本文選題：BorrmannⅣ型胃癌 + 原發(fā)性胃淋巴瘤　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:胃癌和原發(fā)性胃淋巴瘤(PGL)是胃部最常見的兩種惡性腫瘤,內(nèi)鏡和CT成像難以將其鑒別,尤其是Borrmann Ⅳ型胃癌與胃淋巴瘤的表現(xiàn)較為相似,診斷時(shí)容易混淆。然而,胃癌和原發(fā)性胃淋巴瘤的治療方法及預(yù)后存在很大差異,因此,臨床需探討其他有效途徑對(duì)其進(jìn)行鑒別。近年來(lái)興起的影像組學(xué)(radiomics)成為影像研究領(lǐng)域的熱點(diǎn),在疾病的分型診斷、療效評(píng)估和預(yù)后預(yù)測(cè)方面體現(xiàn)出重要價(jià)值,為鑒別胃癌和原發(fā)性胃淋巴瘤提供了新的思路和方法。目前,影像組學(xué)在鑒別Borrmann Ⅳ型胃癌與胃淋巴瘤方面的價(jià)值如何,尚未見報(bào)道。目的:探討基于CT的影像組學(xué)方法在鑒別Borrmann Ⅳ型胃癌和原發(fā)性胃淋巴瘤方面的價(jià)值。方法:本課題來(lái)源于國(guó)家自然科學(xué)基金(N0.81271569),該回顧性研究通過了廣東省人民醫(yī)院(廣東省醫(yī)學(xué)科學(xué)院)倫理委員會(huì)的批準(zhǔn)(批準(zhǔn)號(hào):GDREC2012020H)。本研究最終納入確診為Borrmann Ⅳ型胃癌患者40例及原發(fā)性胃淋巴瘤患者30例,均具備完整的臨床病理資料及治療前的上腹部CT增強(qiáng)掃描圖像。由兩名在腹部影像診斷具有豐富經(jīng)驗(yàn)的副主任醫(yī)師獨(dú)立評(píng)估CT圖像的主觀征象,包括胃壁蠕動(dòng)性、胃周脂肪浸潤(rùn)情況、腎門平面以下腫大淋巴結(jié)及強(qiáng)化模式,并通Kappa檢驗(yàn)評(píng)估觀察者間的可重復(fù)性。通過多元回歸分析聯(lián)合以上CT征象,構(gòu)建基于CT主觀征象的鑒別診斷模型。另外,兩名醫(yī)師對(duì)腫瘤進(jìn)行手動(dòng)分割,進(jìn)而提取影像組學(xué)特征(共485個(gè)),并通過Lasso-logistic回歸模型對(duì)影像組學(xué)特征進(jìn)行篩選,構(gòu)建影像組學(xué)標(biāo)簽。通過組間一致性檢驗(yàn)(interclass correlation coefficient,ICC)比較兩名測(cè)量者在影像組學(xué)評(píng)估上的可重復(fù)性。以獨(dú)立樣本t檢驗(yàn)或Mann-WhitneyU檢驗(yàn)比較兩組間在年齡、影像組學(xué)標(biāo)簽的差異。采用卡方檢驗(yàn)或Fisher's確切概率檢驗(yàn)法比較兩組患者在性別、CT主觀征象的差異。將單因素比較有統(tǒng)計(jì)學(xué)差異的參數(shù)納入多元回歸分析,構(gòu)建聯(lián)合診斷預(yù)測(cè)模型。使用受試者操作曲線(ROC)檢驗(yàn)CT主觀征象模型、影像組學(xué)標(biāo)簽及聯(lián)合診斷模型在診斷Borrmann Ⅳ型胃癌和原發(fā)性胃淋巴瘤中的診斷效能,參數(shù)包括:曲線下面積(area under the curve,AUC)、敏感性、特異性和準(zhǔn)確性。模型的診斷效能采用七倍交叉驗(yàn)證法進(jìn)行驗(yàn)證。各診斷模型間的診斷效能比較采用Delong檢驗(yàn)。結(jié)果:Borrmann Ⅳ型胃癌和胃淋巴瘤兩組患者在性別、胃壁蠕動(dòng)性及強(qiáng)化模式、影像組學(xué)標(biāo)簽上,差異存在統(tǒng)計(jì)學(xué)意義(所有P0.01)。CT主觀征象模型、影像組學(xué)標(biāo)簽、聯(lián)合診斷模型的AUC值及95%CI(confidence interval)分別為 0.806(0.696-0.917)、0.886(0.809-0.963)和 0.903(0.831-0.975);敏感性分別為63.33%、86.67%和70%;特異性分別為95%、82.5%和100%;準(zhǔn)確性分別為81.43%、84.29%和87.14%。CT主觀征象模型的AUC值、敏感性及準(zhǔn)確性均低于影像組學(xué)標(biāo)簽及聯(lián)合診斷模型。影像組學(xué)標(biāo)簽的敏感性及特異性均較高。聯(lián)合診斷模型的AUC值、準(zhǔn)確性及特異性在三個(gè)模型中均最高。然而,三個(gè)診斷模型之間的AUC值比較無(wú)統(tǒng)計(jì)學(xué)意義(CT主觀征象模型vs影像組學(xué)標(biāo)簽,P=0.188;CT主觀征象模型vs聯(lián)合診斷模型,P=0.051;影像組學(xué)標(biāo)簽vs聯(lián)合診斷模型,P=0.422)。交叉驗(yàn)證后的AUC值進(jìn)行兩兩比較,差異亦無(wú)統(tǒng)計(jì)學(xué)意義(P=0.065-0.279)。結(jié)論:基于治療前CT圖像的影像組學(xué)標(biāo)簽可用于鑒別Borrmann Ⅳ型胃癌和原發(fā)性胃淋巴瘤。作為定量方法,影像組學(xué)分析對(duì)評(píng)估者的經(jīng)驗(yàn)依賴性更小,且易于并入現(xiàn)有的影像工作流程,有望成為影像醫(yī)師的重要輔助工具。
[Abstract]:Background: gastric cancer and primary gastric lymphoma (PGL) are the two most common malignant tumors in the stomach. Endoscopy and CT imaging are difficult to identify them. Especially, the manifestations of Borrmann IV type gastric cancer and gastric lymphoma are similar, and the diagnosis is easily confused. However, there are great differences in the treatment and prognosis of gastric cancer and primary gastric lymphadenoma. In recent years, the rise of radiomics has become a hot spot in the field of imaging research, which is of great value in the diagnosis of disease, evaluation of curative effect and prediction of prognosis, and provides new ideas and methods for the identification of gastric cancer and primary gastric lymphoma. The value of non Borrmann type IV gastric cancer and gastric lymphoma has not been reported. Objective: To explore the value of CT based imaging group method in the identification of Borrmann IV gastric cancer and primary gastric lymphoma. Methods: this topic was derived from the National Natural Science Foundation (N0.81271569), and the retrospective study was carried out through the people's medicine in Guangdong province. The Institute (Guangdong Academy of Medical Sciences) Ethics Committee approved (approval number: GDREC2012020H). This study finally