本文關(guān)鍵詞：ADC值及DCE-MRI定量分析在前列腺癌侵襲性評(píng)估中的應(yīng)用　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:探討前列腺癌表觀彌散系數(shù)(ADC)值及動(dòng)態(tài)對(duì)比增強(qiáng)磁共振掃描(DCE-MRI)定量參數(shù)轉(zhuǎn)運(yùn)常數(shù).(Ktrans)、血管外細(xì)胞外間隙體積百分?jǐn)?shù)(Ve)及數(shù)率常數(shù)(Kep)對(duì)前列腺癌侵襲性評(píng)估的價(jià)值。材料與方法:應(yīng)用GE公司3.0 T HDX TWINSP設(shè)備對(duì)臨床疑診前列腺癌的154例患者行磁共振平掃、DWI及動(dòng)態(tài)增強(qiáng)檢查,將其中經(jīng)病理證實(shí)的62例前列腺癌患者納入本研究。根據(jù)MRI平掃及增強(qiáng)圖像確定前列腺病變的形態(tài)、范圍、強(qiáng)化特點(diǎn)及與周圍組織的關(guān)系,在GE工作站經(jīng)GE Function軟件自動(dòng)處理后獲得ADC圖,測(cè)量疑診前列腺癌的感興趣區(qū)ADC值。將所得動(dòng)態(tài)增強(qiáng)數(shù)據(jù)刻盤,在另一臺(tái)電腦將數(shù)據(jù)導(dǎo)入GE藥業(yè)公司開(kāi)發(fā)的專用動(dòng)態(tài)增強(qiáng)分析軟件Omni Kinetics Manual,選取疑診前列腺癌的感興趣區(qū)測(cè)量容積轉(zhuǎn)運(yùn)常數(shù)(Ktrans)、血管外細(xì)胞外間隙體積百分?jǐn)?shù)(Ve)及數(shù)率常數(shù)(Kep)。所有患者在MRI檢查1周內(nèi)行超聲引導(dǎo)下穿刺,除常規(guī)12個(gè)穿刺區(qū)外,對(duì)MRI提示的病灶區(qū)進(jìn)行穿刺。根據(jù)穿刺病理結(jié)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(duì)五組檢查者的ADC、Ktrans、Ve及Kep值進(jìn)行比較分析,應(yīng)用Spearman相關(guān)性分析對(duì)ADC、Ktrans、Ve及Kep值與Gleason分級(jí)進(jìn)行相關(guān)性研究。應(yīng)用受試者工作特征(ROC)曲線分析,估計(jì)曲線下面積(AUC)分析ADC值聯(lián)合Ktrans值評(píng)估前列腺癌侵襲性。結(jié)果:ADC值隨Gleason評(píng)分的升高而降低,Ktrans值隨Gleason評(píng)分的升高而升高,且各組之間具有統(tǒng)計(jì)學(xué)意義(F=20.462,F=13.560,P0.05),前列腺癌區(qū)的 ADC 值與 Gleason 呈負(fù)相關(guān)(r=-0.636,P0.05),Ktrans值與 Gleason 成正相關(guān)(r=0.562,P0.05),Kep及Ve在不同Gleason評(píng)分組間差異無(wú)統(tǒng)計(jì)學(xué)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(yīng)用的AUC大于單獨(dú)使用,差別有統(tǒng)計(jì)學(xué)意義(P0.05),在GS≤8與GS≥9的前列腺癌中聯(lián)合ADC值及Ktrans值A(chǔ)UC大于單獨(dú)使用兩者且差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:ADC值和Ktrans值都可以用來(lái)評(píng)估對(duì)前列腺癌的侵襲性,聯(lián)合使用ADC和Krtn5值對(duì)前列腺癌侵襲性的評(píng)估產(chǎn)生更好的診斷性能。ADC值與Gleason評(píng)分呈中度負(fù)相關(guān),Ktrans值與Gleason評(píng)分呈中度正相關(guān)。因此,ADC值及Ktrans具有預(yù)測(cè)前列腺癌惡性程度的潛力,有助于評(píng)估前列腺癌的侵襲能力,對(duì)于制定治療方案及評(píng)價(jià)預(yù)后至關(guān)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(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.25;R445.2

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