3.0T DW-MRI在评价鼻咽癌N分期及预测放化疗敏感性的应用研究

发布时间：2018-03-13 14:07

本文选题：鼻咽癌　切入点：弥散加权成像　出处：《川北医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨3.0T磁共振多b值弥散加权成像（Diffusion-weightedMagnetic Resonance Imaging，DW-MRI）在评价鼻咽癌（nasopharyngealcarcinoma，NPC）颈部淋巴结转移的价值。材料和方法：对45例经病理活检证实的NPC及15例良性淋巴结增大患者行常规MR及多b值DWI（b=600、800、1000s/mm2）检查，参照图像质量评分标准对多b值DWI图像进行评分，图像质量分为四个等级：差（1），中等（2），良好（3），好（4）。测量NPC、颈部转移性淋巴结及良性淋巴结不同b值的ADC值，采用SPSS13.0统计软件包对所测数据进行统计学分析。结果：1、b值为600、800、1000s/mm2图像质量评分结果分别为2.84±0.767、3.2±0.588、2.89±0.714，b值为800s/mm2时图像质量评分最高。b值为800s/mm2与b值为600s/mm2和1000s/mm2比较差异均有统计学意义（P＜0.05），但b值为600s/mm2和1000s/mm2两组间无统计学意义（P＞0.05）。 2、随着b值增加，NPC、颈部转移性淋巴结及良性淋巴结ADC值逐渐下降，NPC与转移性淋巴结ADC值比较差异无统计学意义（P＞0.05），而在转移性淋巴结与良性淋巴结ADC值比较有统计学差异（P＜0.05）。b值为800s/mm2对于鉴别良恶性淋巴结能力最佳，其ROC曲线下面积为0.891，截断值为0.938×10-3mm2/s，，灵敏度为100%，特异度为83.3%。结论：3.0T DW-MRI技术有助于诊断NPC转移性淋巴结，对提高鼻咽癌N分期有重要作用。b值取800s/mm2时，DWI图像质量较好，且良恶性淋巴结鉴别诊断能力最佳。目的：探讨3.0T磁共振弥散加权成像（Diffusion-weighted MagneticResonance Imaging，DW-MRI）在评估鼻咽癌（Nasopharyngeal Carcinoma，NPC)放化疗（Chemoradiotherapy，CRT)疗效的价值，预测鼻咽癌的放化疗敏感性。材料与方法：收集32例经病理证实的NPC患者，行常规MR及多b值DWI检查，选取b值为800s/mm2测量放化疗前与放化疗5周时NPC及转移性淋巴结ADC值；在轴位T1WI增强扫描上测量放化疗前与放化疗5周时NPC及转移性淋巴结最大者体积（V）。以放化疗后1月作为疗效评价标准将NPC分为低敏感与高敏感组，比较放化疗5周时NPC低敏感组与高敏感组ADC值、治疗前后ADC值变化率（△ADC）及体积消退率（△V）的差异；分析影响NPC放化疗敏感性的相关因素。结果：1、NPC及转移性淋巴结最大者放化疗前体积分别为15.46±9.67cm3、7.96±2.68cm3，放化疗5周时体积分别为5.39±4.53cm3、0.85±0.76cm3，△V分别为（67.28±11.69）%、（91.00±6.83）%。NPC及转移性淋巴结体积在放化疗前与放化疗5周时差异均有统计学意义（P＜0.05）。 2、放化疗5周时，NPC及颈部转移性淋巴结ADC值均明显升高。NPC及转移性淋巴结放化疗前ADC值分别为（0.856±0.084）×10-3mm2/s、（0.876±0.144）×10-3mm2/s，放化疗5周时ADC值分别为（1.735±0.168）×10-3mm2/s、（1.830±0.162）×10-3mm2/s，△ADC分别为（104.46±26.97）%、（116.14±30.76）%。NPC及转移性淋巴结ADC值在放化疗前与放化疗5周时比较均有统计学差异（P＜0.05）。 3、放化疗5周时NPC高敏感组ADC值、△ADC及△V分别为（1.793±0.101）×10-3mm2/s、（117.83±16.80）%、（71.26±11.68）%，低敏感组依次分别为（1.609±0.219）×10-3mm2/s、（75.06±20.32）%、（61.46±9.27）%。 ADC值、△ADC及△V在高、低敏感组之间均有统计学差异（P＜0.05），△ADC为鉴别低敏感与高敏感组最佳指标，其截断值为98.125%，ROC曲线下面积为0.973，灵敏度为95.5%，特异度为90%。 4、非线性Logistic回归分析影响NPC放化疗敏感性的相关临床因素（性别、年龄、治疗方式、T分期及△ADC），结果显示△ADC是影响鼻咽癌放化疗敏感程度的独立预后因素，其相对风险度为1.155，放化疗5周时NPC△ADC越大，肿瘤对放化疗的敏感性越高。结论：DWI对于评价NPC放化疗疗效有重要作用。放化疗5周时鼻咽癌ADC值、△V及△ADC都能有效预测鼻咽癌放化疗敏感性。△ADC是预测NPC放化疗敏感性的最佳指标及独立预后因素。
[Abstract]:Objective: To evaluate the value of 3.0T B Diffusion-weightedMagnetic Resonance Imaging (DW-MRI) in evaluating cervical lymph node metastasis of nasopharyngeal carcinoma (nasopharyngealcarcinoma).
Materials and methods: 45 patients with biopsy proven NPC and 15 cases of benign lymph node enlargement patients underwent conventional MR and b value DWI (b=6008001000s/mm2) examination, reference standard for evaluation of image quality score of B DWI image, the image quality is divided into four levels: (1), moderate (2), good (3), good (4). The measurement of NPC, lymph node metastasis and benign lymph nodes with different b value ADC value package for statistical analysis of the measured data using SPSS13.0 statistical software.
Results: 1, B score value of 6008001000s/mm2 image quality were 2.84 + 0.767,3.2 + 0.588,2.89 + 0.714, B = 800s/mm2 image quality score the highest.B value for the 800s/mm2 and b value of 600s/mm2 and 1000s/mm2 were statistically significant (P < 0.05), but the b value of 600s/mm2 and 1000s/mm2 between the two groups were statistical significance (P > 0.05).
2, with the increase of B value, NPC, lymph node metastasis and benign lymph node ADC values decreased, there was no significant difference between NPC and ADC value of metastatic lymph nodes (P > 0.05), and in metastatic lymph nodes and benign lymph node ADC values were statistically significant difference (P < 0.05).B value of 800s/mm2 for differential diagnosis of benign and malignant lymph nodes. The optimum, the area under the ROC curve was 0.891, the cut-off value of 0.938 * 10-3mm2/s, the sensitivity was 100%, specificity was 83.3%.
