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  本文關鍵詞：ADC值及DCE-MRI定量分析在前列腺癌侵襲性評估中的應用　出處：《山東大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 前列腺癌 Gleason分級 表觀彌散系數(shù) 動態(tài)對比增強磁共振掃描 侵襲性

【摘要】：目的:探討前列腺癌表觀彌散系數(shù)(ADC)值及動態(tài)對比增強磁共振掃描(DCE-MRI)定量參數(shù)轉運常數(shù).(Ktrans)、血管外細胞外間隙體積百分數(shù)(Ve)及數(shù)率常數(shù)(Kep)對前列腺癌侵襲性評估的價值。材料與方法:應用GE公司3.0 T HDX TWINSP設備對臨床疑診前列腺癌的154例患者行磁共振平掃、DWI及動態(tài)增強檢查,將其中經(jīng)病理證實的62例前列腺癌患者納入本研究。根據(jù)MRI平掃及增強圖像確定前列腺病變的形態(tài)、范圍、強化特點及與周圍組織的關系,在GE工作站經(jīng)GE Function軟件自動處理后獲得ADC圖,測量疑診前列腺癌的感興趣區(qū)ADC值。將所得動態(tài)增強數(shù)據(jù)刻盤,在另一臺電腦將數(shù)據(jù)導入GE藥業(yè)公司開發(fā)的專用動態(tài)增強分析軟件Omni Kinetics Manual,選取疑診前列腺癌的感興趣區(qū)測量容積轉運常數(shù)(Ktrans)、血管外細胞外間隙體積百分數(shù)(Ve)及數(shù)率常數(shù)(Kep)。所有患者在MRI檢查1周內行超聲引導下穿刺,除常規(guī)12個穿刺區(qū)外,對MRI提示的病灶區(qū)進行穿刺。根據(jù)穿刺病理結果分為GS=6分、GS=3+4分、GS=4+3分、GS=8分及GS=9～10五組,采用單因素方差分析對五組檢查者的ADC、Ktrans、Ve及Kep值進行比較分析,應用Spearman相關性分析對ADC、Ktrans、Ve及Kep值與Gleason分級進行相關性研究。應用受試者工作特征(ROC)曲線分析,估計曲線下面積(AUC)分析ADC值聯(lián)合Ktrans值評估前列腺癌侵襲性。結果:ADC值隨Gleason評分的升高而降低,Ktrans值隨Gleason評分的升高而升高,且各組之間具有統(tǒng)計學意義(F=20.462,F=13.560,P0.05),前列腺癌區(qū)的 ADC 值與 Gleason 呈負相關(r=-0.636,P0.05),Ktrans值與 Gleason 成正相關(r=0.562,P0.05),Kep及Ve在不同Gleason評分組間差異無統(tǒng)計學意義(r=0.116,r=0.179,P0.05),GS=3 + 3 與 GS≥7 之間、GS ≤ 3+4 與 GS≥4+3之間、GS≤4+3與GS≥8之間,ADC值與Ktrans值聯(lián)合應用的AUC大于單獨使用,差別有統(tǒng)計學意義(P0.05),在GS≤8與GS≥9的前列腺癌中聯(lián)合ADC值及Ktrans值AUC大于單獨使用兩者且差別無統(tǒng)計學意義(P0.05)。結論:ADC值和Ktrans值都可以用來評估對前列腺癌的侵襲性,聯(lián)合使用ADC和Krtn5值對前列腺癌侵襲性的評估產(chǎn)生更好的診斷性能。ADC值與Gleason評分呈中度負相關,Ktrans值與Gleason評分呈中度正相關。因此,ADC值及Ktrans具有預測前列腺癌惡性程度的潛力,有助于評估前列腺癌的侵襲能力,對于制定治療方案及評價預后至關重要。
[Abstract]:Objective: To investigate the apparent diffusion coefficient (ADC) value of prostate cancer and the quantitative parameter transport constant of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), (Ktrans), the value of extravascular extracellular space volume fraction (Ve) and rate constant (Kep) in evaluating the aggressiveness of prostate cancer. Materials and methods: using GE 3 T HDX TWINSP equipment company of clinically suspected prostate cancer 154 patients underwent MRI, DWI and dynamic enhanced examination, which will be the 62 prostate cancer patients confirmed by pathology were enrolled in this study. According to the MRI scan and enhanced image to determine the shape and range of prostate diseases, strengthening characteristics and the relationship with the surrounding tissue, in the GE workstation by GE Function software automatically after ADC, measuring suspected prostate cancer region of interest ADC. The dynamic enhanced data Kepan, on another computer analysis software Omni Kinetics Manual special dynamic development data into the GE pharmaceutical company's enhancement, volume measurement of region of interest selection of suspected prostate cancer transfer constant (Ktrans), extravascular extracellular space volume fraction (Ve) and rate constant (Kep). All patients underwent ultrasound guided puncture in the MRI examination for 1 weeks. In addition to the conventional 12 puncture areas, the lesions were punctured by MRI. According to the pathological results were divided into GS=6 and GS=3+4, GS=4+3, GS=8 and GS=9 10 ~ five group, using the single factor analysis of variance of the examinations of the five groups of ADC, Ktrans, Ve and Kep value for comparative analysis, Spearman correlation analysis was used for ADC, Ktrans, Ve and Kep were associated with Gleason classification. The ROC curve analysis was used to estimate the area (AUC) of the under curve (AUC) to evaluate the ADC value combined with the value of Ktrans to evaluate the invasiveness of prostate cancer. Results: the ADC value increased with the Gleason score decreased, Ktrans value increased with the increase of Gleason score, and the difference was significant between the groups (F=20.462, F=13.560, P0.05), the ADC values of prostate cancer was negatively correlated with Gleason (r=-0.636, P0.05), Ktrans value is positively correlated with Gleason (r=0.562, P0.05), no statistically significant differences in Kep and Ve Gleason scores between groups (r=0.116, r=0.179, P0.05), GS=3 + 3 and GS = 7, GS = 3+4 and GS between 4+3 and GS, between GS = 4+3 = 8, the value of ADC combined with Ktrans value of AUC is greater than used alone, there are statistically significant difference (P0.05), in GS = 8, GS = 9 and prostate cancer combined with ADC and Ktrans values greater than AUC alone and there was no significant difference between the two (P0.05). Conclusion: both ADC and Ktrans values can be used to evaluate the aggressiveness of prostate cancer. Combined use of ADC and Krtn5 values can produce better diagnostic performance for invasive assessment of prostate cancer. The ADC value had a moderate negative correlation with the Gleason score, and the Ktrans value had a moderate positive correlation with the Gleason score. Therefore, ADC and Ktrans have potential to predict the malignancy degree of prostate cancer. It helps to evaluate the invasive ability of prostate cancer, and is essential for formulating therapeutic regimens and evaluating prognosis.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.25;R445.2

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本文編號：1346155