本文選題：擴(kuò)散加權(quán)成像 + 體素內(nèi)不相干運(yùn)動(dòng)��； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2017年博士論文

【摘要】：目的:評(píng)價(jià)體素內(nèi)不相干運(yùn)動(dòng)(intravoxel incoherent motion, IVIM)模型的參數(shù)鑒別前列腺移行帶和外周帶中癌和非癌組織的可行性以及參數(shù)在短期內(nèi)和觀察者內(nèi)的可重復(fù)性。材料和方法:采用3.0T GE磁共振(magnetic resonance MR)掃描儀對(duì)23例前列腺患者行兩次12個(gè)b值(0-3000s/mm2) IVIM掃描。計(jì)算IVIM模型生成的參數(shù)Dslow、Dfast、f和表觀擴(kuò)散系數(shù)(apparent diffusion coefficient, ADC12b)。采用方差分析比較移行帶中癌灶和良性前列腺增生(benign prostatic hyperplasia, BPH)和腺體BPH之間、外周帶中癌灶和良性外周帶和正常外周帶之間的參數(shù)的差異。短期內(nèi)兩次檢查IVIM參數(shù)的可重復(fù)性評(píng)價(jià)采用變異系數(shù)(coefficient of variation, CV)、Bland-Altman分析法,觀察者內(nèi)一致性分析采用組內(nèi)相關(guān)系數(shù)(intraclass correlation coefficient,ICC)評(píng)價(jià)。結(jié)果:移行帶中前列腺癌灶的Dslow、ADC12b和f值比基質(zhì)和腺體BPH的低(P均為0.000);外周帶中癌灶的Dslow、ADC12b和f值比良性和正常外周帶的低(P均為0.000)。兩次檢查移行帶中癌灶和非癌組織的Dslow(CV2.1-5.8%,BA-LA-21-21%)和 ADC12b 的可重復(fù)性好(CV 3.1-6.1%, BA-LA -23-23%),f 次之(CV 4.4-10.3%,BA-LA -42-41 %), Dfast 的可重復(fù)性差(CV 12.8-24.5%,BA-LA -101 -89%)。外周帶中前列腺癌和非癌組織的可重復(fù)性順序與移行帶中的一樣。在移行帶中,Dslow和ADC12b在癌灶中的可重復(fù)性最好。在外周帶中,Dslow在癌灶中可重復(fù)性最好,ADC12b在正常外周帶中的可重復(fù)性最好。觀察者內(nèi)一致性移行帶中癌灶、外周帶中癌和非癌組織所有的參數(shù)的一致性極好。結(jié)論:初步結(jié)果表明前列腺移行帶和外周帶中癌灶的Dslow、ADC12b和f值與非癌組織的顯著不同。前列腺移行帶和外周帶中癌和非癌組織的Dslow和 ADC12b的可重復(fù)性好,f次之,Dast的可重復(fù)性差。目的:評(píng)價(jià)擴(kuò)散峰度成像(diffusion kurtosis imaging, DKI)參數(shù)鑒別前列腺移行帶和外周帶中癌和非癌組織的可行性以及參數(shù)在短期內(nèi)和觀察者內(nèi)的可重復(fù)性。材料和方法:采用3.0T GE MR掃描儀對(duì)23例前列腺患者行兩次3個(gè)b值(0-3000s/mm2)DKI掃描。計(jì)算DKI的參數(shù)K和D值。采用方差分析比較移行帶前列腺癌與良性前列腺增生(BPH)和腺體BPH之間、外周帶前列腺癌和良性外周帶和正常外周帶之間的參數(shù)的差異。短期內(nèi)兩次檢查DKI參數(shù)的可重復(fù)性評(píng)價(jià)采用變異系數(shù)(coefficient of variation, CV)、Bland-Altman分析法,觀察者內(nèi)重復(fù)測(cè)量一致性分析采用組內(nèi)相關(guān)系數(shù)(intraclass correlation coefficient, ICC)評(píng)價(jià)。結(jié)果:在前列腺移行帶中,癌灶的K值顯著高于基質(zhì)BPH和腺體BPH(P0.001),D值明顯低于基質(zhì)和腺體BPH(P0.001);在外周帶中,癌灶的K值比良性外周帶和正常外周帶高,D值比良性和正常外周帶低(P0.001)。兩次檢查移行帶中癌灶和非癌組織K值和D值的可重復(fù)性(CV 3.5-4.3%,BA-LA-17-24%; CV 5.2-5.5%,BA-LA-20-20%)和外周帶中癌和非癌組織K和D值的可重復(fù)性都較好(CV5.1-6.3%,BA-LA-24-21%; CV3.8-5.4%,BA-LA-21-23%)。在移行帶中,K值在癌灶的可重復(fù)性最好,D值在癌和基質(zhì)BPH和腺體BPH中相似。在外周帶中,K值在癌灶中的可重復(fù)性最好;D值在正常外周帶中的可重復(fù)性最好。觀察者內(nèi)一致性前列腺移行帶和外周帶中癌和非癌組織所有的參數(shù)的一致性極好。結(jié)論:初步結(jié)果表明前列腺移行帶和外周帶中癌與非癌組織的K值和D值顯著不同。前列腺移行帶和外周帶中癌和非癌組織K和D值都具有較好的可重復(fù)性。目的:比較超高b值擴(kuò)散加權(quán)成像(DWI)、體素內(nèi)不相關(guān)運(yùn)動(dòng)成像(IVIM)和擴(kuò)散峰度(DKI)鑒別移行帶前列腺癌和基質(zhì)、腺體良性前列腺增生(BPH)的價(jià)值。材料和方法:回顧性分析14例移行帶前列腺癌(22個(gè)癌灶)和23例BPH患者(22個(gè)基質(zhì)BPH和22個(gè)腺體BPH)穿刺活檢前的超高b值DWI、IVIM和DKI檢查的影像資料。計(jì)算所有癌灶、基質(zhì)BPH和腺體BPH的ADC3000、K、Dk、Dslow、Dfast、f和ADC12b。計(jì)算每個(gè)參數(shù)的平均值和標(biāo)準(zhǔn)差。采用方差分析比較移行帶前列腺癌和基質(zhì)BPH和腺體BPH之間的參數(shù)的差異。受試者工作特性(receiver operating characteristic, ROC)曲線分析各參數(shù)的診斷效能。結(jié)果:移行帶前列腺癌中的K值比基質(zhì)BPH和腺體BPH中的高(P值都為0.000)。移行帶前列腺癌中的ADC3000、Dk、Dslow、f和ADC13b比基質(zhì)BPH和腺體BPH中的低(P值都為0.000)。移行帶前列腺癌與基質(zhì)BPH和腺體BPH之間的Dfast無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。ADC3000、K、Dk、Dslow、f和ADC12b鑒別移行帶前列腺癌與基質(zhì)BPH的曲線下面積分別為0.957、0.926、0.942、0.867、0.793和0.894。ADC3000、K、Dk和ADC13b鑒別移行帶與腺體BPH的曲線下面積都為1。結(jié)論:ADC3000和Dk分別在移行帶前列腺癌和基質(zhì)BPH和腺體BPH之間顯著不同,使用它們可以提高鑒別診斷移行帶前列腺癌和基質(zhì)BPH和腺體BPH的效能。
