颈部淋巴结病变的多模态成像研究

发布时间：2018-04-03 01:00

本文选题：颈部　切入点：淋巴结　出处：《兰州大学》2017年硕士论文

【摘要】：目的(1)比较DWI、PET-CT、CT及超声在颈部淋巴结病变鉴别中的诊断效能,为临床合理选择影像学检查提供依据;(2)评价DWI在颈部淋巴结病变鉴别诊断中的价值;(3)探讨PET-CT中SUVmax值联合CT短径值双定量分析在颈部淋巴结病变良、恶性鉴别中的价值;(4)评价DWI在颈部转移性淋巴结放疗疗效评价中的临床应用价值。方法回顾性分析190例颈部淋巴结病变患者,其中61例行颈部DWI检查、23例行18F-FDG PET-CT检查、42例行颈部CT平扫及增强检查、64例行颈部超声检查,共检出淋巴结378枚,所有淋巴结病变性质均经病理确诊或临床治疗随访证实。功能影像在颈部淋巴结病变鉴别诊断中的评价价值:(1)采用?2检验比较DWI、18F-FDG PET-CT、CT以及超声四种不同影像学检查方法的诊断效能;(2)绘制淋巴结ADC值的ROC曲线,获得DWI诊断恶性淋巴结病变的最佳阈值;(3)采用?2检验比较PET-CT SUVmax值联合CT短径值双定量分析与单独SUVmax值、单独CT短径值诊断颈部淋巴结病变的效能,并绘制SUVmax值与CT短径值的ROC曲线,确定恶性淋巴结病变的最佳诊断阈值;(4)采用两独立样本t检验评价20例颈部转移性淋巴结患者放疗前后淋巴结ADC值的差异。结果(1)四种影像学检查方法中,DWI诊断的敏感性、特异性、准确性、阳性预测值及阴性预测值均高于其他三种检查方法,其Kappa值=0.696(P0.01),与病理/随访结果间的一致性较好;PET-CT各项诊断指标低于DWI但高于CT和超声,其Kappa值=0.524(P0.01),与病理/随访结果间的一致性较好;超声检查的各项诊断指标高于CT检查,其Kappa值=0.47(P0.05),与病理/随访结果间的一致性程度中等;CT检查各项诊断指标最低,Kappa值=0.304(P0.05),与病理/随访结果间的一致性程度较低;(2)恶性病变组ADC均值为(0.848±0.087)×10-3mm2/s,良性病变组ADC均值为(1.144±0.164)×10-3mm2/s,恶性病变组ADC均值低于良性病变组(t=10.51,P0.01);绘制ADC值的ROC曲线图,得到恶性淋巴结病变的最佳ADC诊断阈值为0.965×10-3mm2/s,诊断的敏感度为97.4%、特异度为91.3%、准确性为93.85%,曲线下面积(AUC)为0.98±0.01(P0.01);(3)SUVmax值≥1.94联合CT短径值≥0.66cm作为恶性淋巴结病变的诊断阈值,其敏感度为87%、特异度为89.5%、准确性为87.7%,高于单独PET SUVmax值与单独CT短径值;(4)放疗前淋巴结的平均ADC值为(0.791±0.063)×10-3mm2/s,放疗后淋巴结的平均ADC值为(1.284±0.131)×10-3mm2/s,放疗后ADC值明显升高,差异有统计学意义(t=18.07,P0.01)。结论(1)超声、CT等传统影像学检查方法仅从形态学来判断淋巴结病变的性质存在较大的局限性,DWI、PET-CT功能成像技术能通过淋巴结信号变化或代谢变化更加准确地评价颈部淋巴结病变,而DWI较PET-CT诊断的准确性更高;(2)恶性淋巴结病变的ADC值显著小于良性淋巴结病变,DWI通过ADC值测量提高了颈部淋巴结良、恶性病变的鉴别诊断效能;ADC值拟合ROC曲线所确定的阈值有助于淋巴结良、恶性的鉴别,0.965×10-3mm2/s可作为恶性淋巴结病变的诊断阈值;(3)PET-CT淋巴结SUVmax值(≥1.94)联合CT短径值(≥0.66cm)作为PET-CT双定量分析标准的敏感性、特异性、准确性明显高于单独PET SUVmax值与单独CT短径值,PET-CT双定量分析可显著提高颈部淋巴结病变的诊断效能;(4)颈部恶性淋巴结放疗后ADC值明显升高,DWI可作为监测恶性淋巴结放疗疗效的有效的无创性方法。
[Abstract]:The purpose of (1) DWI, PET-CT, CT and ultrasound in the differential diagnosis efficacy of node lesions in the cervical lymph node, for clinical rational choice of imaging basis; (2) in the differential diagnosis of lesions and evaluate the value of DWI in cervical lymph nodes; (3) to investigate the PET-CT value of SUVmax combined with CT short diameter double quantitative value in the analysis of cervical lymph node lesions of benign and malignant, the identification of value; (4) evaluation of DWI metastatic lymph node radiotherapy to evaluate the clinical value of the neck. Methods: a retrospective analysis of 190 cases of cervical lymph node lesions, including 61 cases of cervical DWI examination, 23 cases underwent 18F-FDG PET-CT examination, 42 cases of cervical CT scan and enhancement scan, 64 cases of neck ultrasonography, 378 lymph nodes were detected, all lymph node lesions were confirmed by pathology or clinical follow-up. Differential diagnosis of the lesions of functional imaging in cervical lymph nodes: (1) the 2 Inspection? 18F-FDG PET-CT, DWI test, CT and ultrasound of four different imaging methods in the diagnosis of effectiveness; (2) ROC curve of lymph node ADC value, obtain the optimal threshold of DWI diagnosis of malignant lymph nodes; (3) using the 2 test to compare the PET-CT? SUVmax value and CT value of quantitative analysis and double short diameter a separate SUVmax, single CT short diameter value diagnosis of cervical lymph node lesions efficacy, and draw the ROC curve and the SUVmax value of CT short diameter value, the best diagnostic threshold of malignant lymph nodes; (4) using two independent sample t test to evaluate 20 cases of cervical