included 40 patients with Borrmann IV gastric cancer and 30 cases of primary gastric lymphoma. All of them have complete clinicopathological data and CT enhanced scan images of the upper abdomen before treatment. Two in the abdominal imaging diagnosis are abundant. The experienced deputy chief physician assessed the subjective signs of CT images independently, including the peristalsis of the stomach wall, the infiltration of the stomach peririphal, the enlarged lymph nodes and intensification patterns below the renal portal plane, and evaluated the repeatability between the observers through the Kappa test. Through multiple regression analysis, the above CT signs were combined to construct a differential diagnosis model based on the subjective signs of CT. In addition, two physicians split the tumor manually, and then extracted the image group characteristics (485), and screened the image histology characteristics by Lasso-logistic regression model, and constructed the image group label. Through the interclass correlation coefficient (ICC), two surveyors were compared to the image histology evaluation. The difference between two groups of age and image group labels was compared by independent sample t test or Mann-WhitneyU test. The differences in gender and CT subjective signs were compared with the chi square test or the exact Fisher's test method of the two groups. Diagnostic prediction model. The diagnostic effectiveness of the CT subjective image model, image group label and joint diagnostic model in the diagnosis of Borrmann type IV gastric cancer and primary gastric lymphoma using the subject operator curve (ROC), parameters including the area under the curve (area under the curve, AUC), sensitivity, specificity and accuracy. The diagnostic effectiveness of the model. The seven times cross validation method was used to verify the results. The diagnostic effectiveness of the diagnostic models was compared with the Delong test. Results: there were statistically significant differences in gender, gastric wall peristalsis and intensification patterns in two groups of gastric cancer and gastric lymphoma. The difference was statistically significant (all P0.01).CT subjective signs, image group label, The AUC value and 95%CI (confidence interval) of the combined diagnostic model were 0.806 (0.696-0.917), 0.886 (0.809-0.963) and 0.903 (0.831-0.975), and the sensitivity was 63.33%, 86.67% and 70%, respectively, and the specificity was 95%, 82.5% and 100%, respectively. The accuracy of the model was 81.43%, 84.29% and 87.14%.CT, respectively, and the sensitivity and accuracy were low. The sensitivity and specificity of imaging group labels were high. The AUC value, accuracy and specificity of the combined diagnostic model were the highest among the three models. However, the AUC values between the three diagnostic models were not statistically significant (CT subjective image Model vs image group label, P=0.188; CT subjective sign) Image Model vs joint diagnosis model, P=0.051, image group label vs joint diagnostic model, P=0.422). The AUC value after cross validation was 22 compared, and the difference was not statistically significant (P=0.065-0.279). Conclusion: the image group label based on CT image before treatment can be used to identify Borrmann type IV gastric cancer and primary gastric lymphoma. The method of image analysis has less experience dependence on the assessor, and is easy to incorporate into the existing image workflow. It is expected to become an important auxiliary tool for the image doctor.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉慧;王小宜;龍學(xué)穎;;基于CT圖像紋理分析腫瘤異質(zhì)性的研究進(jìn)展及應(yīng)用[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2016年05期