[Abstract]:Objective: To evaluate the feasibility of the parameters of intravoxel incoherent motion (IVIM) model to identify the prostate transitional zone and the noncancerous tissue in the peripheral zone and the reproducibility of the parameters in the short term and in the observer. Materials and methods: using the 3.0T GE magnetic resonance (magnetic resonance MR) scanner for 23 cases of prostate The patients were treated with 12 b values (0-3000s/mm2) IVIM scan. The parameters Dslow, Dfast, F, and apparent diffusion coefficient (apparent diffusion coefficient, ADC12b) generated by the IVIM model were calculated. The cancer foci and benign prostatic hyperplasia (benign) and glands were compared by variance analysis. The cancer foci and good in the peripheral zone were compared. The difference between the parameters of the peripheral zone and the normal peripheral zone. The reproducibility evaluation of the IVIM parameters in the two time examination was evaluated by the coefficient of variation (coefficient of variation, CV), Bland-Altman analysis, and the intra group correlation analysis was evaluated by the intra group correlation coefficient (intraclass correlation coefficient, ICC). The values of Dslow, ADC12b and F in the adenocarcinoma of the adenocarcinoma were lower than that of the matrix and BPH (P was 0); the Dslow, ADC12b and F values in the peripheral zone were lower than those of the benign and normal peripheral zones (P were 0). Two times for the examination of the Dslow (CV2.1-5.8%, BA-LA-21-21%) and the repeatability of the non cancerous tissues in the transitional zone. F (CV 4.4-10.3%, BA-LA -42-41%), Dfast's repeatability (CV 12.8-24.5%, BA-LA -101 -89%). The repeatability of prostate and noncancerous tissues in the peripheral zone is the same as that in the transitional zone. The reproducibility of C12b in the normal peripheral zone is the best. The consistency of all the cancer and noncancerous tissue in the consistent transitional zone of the observer is excellent. Conclusion: the preliminary results show that the Dslow, ADC12b, and F values of the prostate transitional zone and the peripheral zone are significantly different from those in the non cancer group. The reproducibility of Dslow and ADC12b in medium and noncancerous tissues is good, f times, and Dast repeatability. Objective: To evaluate the feasibility of the diffusion kurtosis imaging (diffusion kurtosis imaging, DKI) parameters to identify the prostate transitional zone and the noncancerous tissue in the peripheral zone, and the reproducibility of the parameters in the short term and in the observer. Two times 3 B (0-3000s/mm2) DKI scans were performed on 23 cases of prostate patients with the 3.0T GE MR scanner. The parameters K and D of DKI were calculated. The variance analysis was used to compare the differences between the transitional zone prostate cancer and benign prostatic hyperplasia (BPH) and gland BPH, the difference between the peripheral zone prostate cancer and the benign peripheral zone and the normal peripheral zone. The reproducibility of the two examination of the DKI parameters was evaluated by the coefficient of variation (coefficient of variation, CV), Bland-Altman analysis, and the intra observation consistency