱壁肌层是否浸润最准确的方法，扩散加权成像（diffusion weighted imaging，DWI）及动态增强磁共振（dynamic contrast-enhanced magnetic resonance imaging，DCE-MRI）作为磁共振功能成像能够实现形态与功能相结合，补充了常规MRI的不足。DWI与DCE-MRI可能有助于判断膀胱壁肌层是否浸润。本研究的目的是分析常规MRI及DWI、DCE-MRI在判断膀胱癌肌层浸润中的应用，通过与常规MRI对比，探讨DWI、DCE-MRI序列判断膀胱癌肌层浸润的价值。资料和方法收集郑州大学附属肿瘤医院2012.10～2014.2期间65例膀胱癌病例进行分析。所有病例进行了常规MRI序列和DWI序列及DCE-MRI序列检查。由两位医生盲法阅片，分别根据常规MRI序列和常规MRI+DWI序列以及常规MRI+DWI+DCE-MRI序列对膀胱癌肌层浸润进行判断。应用受试者工作特征（receiver operating characteristic，ROC）曲线分析单独使用常规MRI序列、常规MRI+DWI序列以及常规MRI+DWI+DCE-MRI序列时诊断膀胱癌肌层浸润的能力。测量病灶邻近膀胱壁肌层表观扩散系数（apparent diffusion coefficient，ADC）值，利用ROC曲线分析膀胱癌浸润肌层的ADC值，得出阈值并计算利用阈值膀胱癌肌层浸润的准确度、敏感度以及特异度。结果 65例膀胱癌患者，其中40例为肌层浸润性膀胱癌，25例为非肌层浸润性膀胱癌。甲医师使用常规MRI序列判断膀胱癌肌层浸润时的曲线下面积（areaunder curve，AUC）为0.859，准确度为75.0%，敏感度为77.5%，特异度为72.0%，常规MRI+DWI序列时AUC为0.907，准确度为83.1%，，敏感度为85.0%，特异度为80.0%，常规MRI+DWI+DCE-MRI时AUC为0.944，准确度为92.3%，敏感度为95.0%，特异度为88.0%，三者AUC之差具有统计学意义（p=0.031＜0.05）；乙医师使用常规MRI序列时的AUC为0.861，准确度为73.8%，敏感度为75.0%，特异度为72.0%，，常规MRI+DWI序列时AUC为0.917，准确度为83.1%，敏感度为82.5%，特异度为84.0%，常规MRI+DWI+DCE-MRI时AUC为0.936，准确度为90.8%，敏感度为90.0%，特异度为92.0%，三者AUC之差具有统计学意义（p=0.026＜0.05）。膀胱癌患者中浸润的肌层ADC值为1.52±0.15×10-3mm2/s，未浸润肌层为2.21±0.39×10-3mm2/s。以1.61×10-3mm2/s为阈值时，诊断膀胱癌肌层浸润的敏感度、特异度分别为91.2%和90.4%。结论与常规MRI相比，常规MRI+DWI+DCE-MRI序列能够提高诊断膀胱癌肌层浸润的准确度。定量测量膀胱壁肌层的ADC值对判断肌层浸润有一定的参考价值，以膀胱癌病灶临近肌层ADC值1.61×10-3mm2/s为阈值时诊断膀胱癌肌层浸润的敏感度及特异度较高。
[Abstract]:Background and objective bladder cancer is the most common malignant tumor in the urinary system. According to T stage, bladder cancer was divided into non-myometrial invasive bladder carcinoma (Tis-Tahl T1 stage) and myometrial invasive bladder carcinoma (T2-T4 stage). The treatment of non-myometrial invasive bladder cancer was performed by transurethral resection of bladder tumor (transurethral resection ofbladder tumor TURBT), and radical cystectomy was performed for myometrial invasive bladder cancer. Therefore, it is important for clinical treatment to correctly judge whether bladder cancer infiltrates muscle layer before operation. MRI is the most accurate method to judge whether bladder wall muscle layer is infiltrating or not. Diffusion weighted (diffusion weighted imaging (DWI) and dynamic enhanced magnetic resonance imaging (dynamic contrast-enhanced magnetic resonance imaging DCE-MRI) can be used to combine the morphology and function of Mr functional imaging. DWI and DCE-MRI may be helpful in judging whether the bladder wall muscle layer is infiltrating or not. The purpose of this study was to analyze the application of conventional MRI and DWICE-MRI in the diagnosis of myometrium invasion in bladder cancer, and to explore the value of DWII-DCE-MRI sequence in judging the myometrial invasion of bladder cancer by comparing with conventional MRI. Materials and methods 65 cases of bladder cancer were collected and analyzed during the period of 2012.10 ~ 2014.2 in affiliated Cancer Hospital of Zhengzhou University. All cases were examined by conventional MRI sequence, DWI sequence and DCE-MRI sequence. The myometrium invasion of bladder cancer was judged by conventional MRI sequence, conventional DWI sequence and conventional DWI DCE-MRI sequence. The ability of using conventional (receiver operating sequences, conventional DWI sequences and conventional DWI DCE-MRI sequences to diagnose the invasion of the muscular layer of bladder cancer was analyzed by using the operating characteristics of the subjects. The apparent diffusion coefficient (apparent diffusion) of the muscle layer adjacent to the bladder wall was measured. The ADC value of the infiltrating layer of bladder cancer was analyzed by using the ROC curve. The threshold value was obtained and the accuracy, sensitivity and specificity of the infiltration of the muscle layer of the bladder cancer were calculated. Results 65 cases of bladder cancer, including 40 cases of myometrial invasive bladder cancer, 25 cases of non-myometrial invasive bladder cancer. The areaunder curved-AUC, accuracy, sensitivity, specificity and specificity were 0.859, 77.5, 72.0, 0.907, 83.1, 85.0 and 80.0 respectively. The AUC of DCE-MRI was 0.944, the accuracy was 92.3, the sensitivity was 95.0 and the specificity was 88.0. The difference of AUC among them was statistically significant (p0.031 < 0.05). The AUC, accuracy, sensitivity and specificity of routine MRI DWI were 0.917, 83.1, 82.5 and 84.0 respectively. The AUC of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 0.936, the sensitivity of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 82.5, the specificity was 84.0, the sensitivity of DCE-MRI was 0.936, the specificity of DWI was 72.0, the accuracy of DWI was 0.917, the accuracy of DWI was 83.1, the sensitivity of DCE-MRI was 0.936. The sensitivity was 90.0 and the specificity was 92.0. The difference of AUC among the three groups was statistically significant (p0.026 < 0.05). The ADC value of infiltrated muscle layer was 1.52 卤0.15 脳 10 ~ (-3) mm ~ (-2) / s and that of uninfiltrated muscle layer was 2.21 卤0.39 脳 10 ~ (-3) mm ~ 2 / s in bladder cancer patients. When the threshold value was 1. 61 脳 10-3mm2/s, the sensitivity and specificity of detecting myometrial invasion of bladder cancer were 91.2% and 90.4%, respectively. Conclusion compared with conventional MRI, conventional DWI DCE-MRI sequence can improve the accuracy of diagnosing myometrial invasion of bladder cancer. Quantitative measurement of ADC value of bladder wall muscle layer has certain reference value for judging myometrial infiltration. When the value of ADC near muscle layer of bladder cancer is 1. 61 脳 10-3mm2/s as threshold, the sensitivity and specificity of diagnosing myometrium infiltration of bladder cancer are higher.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14;R445.2

【参考文献】