2 農(nóng)理紅;;以胃黏膜相對(duì)完整為特征的胃黏液腺癌影像及臨床表現(xiàn)[J];實(shí)用放射學(xué)雜志;2016年09期

3 胡斌;毛秋粉;王錦鋒;謝新立;;~(18)F-FDG PET/CT顯像對(duì)胃部惡性腫瘤的鑒別診斷價(jià)值[J];重慶醫(yī)學(xué);2016年16期

4 姚山虎;羅愛靜;馮麟;;國(guó)外醫(yī)學(xué)大數(shù)據(jù)研究進(jìn)展及其啟示[J];醫(yī)學(xué)信息學(xué)雜志;2016年02期

5 李元方;周志偉;;臨床數(shù)據(jù)庫(kù)在胃癌精準(zhǔn)醫(yī)學(xué)實(shí)施中的地位及其規(guī)范化管理[J];中華胃腸外科雜志;2016年02期

6 鄭于平;;多層螺旋CT動(dòng)態(tài)增強(qiáng)掃描對(duì)胃淋巴瘤與進(jìn)展期胃癌的對(duì)比分析[J];實(shí)用醫(yī)學(xué)影像雜志;2015年03期

7 葛緒波;;MSCT及X線鋇餐造影對(duì)浸潤(rùn)型胃淋巴瘤和浸潤(rùn)型胃癌的診斷價(jià)值[J];罕少疾病雜志;2015年03期

8 李艷明;楊亞東;張昭軍;方向東;;精準(zhǔn)醫(yī)學(xué)大數(shù)據(jù)的分析與共享[J];中國(guó)醫(yī)學(xué)前沿雜志(電子版);2015年06期

9 邱實(shí);汶德勝;王磊;;基于平均密度投影和平移高斯模型的肺結(jié)節(jié)檢測(cè)與分割算法[J];儀器儀表學(xué)報(bào);2014年11期

10 孫磊;胡學(xué)龍;張曉斌;李云;;生物醫(yī)學(xué)大數(shù)據(jù)處理的云計(jì)算解決方案[J];電子測(cè)量與儀器學(xué)報(bào);2014年11期

相關(guān)碩士學(xué)位論文 前1條

1 付志穎;原發(fā)性胃淋巴瘤與胃癌的臨床特點(diǎn)的對(duì)比分析[D];大連醫(yī)科大學(xué);2015年

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