lymph node metastases of lymph nodes before and after radiotherapy in patients with different ADC the value of the results. (1) four imaging methods in diagnosis of DWI, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were higher than the other three methods, the Kappa value of =0.696 (P0.01), consistent with the pathological / follow-up results between PET- is better; CT the diagnosis index of less than DWI but higher than that of CT and ultrasound, the value of Kappa =0.524 (P0.01), consistent with the pathological / follow-up results between good; the diagnosis index of ultrasound is higher than that of CT examination, the value of Kappa =0.47 (P0.05), and pathological / follow-up results between the degree of consistency in the diagnosis; check the minimum CT index, the value of Kappa =0.304 (P0.05), and pathological / follow-up results consistency between the low level; (2) malignant group mean ADC (0.848 + 0.087) * 10-3mm2/s, the benign group mean ADC (1.144 + 0.164) * 10-3mm2/s, malignant degeneration group ADC is lower than the mean of benign lesion group (t=10.51, P0.01); to draw the ROC curves of ADC values, the optimal threshold of ADC in the diagnosis of malignant lymph node lesions is 0.965 * 10-3mm2/s, the diagnostic sensitivity was 97.4%, specificity was 91.3%, accuracy was 93.85%, the area under the curve (AUC) was 0.98 + 0.01 (P0.01); (3) the SUVmax value is more than 1.94 CT Short diameter value is more than 0.66cm as a diagnostic threshold of malignant lymph node lesions, the sensitivity was 87%, specificity was 89.5%, accuracy was 87.7%, higher than the PET SUVmax value and CT value of short diameter; (4) the average ADC value of lymph nodes before radiotherapy (0.791 + 0.063) * 10-3mm2/s, the average ADC radiotherapy after the lymph node value is (1.284 + 0.131) * 10-3mm2/s, ADC after radiotherapy was significantly higher, the difference was statistically significant (t=18.07, P0.01). Conclusion (1) ultrasound, only from morphology to judge the limitation of large properties of lymph node lesions DWI examination method for traditional CT imaging, PET-CT function imaging can more accurately evaluate the cervical lymph node pathological changes or metabolic signal changes in lymph nodes, while DWI was the PET-CT diagnostic accuracy is higher; (2) malignant lymph node lesions in ADC was significantly less than benign lymph node lesions, DWI through ADC measurement to improve benign cervical lymph nodes The differential diagnosis of malignant lesions, efficacy; ADC value fitting ROC curve determined by the threshold is helpful to differentiate malignant benign lymph nodes, 0.965 * 10-3mm2/s, can be used as a diagnostic threshold of malignant lymph nodes; (3) PET-CT lymph node SUVmax (more than 1.94) combined with CT short diameter value (more than 0.66cm) as PET-CT the double standard of quantitative analysis of sensitivity, specificity, accuracy was significantly higher than that of single PET SUVmax value and CT value of short diameter, PET-CT double quantitative analysis can significantly improve the diagnostic efficacy of cervical lymph node lesions; (4) cervical malignant lymph nodes after radiotherapy, the ADC value was significantly increased, DWI can be used to monitor the effective non malignant lymph nodes invasive method of radiotherapy.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445;R730.44

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