本文關(guān)鍵詞： 肝轉(zhuǎn)移瘤 化療 表觀擴(kuò)散系數(shù) 磁共振　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評估表觀彌散系數(shù)（ADC)在胃腸道癌肝臟轉(zhuǎn)移化療療效預(yù)測和早期評價(jià)中的臨床應(yīng)用價(jià)值。 材料與方法 研究對象：收集2012年1月到2014年1月年我院20例胃、結(jié)直腸癌肝臟轉(zhuǎn)移患者的完整臨床及影像資料，其中胃癌肝臟轉(zhuǎn)移8位患者22個(gè)病灶，結(jié)直腸癌肝轉(zhuǎn)移12例患者43個(gè)病灶，共計(jì)65個(gè)病灶。 檢查方法：采用荷蘭Philips Pulsar HP1.5T磁共振掃描儀，應(yīng)用腹部8通道相控陣線圈。 圖像分析：在化療前、化療后2周、12周行磁共振（magnetic resonance,MR）檢查；將原始圖像傳到Philips EWS2.6.3.2工作站進(jìn)行分析和后處理，利用自帶軟件生成ADC圖并測量ADC值，分別測量轉(zhuǎn)移瘤化療前、化療后2周、12周ADC值及最大直徑，根據(jù)化療12周后轉(zhuǎn)移瘤最大直徑的變化，把所有轉(zhuǎn)移瘤分成對化療敏感的有效組和不敏感的無效組，評判兩組化療前、化療后2周、12周三個(gè)時(shí)間點(diǎn)的ADC值及轉(zhuǎn)移瘤最大直徑的差異。 統(tǒng)計(jì)學(xué)分析：使用SPSS18.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析。首先對兩組數(shù)據(jù)進(jìn)行正態(tài)分布性檢驗(yàn)；然后比較兩組轉(zhuǎn)移瘤治療前、后ADC值及最大直徑和年齡的差異；采用Spearman秩相關(guān)性分別對治療前轉(zhuǎn)移瘤ADC值與治療前最大直徑、治療后轉(zhuǎn)移瘤ADC值與治療后最大直徑、治療前轉(zhuǎn)移瘤ADC值與直徑減少率、ADC變化率與轉(zhuǎn)移瘤直徑減少率、治療前的轉(zhuǎn)移瘤最大直徑與轉(zhuǎn)移瘤減少率進(jìn)行相關(guān)性分析，確定其相關(guān)性；使用接受者工作特征（ROC））曲線確定化療前最適的ADC值，以確定預(yù)測胃腸道癌肝轉(zhuǎn)移瘤對化療無效的敏感性及特異性，及預(yù)測的陽性及陰性值。 結(jié)果在65個(gè)病灶中對化療有效的30個(gè)病灶，，無效的35個(gè)病灶，化療前敏感組ADC值（1.05±0.07×10-3mm2/s）與不敏感組（1.26±0.09×10-3mm2/s）對比有明顯統(tǒng)計(jì)學(xué)的差異(P0.001)，化療敏感組在2周后ADC值明顯上升(1.30±0.02×10-3mm2/s,P0.001),與此同時(shí)不敏感的ADC值與治療前對比無顯著差異（1.29±0.10×10-3mm2/s,P=0.128)；化療后12周后有效組上升至1.35±0.06×10-3mm2/s(P0.001），而無效組亦無明顯變化1.27±0.06×10-3mm2/s（P=0.146）；在治療前ADC值與腫瘤最大直徑無明顯相關(guān)性（r=0.191,P=0.127）；治療后ADC值與腫瘤最大直徑無明顯相關(guān)性亦無相關(guān)性（r=0.067,P=0.597）；而治療前平均ADC值與胃腸道癌肝轉(zhuǎn)移瘤減少率呈明顯負(fù)相關(guān)性（r=-0.670,P0.001）；治療后平均ADC值增加率與腫瘤最大直徑減小率呈明顯正相關(guān)性（r=0.685,P0.001）；腫瘤的減小率與治療前腫瘤的最大直徑無明顯相關(guān)性（r=-0.112,P=0.374）；ROC曲線下面積為0.913，以治療前ADC值=1.17×10-3mm2/s斷定轉(zhuǎn)移灶對化學(xué)治療無效的敏感性和特異性分別為80%和90%，判斷胃腸道癌肝轉(zhuǎn)移瘤對化療無效結(jié)果的陽性與陰性值為90.0%和91.4%。 結(jié)論（1）胃腸癌肝轉(zhuǎn)移瘤化療前平均ADC值高的病例對化療不敏感；（2）化療后ADC值早期增加的胃、結(jié)直腸癌肝轉(zhuǎn)移瘤對化學(xué)治療敏感；（3）ADC值能夠預(yù)測胃、結(jié)直腸癌肝轉(zhuǎn)移瘤對化療是否敏感，以治療前ADC值等于1.17×10-3mm2/s作為化療無效的臨界值斷定轉(zhuǎn)移瘤對化學(xué)治療無效的敏感性和特異性分別為80%和90%。
[Abstract]:Objective to evaluate the clinical value of apparent diffusion coefficient (ADC) in the prediction and early evaluation of the curative effect of liver metastasis chemotherapy for gastrointestinal cancer.
Materials and methods
Participants: a total of 20 patients with liver metastases from stomach and colorectal cancer from January 2012 to January 2014 were collected. The clinical data and imaging data of 8 patients with liver metastases from gastric cancer, 22 patients with liver metastases from colorectal cancer, 12 patients with 43 lesions, 65 lesions were included.
Examination method: using the Holland Philips Pulsar HP1.5T magnetic resonance scanner, the 8 channel phased array coil of the abdomen is applied.
Image analysis: before chemotherapy, 2 weeks after chemotherapy, 12 weeks underwent magnetic resonance (magnetic resonance, MR); the original image to Philips EWS2.6.3.2 workstation for analysis and postprocessing, the use of software to generate ADC and ADC measurements, respectively measuring metastases before chemotherapy, 2 weeks after chemotherapy, 12 weeks ADC value and maximum diameter, the maximum diameter of the tumor metastasis according to the change of chemotherapy after 12 weeks, all metastases into effective chemotherapy sensitive and insensitive to the invalid group, evaluation of two groups before chemotherapy, 2 weeks after chemotherapy, the difference between the 12 Wednesday time ADC and the maximum diameter of the metastases.
