本文關(guān)鍵詞：磁共振功能成像在喉及下咽癌診斷及放化療療效評(píng)估中的應(yīng)用研究　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 喉及下咽癌 體素內(nèi)不相干運(yùn)動(dòng)擴(kuò)散加權(quán)成像 磁共振成像 下咽癌 誘導(dǎo)化療 體素內(nèi)不一致運(yùn)動(dòng)擴(kuò)散加權(quán)成像 放化療 動(dòng)態(tài)增強(qiáng)磁共振成像 喉及下咽癌 半定量參數(shù) 喉及下咽癌 動(dòng)態(tài)增強(qiáng)磁共振成像 同步放化療

【摘要】：第一部分喉及下咽癌MR體素內(nèi)不相干運(yùn)動(dòng)擴(kuò)散加權(quán)成像(IVIM-DWI)特征目的:分析喉及下咽癌MR體素內(nèi)不相干運(yùn)動(dòng)擴(kuò)散加權(quán)成像(IVIM-DWI)特征,探討IVIM-DWI對(duì)喉及下咽癌的診斷價(jià)值。材料與方法:分析2014年11月-2015年8月經(jīng)我院診治并病理證實(shí)的32例喉及下咽癌患者,治療前行MR擴(kuò)散加權(quán)成像(IVIM-DWI)序列檢查。IVIM序列掃描采用12個(gè)b值(0、10、20、30、50、70、100、150、200、400、800和1000s/mm2)。IVIM-DWI掃描所得原始數(shù)據(jù)經(jīng)雙指數(shù)模型處理,生成對(duì)應(yīng)參數(shù)圖。分別測量原發(fā)癌、正常咽壁及不同病理分級(jí)原發(fā)癌的純擴(kuò)散系數(shù)D值、偽擴(kuò)散系數(shù)D*值及灌注分?jǐn)?shù)f值,比較及分析其差異。結(jié)果:D、f值在喉與下咽癌組間無顯著差異(P0.903、0.223),D*值在組間有顯著差異(P=0.028)。原發(fā)癌D、D*及f值分別為(0.84±0.22)×10-3mm2/s、(65.71± 19.66)X 10-3mm2/s和44.90%± 14.49%;正常咽壁組織D、D*及f分別為(1.48± 1.04)×10-3mm2/s、(37.85±14.04)× 10-3mm2/s 和35.88%±11.51%。原發(fā)癌與正常咽壁D、D*及f值比較,D值較正常咽壁低(P=0.001),D*、f值較正常咽壁高(P=0.000、0.006)。ROC曲線分析D值診斷效能最佳,以D=0.949×10-3mm2/s為閾值,鑒別原發(fā)癌與正常咽壁,敏感度、特異度和準(zhǔn)確度分別為91.2%、88.2%和85.5%。不同病理分級(jí)原發(fā)癌比較,D、f在各組間無顯著差異(P=0.558、0.809),D*值有顯著差異(P=0.001)。D*值在高分化組與中、低分化組間比較差異具有顯著性(P=0.027、0.000),在中分化與低分化組間無顯著性差異(P==0.110)。結(jié)論:喉及下咽癌與正常咽壁IVIM參數(shù)存在顯著差別,D值的診斷價(jià)值最高。D*值在不同病理分級(jí)的喉及下咽癌中存在差異,可以在一定程度上反映腫瘤的分化程度。第二部分IVIM-DWI預(yù)測下咽癌誘導(dǎo)化療療效價(jià)值研究目的:探討MR擴(kuò)散加權(quán)成像(IVIM-DWI)預(yù)測進(jìn)展期下咽癌誘導(dǎo)化療療效的價(jià)值。材料與方法:搜集2014年12月-2015年10月經(jīng)我院診治并病理證實(shí)的28例下咽癌患者,在治療前及誘導(dǎo)化療后3周內(nèi)分別行IVIM-DWI檢查。IVIM序列設(shè)置12個(gè)b值(b=0、10、20、30、50、70、100、150、200、400、800 和 1000 s/mm2)。分析 IVIM雙指數(shù)模型D*、D、f值,并與單指數(shù)模型ADC值進(jìn)行比較,誘導(dǎo)化療結(jié)束后進(jìn)行療中評(píng)價(jià)。根據(jù)RECIST標(biāo)準(zhǔn),將患者分為治療有效組(CR和PR)和無效組(SD和PD)。根據(jù)腫瘤的病理分級(jí),將患者分為高分化組(G1)、中分化組(G2)和低分化組(G3)。有預(yù)測價(jià)值的IVIM參數(shù)及閾值通過獨(dú)立樣本t檢驗(yàn)、單因素方差分析和受試者特征曲線(ROC)分析和確定。結(jié)果:接受誘導(dǎo)化療的下咽癌患者中,18例治療有效,10例治療無效。誘導(dǎo)化療后,IVIM參數(shù)中ADC、D值均升高,D*值降低(P均0.05),f值改變不明顯(P0.05)。與治療無效組比較,治療有效組中療前ADC、D、療后D*值較低,療后ADC、D、AADC、△D和△D*較高,而△f變化不顯著。ROC曲線分析治療前D值預(yù)測療效最佳,以D值為0.847×10-3 mm2/s為閾值,對(duì)應(yīng)的AUC、敏感度和特異度分別為0.806、75.0%和88.9%。盡管治療前IVIM各參數(shù)在不同病理分化組的下咽癌間無顯著差異,但隨著病理分級(jí)的增高(低分化到高分化),D*值有逐漸降低的趨勢。結(jié)論:IVIM-DWI有助于預(yù)測下咽癌誘導(dǎo)化療療效,可以為后續(xù)臨床治療提供有價(jià)值信息。第三部分MR動(dòng)態(tài)增強(qiáng)(DCE-MRI)半定量預(yù)測喉及下咽癌放化療近期療效研究目的:分析及探討MR動(dòng)態(tài)增強(qiáng)(DCE-MR)半定量參數(shù)預(yù)測喉及下咽癌放化療近期療效的價(jià)值。材料與方法:搜集2013年12月-2015年10月經(jīng)病理確診的62例喉癌及下咽癌患者,分別于治療前及治療后3周內(nèi)行DCE-MRI檢查。治療結(jié)束后根據(jù)RECIST標(biāo)準(zhǔn),將患者分為治療有效組(包括CR和PR)和治療無效組(包括SD和PD)。分析時(shí)間信號(hào)曲線(TIC曲線)相關(guān)的半定量參數(shù):達(dá)峰時(shí)間(TTP),最大上升斜率(MSI),最大下降斜率(MSD)和正性增強(qiáng)積分(PEI),比較其在兩組間的差異,建立預(yù)測治療有效的閾值。結(jié)果:放化療結(jié)束三周內(nèi)評(píng)價(jià),54例治療有效,8例治療無效。與治療前相比,治療后的MSI、MSD和PEI均顯著降低(P0.05)。與治療無效組比較,治療有效組療前MSI、MSD和PEI值較高(P0.05),療后MSI、MSD和PEI均較低(P0.05),而TTP在治療前后均無明顯改變(P0.05)。ROC曲線分析,治療前MSI為預(yù)測療效有效的最佳指標(biāo),其閾值為154.81時(shí),對(duì)應(yīng)的曲線下面積(AUC)、敏感度和特異度分別為0.882、89.3%和 73.5%。