高b值扩散加权成像和动态增强定量参数在前列腺移行区癌诊断中的应用

发布时间：2018-03-09 18:53

本文选题：前列腺　切入点：扩散加权成像　出处：《中国人民解放军医学院》2017年博士论文　论文类型：学位论文

【摘要】：第一部分不同b值DWI图像及ADC值在前列腺移行区癌诊断中的价值目的:探讨b值为 1000、2000和3000s/mm2时扩散加权成像(diffusion-weighted imaging,DWI)图像和表观扩散系数(apparent diffusion coefficient, ADC)值在前列腺移行区(transition zone, TZ)癌诊断中的价值。材料与方法:本项前瞻性研究获得了伦理委员会的批准。依据纳入和排除标准,纳入的患者接受前列腺3.0T磁共振扫描,扫描序列包括T2WI、DWI(b=1000, 2000和3000 s/mm2)和T1WI。2名放射科医生采用以下三种方案分析患者的MRI图像,达成一致后对可疑病灶进行评分,方案A: T2WI和DWI图像(b= 1000s/mm2);方案B: T2WI和DWI 图像(b = 2000s/mm2);方案C: T2WI和DWI 图像(b = 3000s/mm2)。同时测量b值为1000、2000和3000s/mm2时可疑病灶的ADC值。采用独立样本t检验和Mann-Whitney U检验比较不同b值时,TZ癌和良性前列腺组织间ADC值的差异。采用受试者工作特征(receiveroperating characteristic, ROC)曲线分析不同方案以及不同b值时ADC值的诊断效能。结果:本研究共纳入49例患者,经超声引导下穿刺活检证实TZ癌25例,良性前列腺组织24例。方案C的曲线下面积(areaunderthecurves,AUC)显著高于方案A和方案B(p= 0.0029, 0.0492)。b值为1000s/mm2、2000s/mm2和3000s/mm2时,TZ癌的ADC值均显著低于良性前列腺组织(p= 0.002,p0.001和p0.001)。不同b值时,ADC值诊断TZ癌的AUC分别为:0.718、0.839和0.887。b值为3000s/mm2和2000s/mm2时ADC值的AUC差异不具有统计学意义,p= 0.308。结论:3.0TMRI扫描仪上,DWI图像在b值为3000s/mm2时对TZ癌的诊断效能最高。在定量分析中,b值为2000 s/mm2和3000 s/mm2的ADC值对TZ癌的诊断效能高于b值为1000s/mm2 时。第二部分高b值ADC值在诊断前列腺移行区癌中对PI-RADS v2的附加价值研究目的:探讨前列腺移行区(transition zone, TZ)癌诊断中ADC值对第2版的前列腺成像报告和数据系统(Prostate Imaging Reporting and Data System version 2, PI-RADS v2)是否具有附加价值。材料与方法:本项前瞻性研究获得了伦理委员会的批准。依据纳入和排除标准,纳入的患者接受前列腺3.0T磁共振扫描。2名放射科医生独立分析患者的MRI图像,依据PI-RADS v2指南对可疑病灶评分并测量可疑病灶的ADC值。以超声引导下穿刺活检的病理结果为金标准。分别采用kappa系数和组内相关系数(ICC)评估PI-RADS v2评分和ADC值测量的观察者间一致性。采用二元logistic回归和受试者工作特征(receiver operating characteristic, ROC)曲线分析ADC值联合PI-RADS v2 以及单独使用PI-RADS v2对TZ癌的诊断效能。结果:本研究共纳入49例患者,其中TZ癌25例,良性前列腺组织24例。在两名观察者之间,PI-RADSv2评分表现出良好的一致性(κ= 0.753), ADC值表现出极好的一致性(ICC = 0.988)。ADC值联合PI-RADS v2诊断TZ癌的AUC显著高于单独使用PI-RADS v2时(观察者A: 0.861 vs 0.748, p= 0.0475;观察者B: 0.863 vs 0.723, =0.0224) 。结论:ADC值与PI-RADS v2联合使用可以显著提高PI-RADS v2对TZ癌的诊断效能。第三部分DCE-MRI定量参数对ADC值诊断前列腺移行区癌的附加价值研究目的:探讨前列腺移行区(transitionzone,TZ)癌诊断中DCE-MRI定量参数对ADC值是否具有附加价值。材料与方法:本项前瞻性研究获得了伦理委员会的批准。依据纳入和排除标准,纳入的患者接受前列腺3.0T磁共振平扫和动态增强扫描。2名放射科医生分析患者的MRI图像,达成一致后测量可疑病灶的ADC值、Ktrans、Kep和Ve值。以超声引导下穿刺活检的病理结果为金标准。采用Mann-Whitney U检验比较TZ癌和良性前列腺组织之间各参数的差异。采用二元logistic回归和受试者工作特征(receiver operating characteristic, ROC)曲线分析Ktrans、Kep和Ve值联合ADC值后对TZ癌的诊断效能。结果:本研究共纳入49例患者,其中TZ癌25例,良性前列腺组织24例。TZ癌的ADC值和Kep值显著低于良性前列腺组织(p 0.001,p = 0.032),Ktrans和Ve值在两组的差异不具有统计学意义(p= 0.085,p=0.610)。Ktrans联合ADC值、Kep联合ADC值和Ve联合ADC值诊断TZ癌的AUC与单独使用ADC值没有显著差异(p = 0.858,0.699和0.709)。结论:Ktrans值、Kep值和Ve值与ADC值联合均不能提高ADC值对TZ癌的诊断效能。
[Abstract]:The first part of different b value and ADC value in the DWI image area to shift value of diagnosis of prostate carcinoma: To investigate the value of B was 10002000 and 3000s/mm2 diffusion weighted imaging (diffusion-weighted imaging DWI) apparent diffusion coefficient (apparent diffusion images and tables coefficient, ADC) value in prostate transitional zone (transition zone TZ) cancer diagnosis. Materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, in patients receiving 3.0T prostate magnetic resonance scanning, scanning sequences included T2WI, DWI (b=1000, 2000 and 3000 s/mm2) and T1WI.2 radiologists using the following three schemes of MRI image analysis after the agreement of patients, wasassessed suspicious lesions, T2WI and DWI A: images (b= 1000s/mm2); B: T2WI scheme and DWI images (b = 2000s/mm2); C: T2WI scheme and DWI images (b = 3000s/m M2). Simultaneous measurement of B value of 10002000 and 3000s/mm2 of suspicious lesions ADC value. By using independent sample t test and Mann-Whitney U test comparison of different b value, different ADC value TZ cancer and benign prostate tissue. The receiver operating characteristic (receiveroperating characteristic, ROC) of different schemes and different b values the ADC value of the diagnostic efficiency curves. Results: the study included 49 patients with ultrasound guided biopsy confirmed 25 cases of TZ carcinoma, 24 cases of benign prostate tissue. The area under the curve C (areaunderthecurves, AUC) was significantly higher than that of plan A and B (p= 0.0029, 0.0492).B = 1000s/mm22000s/mm2 and 