磁共振成像表观弥散系数值的变化对鼻咽癌转移性淋巴结放射治疗后残留的预测作用

发布时间：2018-03-24 00:00

本文选题：MRI　切入点：表观弥散系数　出处：《福建医科大学》2010年硕士论文

【摘要】： 目的探讨核磁共振表观弥散系数(ADC)值的变化与鼻咽癌颈部转移性淋巴结放疗后残留的关系。建立ADC值对鼻咽癌颈部转移性淋巴结放疗后残留的预测阈值。方法按入组及排除标准选取2009年3月～2009年10月间我院收治的36例原发鼻咽癌患者,行常规磁共振(magnetic resonance imaging, MRI )扫描和磁共振全身弥散加权成像(magnetic resonance whole body diffusion weighted imaging, MR WB-DWI),检测放疗前、放疗开始后的第二周末颈部转移性淋巴结的表观弥散系数(apparent difusion coefficient, ADC)值。共有17枚颈部淋巴结治疗前经MRI检查确认为NPC转移,经随访考虑为放疗后残留。共有39枚颈部淋巴结放疗前经MRI检查确认为NPC转移,并且在放疗结束时完全退缩。设颈部转移性淋巴结放疗开始后的第二周末与放疗前ADC值的差值为R,用受试者工作特性曲线(receiver operator characteristic curve, ROC)曲线找出R的最佳截断值,用此截断值将56枚鼻咽癌转移性淋巴结分为两组,比较两组淋巴结残留率是否有统计学差异。应用logistic多元回归分析颈部转移性淋巴结R值、淋巴结大小、淋巴结坏死情况、年龄、性别、淋巴结所接受放疗剂量与放疗后淋巴结残留的关系。结果颈部淋巴结残留组的R值与颈部淋巴结无残留组的R值的差异有显著统计学意义(P=0.0000.001)。鼻咽癌颈部转移性淋巴结R值的受试者工作特性曲线(receiver operator characteristic curve, ROC)下的面积为0.895。以R≤0.1965作为预测鼻咽非角化未分化型癌转移性淋巴结放疗后残留的阈值,其特异性为97.4%,敏感性为64.7%。用此截断值将56枚鼻咽癌转移性淋巴结分为两组,两组淋巴结残留率差异有显著统计学意义(χC2 =23.59, P=0.0000.001)。logistic多元回归分析发现鼻咽癌颈部转移性淋巴结R值对于鼻咽癌转移性颈淋巴结放疗后残留存在负相关关系(回归系数:-3.891) 结论鼻咽癌颈部转移性淋巴结的R值能在一定程度上预测鼻咽癌颈部转移性淋巴结放疗后残留。
[Abstract]:Objective to investigate the relationship between the change of apparent diffusion coefficient (ADC) and the residual of cervical metastatic lymph nodes after radiotherapy, and establish a predictive threshold of ADC value for residual radiotherapy of metastatic cervical lymph nodes after radiotherapy.
Methods from March 2009 to October 2009 in our hospital were selected according to inclusion and exclusion criteria of the 36 cases of primary nasopharyngeal carcinoma patients underwent conventional magnetic resonance (magnetic resonance imaging, MRI) scan and magnetic resonance imaging diffusion weighted imaging (magnetic resonance whole body diffusion weighted imaging, MR, WB-DWI) detection before radiotherapy, radiotherapy after the start of the second the weekend of metastatic cervical lymph nodes of apparent diffusion coefficient (apparent difusion, coefficient, ADC). There were 17 pieces of cervical lymph nodes before and after the treatment, MRI examination confirmed NPC transfer, followed by considering the residual after radiotherapy. There were 39 pieces of cervical lymph nodes before radiotherapy by MRI examination confirmed NPC and metastasis. Complete withdrawal at the end of radiotherapy. Lymph node metastasis after radiotherapy second weeks before radiotherapy and the difference of ADC value for the R receiver operating characteristic curve (receiver operator charac Teristic curve, ROC) the best cut-off curve to find the value of R, the 56 nasopharyngeal carcinoma metastatic lymph nodes were divided into two groups with the cut-off values, compared two groups of lymph node residual rate of whether there is a significant difference. Logistic regression analysis was applied to analyze metastatic cervical lymph nodes R, lymph node size, lymph node necrosis age, sex, relationship, lymph node received radiotherapy and after radiotherapy. The residual lymph node residual cervical lymph node of the value of R and cervical lymph node showed no residual group R values were statistically significant (P=0.0000.001). The receiver operating characteristic curve of neck lymph node metastasis of nasopharyngeal carcinoma R (the receiver operator characteristic curve, ROC) under the area of 0.895. to R is less than or equal to 0.1965 as a predictor of residual undifferentiated nasopharyngeal non keratinizing carcinoma metastatic lymph node after radiotherapy threshold, the specificity was 97.4%, sensitivity was 64.7%. with this The cutoff value of 56 pieces of nasopharyngeal carcinoma metastatic lymph nodes were divided into two groups, two groups of lymph node residual rate difference was statistically significant (C2 =23.59, P=0.0000.001).Logistic multiple regression analysis showed that nasopharyngeal carcinoma metastatic cervical lymph nodes R value for the negative correlation between the residual of neck lymph node metastasis of nasopharyngeal carcinoma after radiotherapy (regression coefficient: -3.891)
Conclusion the R value of metastatic lymph nodes in the neck of nasopharyngeal carcinoma can be used to predict the residual cervical metastasis of nasopharyngeal carcinoma to a certain extent after radiotherapy.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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