analysis was evaluated by the intra group correlation coefficient (intraclass correlation coefficient, ICC). Results: the K value of the cancer was significantly higher than that of the matrix BPH and gland in the anterior gland migrating zone. BPH (P0.001), D value was significantly lower than matrix and BPH (P0.001); in the peripheral zone, the K value of the cancer was higher than that of the benign peripheral zone and normal peripheral zone, and the D value was lower than that of the benign and normal peripheral zone (P0.001). The repeatability of the K and D values of the cancer and non cancerous tissues in the transitional zone was examined by two times (CV 3.5-4.3% The reproducibility of K and D values in both middle and non cancer tissues is better (CV5.1-6.3%, BA-LA-24-21%; CV3.8-5.4%, BA-LA-21-23%). In the transitional zone, the K value is the best repeatability in the cancer, and the D value is similar in the cancer and matrix BPH and the gland BPH. In the peripheral zone, the K value in the cancer is best; the repeatability of the D value in the normal peripheral zone is the best. Good consistency of all the parameters of the carcinoma and noncancerous tissues in the consistent prostate transitional zone and the peripheral zone. Conclusion: the preliminary results show that the K and D values of the cancer and non cancerous tissues in the prostate transitional zone and the peripheral zone are significantly different. The values of K and D in the carcinoma and non cancer tissues of the prostate transitional zone and the peripheral zone are both good repeatable. Objective: To compare the value of ultra high B diffusion weighted imaging (DWI), voxel unrelated motion imaging (IVIM) and diffusion kurtosis (DKI) in the differential diagnosis of transitional prostate cancer and matrix, and the value of benign prostatic hyperplasia (BPH). Materials and methods: retrospective analysis of 14 cases of transitional zone prostate cancer (22 cancer foci) and 23 cases of BPH patients (22 matrix BPH and 22 glands. Body BPH) the imaging data of the ultra high b value DWI, IVIM and DKI before biopsy. Calculate the average and standard deviation of all the cancer foci, the ADC3000 of the matrix BPH and the BPH of the gland, K, Dk, Dslow, Dfast, and the difference between the parameters of each parameter. Diagnostic efficacy of receiver operating characteristic (ROC) curve analysis. Results: the K value in transitional zone prostate cancer is higher than that in matrix BPH and gland BPH (P value is 0). ADC3000, Dk, Dslow, F and basal mass and glands in transitional zone prostate cancer (0). Transitional zone prostate The Dfast between cancer and matrix BPH and gland BPH was not statistically significant (P0.05).ADC3000, K, Dk, Dslow, F and ADC12b, respectively. The area under the curve of prostate cancer and matrix BPH was 1. There is a significant difference between the transitional zone prostate cancer and the matrix BPH and the glandular BPH. The use of them can improve the effectiveness of the differential diagnosis of transitional prostate cancer and matrix BPH and BPH.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R737.25

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