本文選題：肝臟腫瘤　切入點：磁共振成像　出處：《重慶醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討動態(tài)增強磁共振成像(Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)全定量參數(shù)及Ktrans紋理特征在鑒別肝臟良惡性病變中的診斷效能。方法:回顧性分析60例經(jīng)病理或臨床證實患有肝臟占位性病變患者的DCE-MRI圖像資料。原始圖像資料導入后處理工作站,應(yīng)用雙輸入ETK(Extended Tofts-Kermode,ETK)模型計算全定量參數(shù)容積轉(zhuǎn)運常數(shù)(Volume transfer constant,Ktrans)、血管外細胞外容積分數(shù)(Volume fraction of extravascular extracellular space,Ve)、速率常數(shù)(Interstitium-to-plasma rate constant,Kep)、血漿容積分數(shù)(volume fraction of plasma,Vp)。應(yīng)用灰度直方圖(Gray-level Histogram)紋理分析提取Ktrans圖像的紋理特征,如能量(Energy)、熵(Entropy)、偏度系數(shù)(Skewness)、峰度系數(shù)(Kurtosis)、均勻度(Uniformity)。將所獲得的全定量參數(shù)及Ktrans灰度直方圖紋理特征通過獨立樣本t檢驗或Mann-Whitney U檢驗進行統(tǒng)計學分析。并通過二元Logistic回歸分別將兩組影像學參數(shù)擬合為兩兩聯(lián)合診斷模型,包括Ktrans-Kep、Ktrans-Ve、Kep-Ve和Energy-Entropy、Energy-Skewness、Energy-Kurtosis、Entropy-Skewness、Entropy-Kurtosis、Skewness-Kurtosis。計算各影像學指標及對應(yīng)聯(lián)合診斷模型對病灶的預測頻率。以病理或臨床診斷為金標準,利用頻率變量繪制受試者工作特征(Receiver operating characteristic,ROC)曲線并計算曲線下面積(Area under the curve,AUC)。利用最大約登指數(shù)分別探討兩組影像學指標及對應(yīng)兩兩聯(lián)合診斷模型的敏感度、特異度。結(jié)果:全定量參數(shù)中Ktrans、Kep、Vp符合正態(tài)分布及方差齊同性,Ve符合正態(tài)分布,不符合方差齊同性。惡性病灶組Ktrans及Kep(1.233±0.613,1.777±0.848)明顯高于良性病灶組(0.532±0.371,0.942±1.151),組間差異具有統(tǒng)計學意義(獨立樣本t檢驗,t值分別為㧟5.064和㧟3.004,P值分別為0.000和0.004)。良性病灶組Ve(4.343±2.996)明顯高于惡性病灶組(1.271±0.675),組間差異具有統(tǒng)計學意義(Mann-Whitney U檢驗,P值為0.000)。惡性病灶組Vp(0.332±0.243)高于良性病灶組(0.219±0.267),組間差異不顯著,無統(tǒng)計學意義(獨立樣本t檢驗,t值為㧟1.601,P值為0.116)。全定量參數(shù)及兩兩聯(lián)合診斷模型ROC曲線下面積分別為0.841(Ktrans)、0.848(Ve)、0.815(Kep)、0.844(Ktrans-Kep)、0.929(Ktrans-Ve)、0.808(Kep-Ve),根據(jù)最大約登指數(shù)分析,Ktrans-Ve診斷效能最佳,特異度最高(100%);Ve診斷效能次于Ktrans-Ve,敏感度最高(85.7%)。Ktrans直方圖紋理特征均符合正態(tài)分布及方差齊同性。良性病灶組Energy、Kurtosis(0.762±0.264,2.100±0.894)高于惡性病灶組(0.610±0.265,1.126±0.751),組間差異具有統(tǒng)計學意義(獨立樣本t檢驗,t值分別為㧟2.022、㧟4.187,P值分別為0.049、0.000)。惡性病灶組Entropy、Skewness(1.056±0.683、0.489±0.579)高于良性病灶組(0.658±0.695、0.244±0.583),組間差異具有統(tǒng)計學意義(獨立樣本t檢驗,t值分別為2.033、4.450,P值分別為0.048、0.000)。惡性病灶組Uniformity(㧟0.543±0.432)高于良性病灶組(㧟0.555±0.607),組間差異無統(tǒng)計學意義(獨立樣本t檢驗,t值為0.067,P值為0.947)。紋理特征及兩兩聯(lián)合診斷模型ROC曲線下面積分別為0.654(Energy)、0.645(Entropy)、0.825(Skewness)、0.828(Kurtosis)、0.643(Energy-Entropy)、0.857(Energy-Skewness)、0.842(Energy-Kurtosis)、0.835(Entropy-Skewness)、0.842(Entropy-Kurtosis)、0.839(Skewness-Kurtosis)。Energy、Entropy、Energy-Entropy三組ROC曲線不具有統(tǒng)計學意義。Energy-Skewness模型診斷效能最佳,曲線下面積為0.857。根據(jù)最大約登指數(shù)獲得敏感度及特異度,Skewness、Energy-Skewness、Entropy-Skewness、Entropy-Kurtosis特異度高(81.5%),Kurtosis、Energy-Skewness、Energy-Kurtosis、Entropy-Skewness敏感度高(87.0%)。結(jié)論:DCE-MRI獲得的全定量參數(shù)Ktrans、Kep、Ve及Ktrans灰度直方圖紋理特征Energy、Entropy、Skewness、Kurtosis能夠有效鑒別肝臟良惡性病灶。而全定量參數(shù)Vp及紋理特征Uniformity不能有效鑒別肝臟良惡性病灶。全定量參數(shù)兩兩聯(lián)合診斷模型Ktrans-Ve,紋理特征兩兩聯(lián)合診斷模型Energy-Skewness在各組內(nèi)分析中具有更高診斷效能,對鑒別診斷肝臟良惡性病變方面較其他影像學指標及聯(lián)合診斷模型更具優(yōu)勢。
[Abstract]:Objective: To investigate the dynamic enhanced magnetic resonance imaging (Dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI) the diagnostic efficacy of quantitative parameters and Ktrans texture features in the differential diagnosis of benign and malignant liver lesions. Methods: a retrospective analysis of 60 cases proved by pathology or clinical withLiver accounted for DCE-MRI image data of lesions. Into the original image data the workstation, using double input ETK (Extended Tofts-Kermode ETK) model to calculate the total volume transport quantitative parameters (Volume