本文選題：磁共振成像　切入點：擴(kuò)散加權(quán)成像　出處：《南京醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分功能MR成像在直腸癌新輔助放化療療效評估中的運用及臨床價值研究一目的:評估擴(kuò)散峰度成像(DKI)在評估局部晚期直腸癌患者新輔助放化療治療反應(yīng)中的可行性和價值。材料方法:本研究納入41名患者,所有患者在新輔助放化療前以及新輔助治療后均行MR檢查。后處理得到定量參數(shù)Dapp、Kapp以及ADC值,同時計算上述定量參數(shù)新輔助治療前后的變化值(AX)以及變化率(rΔX)。病理學(xué)腫瘤回歸分?jǐn)?shù)參考Mandard標(biāo)準(zhǔn):療效好的為pTRG1-2;療效差者為pTRG3-5。運用ROC分析比較診斷性能。結(jié)果:新輔助治療前的定量值pre-Dapp-10th在療效好的組低于療效差的組(p等于0.036)。ROC實驗得到pre-Dapp-10th的AUC為0.753(p等于0.036),敏感性為66.67%,特異性為77.78%。上述所有定量值中,Dapp值的前后變化率(rΔDapp)有相對最高的AUC(0.859)及敏感性(100%)。結(jié)論:DKI可以用于篩選出新輔助放化療療效好的局部晚期直腸癌患者。研究二目的:探索DCE-MRI評估局部晚期直腸癌患者新輔助放化療得到病理性完全緩解的價值。材料方法:35名局部晚期接受新輔助放化療的直腸癌患者納入研究。DCE-MRI后處理得到定量參數(shù)Ktrans、K以及Ve值,并計算新輔助放化療前后Ktrans的變化率:ΔKtrans=(post-Ktrans-pre-Ktrans)/pre-Ktrans。ROC 診斷實驗分析 DCE-MRI的預(yù)測價值以及敏感性、特異性。結(jié)果:Ktrans值新輔助放化療前后的變化值在病理完全緩解組顯著高于未緩解組(45.437%±10.703%vs.34.063%±15.856%,p 等于 0.022)。ΔKtrans的 AUC 為 0.777,敏感性為80%,以及特異性為75%。結(jié)論:DCE-MRI能夠評估局部晚期直腸癌新輔助放化療后的病理性完全緩解。第二部分功能MR成像與直腸癌遠(yuǎn)處轉(zhuǎn)移相關(guān)性的臨床研究研究一目的:探索常規(guī)彌散成像(DWI)及彌散峰度成像(DKI)與直腸腺癌遠(yuǎn)處轉(zhuǎn)移之間的相關(guān)性。材料與方法:58名直腸腺癌患者(其中27名發(fā)生遠(yuǎn)處轉(zhuǎn)移,31名沒有發(fā)生遠(yuǎn)處轉(zhuǎn)移)納入研究。常規(guī)彌散后處理得到ADC值(b值為0以及1000 sec/mm2),DKI后處理得到Dapp以及Kapp值(b值為0,700,1400以及2000 sec/mm2)。上述定量參數(shù)基于整體腫瘤分析(感興趣區(qū)域ROI包括整體腫瘤)。組間定量參數(shù)的比較使用獨立t檢驗,運用ROC診斷實驗評價定量參數(shù)鑒別遠(yuǎn)處轉(zhuǎn)移的效能。結(jié)果:定量參數(shù)Dapp直方圖分析得到百分位數(shù)值百分之十(Dapp-10th),ADC值最小值(ADC-min)在轉(zhuǎn)移組顯著低于對照組(0.972±0.119 vs 1.121±0.134及0.486±0.228 vs 0.596±0.086×10-3 mm2/s,p 值小于 0.05);Kapp最大值(Kapp-max)在轉(zhuǎn)移組顯著高于對照組(1.407±0.337vs1.215±0.147;P值等于0.014)。ROC診斷實驗發(fā)現(xiàn)Dapp-10th較ADC-min有更高的曲面下面積(0.856 vs.0.677),更高的特異性(100%vs 60%)。結(jié)論:與常規(guī)DWI相比,DKI能更好得區(qū)分直腸腺癌是否發(fā)生遠(yuǎn)處轉(zhuǎn)移。研究二目的:探索DCE-MRI定量參數(shù)與直腸癌遠(yuǎn)處轉(zhuǎn)移以及臨床病理學(xué)指標(biāo)的相關(guān)性。材料與方法:63名患者納入研究(其中發(fā)生遠(yuǎn)處轉(zhuǎn)移31名,未發(fā)生遠(yuǎn)處轉(zhuǎn)移者32名)。定量參數(shù)(Ktrans、Kep以及Ve值)的比較運用t檢驗或者ANOVA檢驗;ROC診斷實驗用于評估DCE-MRI定量參數(shù)區(qū)分直腸腺癌是否發(fā)生遠(yuǎn)處轉(zhuǎn)移的效價。結(jié)果:Ktrans、Kep以及Ve值在轉(zhuǎn)移組顯著高于對照組(0.536±0.242vs0.299±0.118 min-1,p小于 0.001;1.598±0.477 vs 1.341±0.390 min-1,p等于 0.022;0.324±0.173 vs 0.249±0.091,p 等于 0.034)。定量參數(shù)中Ktrans值得 AUC 為 0.788(p小于 0.001),敏感性為61.29%,特異性為87.5%。結(jié)論:DCE-MRI定量參數(shù)有望成為預(yù)測直腸癌發(fā)生遠(yuǎn)處轉(zhuǎn)移的有效指標(biāo)。
[Abstract]:The first part of the study on the application of functional MR imaging in evaluation of chemotherapy efficacy and clinical value of neoadjuvant rectal cancer Objective: To evaluate the diffusion kurtosis imaging (DKI) in the assessment of patients with locally advanced rectal cancer neoadjuvant chemotherapy in the treatment of the feasibility and value of reaction. Materials and methods: the study included 41 patients, all patients before chemotherapy and neoadjuvant therapy in neoadjuvant were examined by MR and postprocessing quantitative parameters of Dapp, Kapp and ADC, and calculate the changes before and after neoadjuvant therapy for the quantitative values of the parameters (AX) and the rate of change (R X). The pathological tumor regression score Mandard standard reference: good curative effect for pTRG1-2; poor effect to pTRG3-5. using ROC analysis to compare the diagnostic performance of neoadjuvant therapy. Results: the quantitative values before pre-Dapp-10th was lower than that of poor outcome group in the curative group (P = 0.036).ROC pre-Dapp-10th AUC experiment 0.753 (P = 0.036), the sensitivity was 66.67%, specificity was 77.78%. all of the above quantitative value, before and after the change rate of Dapp value (R Dapp) had the highest relative AUC (0.859) and sensitivity (100%). Conclusion: DKI can be used for the screening of new adjuvant chemotherapy has good curative effect of local advanced study on two patients with rectal cancer. Objective: To explore the DCE-MRI evaluation of locally advanced rectal cancer patients with neoadjuvant chemotherapy and get pathological complete remission value. Materials and methods: 35 women with locally advanced rectal cancer patients received neoadjuvant chemotherapy were included in the study of.DCE-MRI postprocessing quantitative parameters of Ktrans, K and Ve, and calculate the rate of Ktrans neoadjuvant chemotherapy the change before and after chemotherapy: a Ktrans= (post-Ktrans-pre-Ktrans) /pre-Ktrans.ROC diagnosis experimental analysis of DCE-MRI predictive value and sensitivity, specificity. Results: the Ktrans value of neoadjuvant chemotherapy before and after chemotherapy in pathological changes completely The remission group was significantly higher than non remission group (45.437% + 10.703%vs.34.063% + 15.856%, P = 0.022). Ktrans AUC was 0.777, the sensitivity was 80%, and the specificity was 75%. conclusion: DCE-MRI can assess the pathological of locally advanced rectal cancer after neoadjuvant chemoradiotherapy in complete remission. Clinical research of second functional MR imaging and rectal cancer distant metastasis Objective: To explore the correlation between the conventional diffusion weighted imaging (DWI) and diffusion kurtosis imaging (DKI) and the correlation between rectal adenocarcinoma metastasis. Materials and methods: 58 patients with rectal cancer (including 27 metastasis, 31 without metastasis) were enrolled in the study. The conventional diffusion by postprocessing the ADC value (b value of 0 and 1000 sec/mm2), DKI Dapp postprocessing and Kapp value (b value of 07001400 and 2000 sec/mm2). The quantitative analysis based on the parameters of the whole tumor (region of interest including ROI The whole tumor.) using quantitative parameters between groups using independent t test, performance evaluation of ROC diagnosis of experimental quantitative parameter identification of distant metastasis. Results: the quantitative parameters of Dapp histogram analysis percentile ten percent (Dapp-10th), the ADC value of the minimum value (ADC-min) in the metastasis group was significantly lower than the control group (0.972 + 0.119 vs 1.121 + 0.134 and 0.486 + 0.228 vs 0.596 + 0.086 * 10-3 mm2/s, P value is less than 0.05); the maximum value of Kapp (Kapp-max) in the metastasis group was significantly higher than the control group (1.407 + 0.337vs1.215 + 0.147; P = 0.014).ROC diagnosis test showed that Dapp-10th is ADC-min higher surface area (0.856 vs.0.677), higher specificity (100%vs 60%). Conclusion: compared with conventional DWI, DKI can better distinguish whether rectal adenocarcinoma metastasis. Two research objective: To explore the quantitative parameters of DCE-MRI and colorectal cancer metastasis and clinical pathology refers to Subject correlation. Materials and methods: 63 patients (including distant metastasis occurred in 31, without the occurrence of distant metastasis 32). Quantitative parameters (Ktrans, Kep and Ve) comparison by t test or ANOVA test; ROC diagnostic tests for DCE-MRI quantitative parameters to evaluate the distinction of rectal adenocarcinoma is titer distant metastasis. Results: Ktrans, Kep and Ve value in metastasis group was significantly higher than the control group (0.536 + 0.242vs0.299 + 0.118 min-1, P is less than 0.001; 1.598 + 0.477 vs 1.341 + 0.390 min-1, P = 0.022; 0.324 + 0.173 vs 0.249 + 0.091, P = 0.034). The quantitative parameters of Ktrans AUC is worth 0.788 (p less than 0.001), the sensitivity was 61.29%, specificity was 87.5%. conclusion: DCE-MRI quantitative parameters prediction is expected to become the effective index of distant metastasis of rectal cancer.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R735.37;R445.2

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