結(jié)論:DCE-MRI半定量參數(shù)有助于預(yù)測喉及下咽癌早期放化療療效。第四部分MR動(dòng)態(tài)增強(qiáng)(DCE-MRI)定量預(yù)測喉及下咽癌同步放化療敏感性研究目的:探討MR動(dòng)態(tài)增強(qiáng)掃描(DCE-MRI)定量參數(shù)預(yù)測喉及下咽癌對(duì)同步放化療敏感性的價(jià)值。材料與方法:搜集2014年12月-2015年12月經(jīng)本院喉鏡活檢病理證實(shí)并行同步放化療治療的喉及下咽癌患者36例。所有患者于治療前行DCE-MRI檢查,放療劑量累積達(dá)50Gy時(shí)行療中MRI復(fù)查。根據(jù)治療結(jié)束后腫瘤緩解情況,分為完全緩解組(CR)及部分緩解組(PR)。測量DCE-MRI定量參數(shù)包括:容積轉(zhuǎn)移常數(shù)(Ktrans)、速率常數(shù)(Kep)和血管外細(xì)胞外容積分?jǐn)?shù)(Ve)值,比較三者在CR組與PR組間的差異,并繪制ROC曲線評(píng)估各定量參數(shù)預(yù)測喉及下咽癌同步放化療近期療效的效能。結(jié)果:36例喉及下咽癌,同步放化療后達(dá)CR20例,PR 16例。喉癌和下咽癌組間療前DCE-MRI各定量參數(shù)比較均未見顯著差異(P均0.05)。療前CR組Ktrans、Kep和Ve值分別為(0.307±0.055)/min、(0.527±0.114)/min和0.587±0.045,療前PR組Ktrans、Kep和Ve值分別為(0.234±0.049)/min、(0.390±0.090)/min和0.602±0.037。療前CR組和PR組比較,Ktrans和Kep差異均有統(tǒng)計(jì)學(xué)意義(P均0.05),Ve差異無統(tǒng)計(jì)學(xué)意義(P0.05)。ROC曲線分析,以Ktrans=0.283/min為閾值,預(yù)測同步放化療后達(dá)CR,相應(yīng)的AUC、敏感度及特異度分別為0.839、70.0%和81.2%;以Kep=0.446/min為閾值,預(yù)測同步放化療后達(dá)CR,相應(yīng)的AUC、敏感度及特異度分別為0.809、75.0%和75.0%。結(jié)論:療前DCE-MRI定量參數(shù)有助于預(yù)測喉及下咽癌同步放化療敏感性。
[Abstract]:The first part of larynx and hypopharynx carcinoma is MR intra body incoherent motion diffusion-weighted imaging (IVIM-DWI). Purpose: to analyze the characteristics of MR voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in larynx and hypopharyngeal carcinoma, and to explore the diagnostic value of IVIM-DWI for laryngeal and hypopharyngeal carcinoma. Materials and methods: 32 patients with laryngopharyngeal and hypopharyngeal carcinoma confirmed by pathology in our hospital in November 2014 8, -2015, were treated by MR diffusion-weighted imaging (IVIM-DWI) sequence. The IVIM sequence scan uses 12 b values (0, 10, 20, 30, 50, 70, 100, 150, 200, 400, 800, and 1000s/mm2). The original data obtained by IVIM-DWI scan are processed by double exponential model, and the corresponding parameters are generated. The pure diffusion coefficient D value, pseudo diffusion coefficient D* value and perfusion fraction f value of primary carcinoma, normal pharyngeal wall and different pathological grades of primary carcinoma were measured and compared. Results: there was no significant difference between the D and F values in the larynx and hypopharyngeal cancer groups (P0.903, 0.223), and there was a significant difference between the groups of D* (P=0.028). The values of D, D* and F in primary carcinoma were (0.84 + 0.22) x 10-3mm2/s, (65.71 + 19.66) X 10-3mm2/s and 44.90% + 14.49%, respectively, and D, D* and F in normal pharyngeal tissues were (1.48 + 1.04) x 10-3mm2/s, 37.85 37.85 14.04, 35.88% and 35.88% 35.88%, respectively. Compared with normal pharyngeal wall D, D* and F, the value of D was lower than that of normal pharynx wall (P=0.001), and the value of D* and F was higher than that of normal pharynx wall (P=0.000, 0.006). ROC curve analysis D value has the best diagnostic efficiency. The sensitivity, specificity and accuracy of D=0.949 value 10-3mm2/s as the threshold