Statistical analysis: statistical analysis was performed using SPSS18.0 software package. The data of the two groups were tested for normal distribution; and then compare the two groups of metastatic tumor before treatment, the difference ADC and the maximum diameter and age; the Spearman rank correlation of ADC value before treatment of metastatic tumor before treatment with the maximum diameter, value and treatment after the maximum diameter of tumor metastasis of ADC after treatment, before the treatment of metastatic tumor ADC value and the diameter reduction rate, ADC rate and metastasis rate of decrease in diameter, the largest diameter of metastatic tumor before treatment and reduce the rate of metastasis by correlation analysis to determine the correlation; using the receiver operating characteristic (ROC) curve to determine the optimal chemotherapy before) the value of ADC to determine the sensitivity and specificity for prediction of tumor chemotherapy ineffective liver metastasis of gastrointestinal tract cancer, and the positive and negative predictive value.
Results 30 lesions in 65 lesions of effective chemotherapy, 35 lesions invalid, before chemotherapy sensitive group ADC (1.05 + 0.07 * 10-3mm2/s) and sensitive group (1.26 + 0.09 * 10-3mm2/s) had obvious statistical difference (P0.001), chemotherapy group at 2 weeks after the ADC value of Ming Dynasty significantly increased (1.30 + 0.02 * 10-3mm2/s, P0.001), at the same time is not sensitive to the ADC value had no significant difference compared with before treatment (1.29 + 0.10 * 10-3mm2/s, P=0.128); after 12 weeks after chemotherapy effective group increased to 1.35 + 0.06 * 10-3mm2/s (P0.001), and the ineffective group there was no obvious change of 1.27 + 0.06 * 10-3mm2/s (P=0.146); before treatment, ADC value and the maximum diameter of the tumor was no significant correlation (r=0.191, P=0.127); after treatment, ADC value and the maximum diameter of the tumor had no obvious correlation with no correlation (r=0.067, P=0.597); and before treatment the average ADC value decrease rate was significantly negative correlation with gastrointestinal cancer liver metastases (R =-0.670, P0.001); the average ADC value increased after treatment rate and maximum tumor diameter reduction rate was significantly correlated (r=0.685, P0.001); the maximum diameter of tumor reduction rate and tumor before treatment had no significant correlation (r=-0.112, P=0.374); the area under the ROC curve was 0.913, with the ADC value before treatment =1.17 * 10-3mm2/s concluded metastasis on chemical treatment is invalid. The sensitivity and specificity were 80% and 90%, the judgment of gastrointestinal cancer liver metastases results invalid to chemotherapy, the positive and negative values of 90% and 91.4%.
Conclusion (1) liver metastasis of gastrointestinal cancer chemotherapy before the average ADC value of high case is not sensitive to chemotherapy; (2) ADC increased early gastric value after chemotherapy for colorectal liver metastases are sensitive to chemotherapy; (3) the value of ADC can predict the stomach, liver metastases of colorectal cancer is sensitive to chemotherapy, to before treatment, ADC value is equal to the critical value of 1.17 * 10-3mm2/s as chemotherapy ineffective concluded that metastases were 80% and 90%. on chemical therapy sensitivity and specificity