3000s/mm2, TZ cancer ADC were significantly lower than those in benign prostate tissue (p= 0.002, p0.001 and p0.001) at different b values and ADC values in diagnosis of TZ carcinoma of the AUC were: 0.718,0.839 and 0.887.b value of 3000s/ mm2 and 2000s/mm2 ADC The AUC difference was not statistically significant, p= 0.308. conclusion: 3.0TMRI scanner, DWI image in the b value of 3000s/mm2 for diagnosis of TZ cancer is the highest. In quantitative analysis, the b value is 2000 s/mm2 and 3000 s/mm2 ADC value of the diagnostic efficacy of TZ cancer is higher than that of the b value is 1000s/mm2. The second part is high the B ADC value in the diagnosis of prostate displacement added value objective to study the PI-RADS V2 for cancer in the prostate transitional zone (transition, zone, TZ) in the diagnosis of prostate cancer ADC imaging report on version second and data system (Prostate Imaging Reporting and Data System version 2, PI-RADS V2) has added value materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, independent analysis of MRI images were included in patients with prostate 3.0T magnetic resonance scanning.2 radiologists, according to PI-RADS V2 guide to the suspicious lesion score and measurement of suspicious lesions ADC value. Pathological biopsy guided by ultrasound results as the gold standard. We use the kappa coefficient and intraclass correlation coefficient (ICC) measurement of the inter observer consistency assessment PI-RADS V2 score and ADC value of two yuan. By using logistic regression and receiver job characteristics (receiver operating characteristic, ROC) ADC value curve analysis combined with PI-RADS V2 and PI-RADS V2 TZ alone for the cancer diagnostic efficacy. Results: This study included 49 patients, including 25 cases of TZ cancer and benign prostate tissue in 24 cases. Among the two observers, PI-RADSv2 score showed good consistency the (k = 0.753), the ADC value showed an excellent agreement (ICC = 0.988) value of.ADC combined with PI-RADS V2 in the diagnosis of cancer was significantly higher than that of AUC TZ using PI-RADS V2 alone (observer A: 0.861 vs 0.748, p= 0.0475; observer B: 0.863 vs 0.723, =0.0224). Conclusion: the value of ADC combined with PI-RADS V2 can significantly improve the diagnostic efficacy of PI-RADS V2 for TZ cancer. Objective additional diagnostic value of prostate transitional zone cancer DCE-MRI quantitative parameters of third ADC values: prostate transitional zone (transitionzone, TZ) in the diagnosis of cancer DCE-MRI quantitative parameters whether it has added value to ADC value. Materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, patients scanned.2 radiologists MRI image analysis in patients with prostate 3.0T magnetic resonance scan and dynamic enhanced, suspicious lesions after the agreement of ADC measurement value, Ktrans Kep, and Ve. Pathological biopsy guided by ultrasound results as the gold standard. The difference between the Mann-Whitney U test to compare TZ cancer and benign prostate tissue with two parameters. Logistic regression and receiver operating characteristic (receiver operating characteristic, ROC Ktrans) Kep curve analysis and Ve value of diagnostic efficacy of combined ADC values of TZ cancer. Results: the study included 49 patients, including 25 cases of TZ carcinoma, 24 cases of benign prostate cancer.TZ ADC value and Kep value was significantly lower than that in benign prostate tissue (P 0.001, P = 0.032), Ktrans and Ve was not statistically significant difference in the two groups (p= 0.085, p=0.610.Ktrans) combined with ADC, combined with ADC Kep combined with ADC and Ve values in diagnosis of TZ cancer AUC and ADC alone had no significant difference (P value = 0.858,0.699 and 0.709). Conclusion: Ktrans value, Kep value and Ve value and could not significantly improve the diagnostic efficiency of TZ ADC cancer and ADC value.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R737.25

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