value are 91.2%, 88.2% and 85.5%, respectively. There was no significant difference between D and f (P=0.558, 0.809), and significant difference in D* (P=0.001). There was a significant difference in the D* value between the highly differentiated group and the moderately differentiated group (P=0.027, 0), but there was no significant difference between the moderately differentiated and the poorly differentiated group (P==0.110). Conclusion: there is a significant difference between the IVIM parameters of laryngeal and hypopharyngeal carcinoma and the normal pharyngeal wall, and the value of D is the highest. The difference of D* value in different pathological grades of larynx and hypopharyngeal carcinoma can reflect the degree of differentiation of the tumor to a certain extent. The second part is the value of IVIM-DWI in predicting the efficacy of induction chemotherapy for hypopharyngeal carcinoma. Objective: To explore the value of MR diffusion weighted imaging (IVIM-DWI) in predicting the efficacy of induction chemotherapy for advanced hypopharyngeal carcinoma. Materials and methods: a total of 28 hypopharyngeal cancer patients diagnosed and pathologically confirmed in our hospital in December 2014 10, -2015, were collected for IVIM-DWI examination before treatment and 3 weeks after induction chemotherapy. The IVIM sequence sets 12 b values (b=0, 10, 20, 30, 50, 70, 100, 150, 200, 400, 800, and 1000 s/mm2). The values of D*, D, and F of IVIM double index model were analyzed and compared with the ADC value of single index model, and the evaluation was made in the treatment of chemotherapy after chemotherapy. According to the RECIST standard, the patients were divided into effective treatment group (CR and PR) and ineffective group (SD and PD). According to the pathological grade of tumor, the patients were divided into high differentiation group (G1), middle differentiation group (G2) and low differentiation group (G3). The predictive value of IVIM parameters and thresholds was analyzed and determined by independent sample t test, single factor variance analysis and subject characteristic curve (ROC). Results: of the patients with hypopharyngeal carcinoma receiving induction chemotherapy, 18 cases were treated effectively and 10 cases were not effective. After induction chemotherapy, the values of ADC and D in the IVIM parameters were all increased, the value of D* decreased (P 0.05), and the F value was not significantly changed (P0.05). Compared with group therapy, treatment group before treatment in ADC, D, D* after treatment was lower, after treatment of ADC, D, AADC, Delta D and delta D* is higher, but there was no significant change in F. ROC curve analysis showed that the best prediction value of D before treatment was D value of 0.847 * 10-3 mm2/s, and the corresponding AUC, sensitivity and specificity were 0.806, 75% and 88.9%, respectively. Although there was no significant difference in the parameters of IVIM between hypopharyngeal carcinoma