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R735;R445.2;R730.53

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 L.Heijmen;E.E.G.W.ter Voert;I.D.Nagtegaal;P.Span;J.Bussink;C.J.A.Punt;徐后云;;結(jié)直腸癌肝轉(zhuǎn)移的MR擴(kuò)散加權(quán)成像:可重復(fù)性及生物學(xué)驗(yàn)證[J];國際醫(yī)學(xué)放射學(xué)雜志;2013年03期

2 I.R.Kamel;E.Liapi;D.K.Reyes;M.Zahurak;D.A.Bluemke;J.F.H. Geschwind;孫志超;;不可切除性肝細(xì)胞癌經(jīng)肝動脈化療栓塞后早期血管和細(xì)胞變化的MR監(jiān)測[J];國際醫(yī)學(xué)放射學(xué)雜志;2009年02期

3 李振武;張偉;孫立軍;齊順;;磁共振擴(kuò)散加權(quán)成像在肝癌化療栓塞術(shù)后隨訪中的價(jià)值[J];介入放射學(xué)雜志;2010年08期

4 鄭曉林;徐輝雄;呂明德;謝曉燕;徐作峰;賴英榮;;肝臟擴(kuò)散加權(quán)MRI在檢測消融后腫瘤存活中的應(yīng)用[J];臨床放射學(xué)雜志;2006年02期

5 黃昌保;江曉紅;江曉華;;大腸癌肝轉(zhuǎn)移的治療進(jìn)展[J];中國現(xiàn)代手術(shù)學(xué)雜志;2009年06期

6 桑莉;王濱;劉峰;吳圓圓;寧厚法;孫業(yè)全;蹇兆成;;兔VX2肝移植瘤TACE治療前后ADC值與細(xì)胞密度的相關(guān)性研究[J];醫(yī)學(xué)影像學(xué)雜志;2009年04期

7 鄭曉林;徐輝雄;呂明德;徐作峰;謝曉燕;賴英榮;;MR擴(kuò)散加權(quán)成像對經(jīng)皮肝臟消融灶組織成分定性研究的初探[J];中華放射學(xué)雜志;2006年04期

本文編號：1485505