transfer constant, Ktrans constant), extravascular extracellular volume fraction (Volume fraction of extravascular extracellular space, Ve), the rate constant (Interstitium-to-plasma rate constant Kep (volume), plasma volume fraction fraction of plasma, Vp). The application of gray histogram (Gray-level Histogram) extract texture feature texture analysis Ktrans image, such as Volume (Energy), entropy (Entropy), skewness, kurtosis coefficient (Skewness) (Kurtosis), evenness (Uniformity). The quantitative parameters of gray histogram and Ktrans texture features obtained were analyzed by independent samples t test or Mann-Whitney U test. Logistic regression and by two yuan respectively two imaging parameters fitting 22 combined diagnosis model, including Ktrans-Kep, Ktrans-Ve, Kep-Ve and Energy-Entropy, Energy-Skewness, Energy-Kurtosis, Entropy-Skewness, Entropy-Kurtosis, Skewness-Kurtosis. to calculate the combined imaging diagnosis index and the corresponding model for the prediction of lesion frequency. The pathological or clinical diagnosis as the gold standard, drawing the subjects using the frequency variable operating characteristic (Receiver operating characteristic, ROC) curve of area under the curve was calculated (Area under the curve, AUC) were discussed using the maximum Youden index. Sensitivity of the two groups of combined imaging diagnosis index model and the corresponding 22 specificity. Results: Ktrans, the quantitative parameters of Kep and Vp with normal distribution and homogeneity of variance, Ve with normal distribution, does not meet the variance homogeneity. Malignant lesions group Ktrans and Kep (1.233 + 0.613,1.777 + 0.848) significantly higher than that in benign lesion group (0.532 + 0.371,0.942 + 1.151), a statistically significant difference between the groups (independent sample t test, the T values were 5.064 and 3.004??, P = 0 and 0.004). Benign lesions group Ve (4.343 + 2.996) was significantly higher than that of malignant disease lesion group (1.271 + 0.675). The differences between groups was statistically significant (Mann-Whitney U test, P = 0). Malignant lesions group Vp (0.332 + 0.243) higher than that of benign lesions group (0.219 + 0.267), no significant difference between the groups, no statistical significance (independent samples t test, t =? 1.601, P = 0.116). The quantitative parameters and 22 combined diagnosis The area of fault model under the ROC curve were 0.841 (Ktrans), 0.848 (Ve), 0.815 (Kep), 0.844 (Ktrans-Kep), 0.929 (Ktrans-Ve), 0.808 (Kep-Ve), according to the analysis of the maximum Youden index, Ktrans-Ve diagnosis efficiency was the best, the highest specificity (100%); Ve diagnostic efficacy after Ktrans-Ve, sensitivity the highest (85.7%).Ktrans histogram texture features accord with normal distribution and homogeneity of variance. Benign lesions group Energy, Kurtosis (0.762 + 0.264,2.100 + 0.894) higher than that of malignant lesions group (0.610 + 0.265,1.126 + 0.751), a statistically significant difference between the groups (independent sample t test, t =? 2.022, 4.187?, P = 0.049,0.000). Malignant lesions group Entropy, Skewness (1.056 + 0.683,0.489 + 0.579) higher than that of benign lesions group (0.658 + 0.695,0.244 + 0.583), a statistically significant difference between the groups (independent sample t test, t = 2.033,4.450, P = 0.048,0.000) evil. 鎬х梾鐏剁粍Uniformity(?0.543鹵0.432)楂樹簬鑹，

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