Conclusion: 3.0T DW-MRI technology is helpful for the diagnosis of NPC metastatic lymph nodes, and plays an important role in improving N staging of nasopharyngeal carcinoma. When.B value is 800s/mm2, DWI image quality is better, and the differential diagnosis ability of benign and malignant lymph nodes is the best.
Objective: To investigate the value of Diffusion-weighted MagneticResonance Imaging (DW-MRI) in evaluating the efficacy of radiotherapy and chemotherapy (Chemoradiotherapy, CRT) in patients with nasopharyngeal carcinoma (3.0T), and to predict the sensitivity of nasopharyngeal carcinoma to radiotherapy and chemotherapy.
Materials and methods: 32 patients with pathologically confirmed NPC patients underwent conventional MR and b value DWI, select the b value for 800s/mm2 measurements before chemoradiotherapy and chemotherapy 5 weeks NPC and metastatic lymph node ADC; enhanced scan measurement before chemotherapy and chemotherapy in 5 weeks and NPC transfer the largest volume of lymph node in the axial T1WI (V) in January. After radiotherapy and chemotherapy as curative effect evaluation criteria of NPC were divided into low sensitivity and Gao Min group, compared with chemotherapy 5 weeks NPC low sensitive group and Gao Min group before and after treatment ADC value, ADC value change rate (ADC) and volume regression the rate difference (delta V); to analyze the factors influencing the NPC sensitivity of radiotherapy and chemotherapy.
Results: 1, NPC and metastatic lymph node maximum volume before chemotherapy were 15.46 + 9.67cm3,7.96 + 2.68cm3, chemotherapy 5 weeks volume were 5.39 + 4.53cm3,0.85 + 0.76cm3, V respectively (67.28 + 11.69)% and (91 + 6.83)%.NPC and metastatic lymph node size in chemotherapy before radiotherapy and chemotherapy for 5 weeks the difference was statistically significant (P < 0.05).
2, 5 weeks of chemotherapy, NPC and lymph node metastasis of ADC increased obviously in.NPC and metastatic lymph node radiotherapy and chemotherapy before ADC = (0.856 + 0.084) * 10-3mm2/s (0.876 + 0.144) * 10-3mm2/s, chemotherapy 5 weeks ADC = (1.735 + 0.168) * 10-3mm2/s, (1.830 + 0.162) * 10-3mm2/s, Delta ADC respectively (104.46 + 26.97)% and (116.14 + 30.76) in chemotherapy and chemotherapy in 5 weeks, there were statistically significant differences in%.NPC and metastatic lymph node ADC (P < 0.05).
3, chemotherapy for 5 weeks and NPC Gao Min group ADC, Delta ADC and delta V respectively (1.793 + 0.101) * 10-3mm2/s (117.83 + 16.80)% and (71.26 + 11.68)%, low sensitivity group respectively (1.609 + 0.219) * 10-3mm2/s (75.06 + 20.32)%. (61.46 + 9.27)%. The value of ADC, Delta ADC and delta V in the high and low sensitive groups were statistically significant (P < 0.05), ADC for the identification of low sensitivity and Gao Min was the best index, the cut-off value of 98.125%, the area under the ROC curve was 0.973, sensitivity was 95.5%, specificity was 90%.
4, the related clinical factors of nonlinear Logistic regression analysis of effects of NPC chemotherapy sensitivity (gender, age, treatment, T staging and delta ADC, Delta ADC) results are independent prognostic factors of sensitivity to chemoradiotherapy in nasopharyngeal carcinoma, the relative risk was 1.155, chemotherapy 5 weeks NPC Delta ADC more and the sensitivity of the tumor to chemotherapy is high.
Conclusion: DWI plays an important role in evaluating the efficacy of radiotherapy and chemotherapy. NPC chemotherapy 5 weeks of nasopharyngeal carcinoma ADC, Delta V and delta ADC can effectively predict the sensitivity of radiotherapy and chemotherapy. Nasopharyngeal carcinoma is the best predictor of ADC factors NPC chemotherapy sensitivity and prognosis independently.

【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.63

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