of different pathological differentiation group before treatment, but with the increase of pathological grade (low differentiation to high differentiation), the D* value tended to decrease. Conclusion: IVIM-DWI is helpful to predict the curative effect of hypopharyngeal carcinoma induced chemotherapy and can provide valuable information for follow-up clinical treatment. The third part is MR dynamic enhancement (DCE-MRI) semi quantitative prediction of the short-term efficacy of radiotherapy and chemotherapy for laryngeal and hypopharyngeal carcinoma. Objective: to analyze and discuss the value of MR dynamic enhancement (DCE-MR) semi quantitative parameter in predicting the short-term efficacy of radiotherapy and chemotherapy for laryngeal and hypopharyngeal carcinoma. Materials and methods: 62 cases of laryngocarcinoma and hypopharyngeal carcinoma diagnosed in December 2013 10 menstrual period in -2015 were collected, and DCE-MRI examination was performed before and 3 weeks after treatment. After the treatment, the patients were divided into effective group (including CR and PR) and the treatment group (including SD and PD) according to the RECIST standard. The semi quantitative parameters related to time signal curve (TIC curve) were analyzed: peak to peak time (TTP), maximum ascending slope (MSI), maximum descending slope (MSD) and positive reinforcement integral (PEI). The difference between the two groups was compared, and an effective threshold for predicting treatment was established. Results: after three weeks of chemotherapy and chemotherapy, 54 cases were treated effectively and 8 cases were not effective. Compared with before treatment, MSI, MSD and PEI after treatment were significantly decreased (P0.05). Compared with the treatment ineffective group, the effective MSI, MSD and PEI values of the effective group were higher (P0.05). After treatment, MSI, MSD and PEI were all lower (P0.05), while TTP had no obvious change before and after treatment (P0.05). ROC curve analysis showed that MSI was the best index for predicting effective response before treatment. When the threshold value was 154.81, the corresponding area under the curve (AUC), sensitivity and specificity were 0.882, 89.3% and 73.5%, respectively. Conclusion: DCE-MRI semi quantitative parameters can be used to predict the early radiotherapy and chemotherapy of larynx and hypopharyngeal carcinoma. The fourth part is MR dynamic enhancement (DCE-MRI) to predict the sensitivity of concurrent chemoradiotherapy for laryngeal and hypopharyngeal carcinoma. Objective: To explore the value of MR dynamic enhanced scan (DCE-MRI) in predicting the sensitivity of laryngeal and hypopharyngeal carcinoma to concurrent chemoradiotherapy. Materials and methods: collection of laryngoscope biopsy pathology confirmed in our hospital in December 2014, -2015, -2015.
【學(xué)位授予單位】：北京協(xié)和醫(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;R739.63

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