發(fā)布時間：2018-04-10 09:06

  本文選題：直腸癌　切入點：表觀擴散系數(shù)　出處：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討磁共振擴散加權(quán)成像表觀擴散系數(shù)及功能擴散圖對局部進展期直腸癌術(shù)前放化療早期監(jiān)測的可行性及應(yīng)用價值,為臨床個體化治療方案的制定提供可靠的影像學(xué)依據(jù)。臨床資料和方法:收集2015年3月至2016年12月于我院診治的經(jīng)病理證實的局部進展期直腸癌患者32例作為研究對象,所有患者行術(shù)前同步放化療并分別于放化療前(A節(jié)點)、放化療第l周后(B節(jié)點)、放化療第2周后(C節(jié)點)、放化療結(jié)束后(D節(jié)點)4個監(jiān)測時間點行常規(guī)MRI及DWI檢查,生成對應(yīng)的ADC圖及功能擴散圖,分別測量腫瘤的浸潤深度及ADC值,計算不同監(jiān)測時間點ADC值的變化情況(包括變化值△ADC及變化率ADC%)以及功能擴散圖中紅色體素占比的變化值。根據(jù)Dworak’s腫瘤消退分級(tumor regression grade,TRG)標準將患者分為非敏感組(TRG0-2級)和敏感組(TRG3-4級)。采用兩獨立樣本t檢驗、Wilcoxon秩和檢驗、單因素方差分析、Kruskal-Wallis檢驗及ROC曲線對數(shù)據(jù)進行統(tǒng)計學(xué)分析。結(jié)果:1.32例直腸癌患者的腫瘤浸潤深度在不同時間節(jié)點之間存在顯著的統(tǒng)計學(xué)差異(P0.05),腫瘤的浸潤深度在治療過程中逐漸降低,主要集中在治療中后期;腫瘤的ADC值在不同時間節(jié)點之間亦存在顯著的統(tǒng)計學(xué)差異(P0.05),ADC值在治療過程中呈逐漸升高趨勢,在治療早期即顯示出明顯差異。2.32例患者中敏感組或非敏感組分別為20例和12例。敏感組和非敏感組不同時間節(jié)點的腫瘤ADC值比較均具有顯著統(tǒng)計學(xué)差異(P0.05),兩組的ADC值都隨治療時間逐漸上升。在A、B、C治療時間節(jié)點中敏感組的腫瘤ADC值與非敏感組二者比較均無統(tǒng)計學(xué)差異(P0.05);而D節(jié)點敏感組腫瘤的ADC值大于非敏感組的,且差異具有統(tǒng)計學(xué)意義(P0.05)。敏感組的△ADC1(放化療1周后與放化療前ADC值的差值)、△ADC3(放化療結(jié)束后與放化療第2周后ADC值的差值)大于非敏感組對應(yīng)的ADC1、ADC3,且具有統(tǒng)計學(xué)差異(P0.05)。敏感組的△ADC2(放化療第2周與第1周ADC值的差值)大于非敏感組的△ADC2,但二者無統(tǒng)計學(xué)差異(P0.05)。3、以治療后第1周腫瘤ADC值的升高值、變化率以及fDM紅色體素占比的變化值作為預(yù)測腫瘤對放化療敏感性的指標,采用ROC曲線分析結(jié)果如下:ADC值的升高值預(yù)測腫瘤對放化療反應(yīng)為敏感組的閾值為0.128×10-3 mm2/s,敏感性為70.0%,特異性為75.0%,曲線下面積為0.754(95%可信區(qū)間0.570~0.888);ADC變化率預(yù)測腫瘤對放化療反應(yīng)為敏感組的閾值為13.46%,敏感性為75.0%,特異性為66.7%,曲線下面積為0.733(95%可信區(qū)間0.548~0.873);紅色體素占比變化值預(yù)測腫瘤對放化療反應(yīng)為敏感組的閾值為18.78%,敏感性為85.0%,特異性為91.7%,曲線下面積為0.875(95%可信區(qū)間0.710~0.965)。上述三個指標的ROC曲線比較結(jié)果顯示fDM紅色體素占比的變化值的曲線下面積最大,但三者ROC的曲線下面積兩兩比較均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、ADC值反映腫瘤內(nèi)部微環(huán)境的變化,能早期、定量地評估直腸癌術(shù)前放化療的治療效果,較通過形態(tài)學(xué)改變來評估療效的方法有明顯優(yōu)勢。2、在直腸癌術(shù)前放化療的過程中,ADC值及其變化情況一定程度反映了癌腫對放化療的敏感程度,對治療方案的調(diào)整具有指導(dǎo)意義。3、直腸癌放化療第1周ADC值的變化值及變化率、fDM紅色體素占比變化值在早期判斷癌腫對放化療敏感與否具有較高的診斷效能,而fDM紅色體素占比的變化值的診斷價值最高。
[Abstract]:Objective: To investigate the magnetic resonance diffusion-weighted imaging apparent feasibility and application of chemotherapy and early detection of locally advanced rectal cancer preoperative diffusion coefficient and diffusion graph function value, making treatment for clinical provide reliable imaging evidence. The clinical data and methods: from March 2015 to December 2016 in our hospital by pathology confirmed locally advanced rectal cancer in 32 cases as the object of study, all patients underwent preoperative chemoradiotherapy and chemotherapy respectively before chemotherapy (A node), l weeks (B node), after second weeks of chemotherapy (C node), after the end of radiotherapy and chemotherapy (D node) 4 monitoring at the time of routine MRI and DWI examination, ADC diagram and function to generate the corresponding diffusion map, tumor invasion depth were measured and calculated ADC value changes of different time point monitoring ADC value (including the change value of delta ADC and ADC% and the rate of change) The function of diffusion map red voxel accounted for the change value. According to the Dworak 's (tumor regression grade TRG, TRG standard) were divided into non sensitive group (TRG0-2) and sensitive group (TRG3-4). By using two independent samples t test, Wilcoxon test, analysis of variance in Dan Yin. Kruskal-Wallis test and ROC curve of the data were analyzed. Results: 1.32 cases of rectal cancer patients with tumor invasion depth. There was a statistically significant difference between different time points (P0.05), depth of tumor invasion decreased gradually in the course of treatment, mainly concentrated in the late treatment; there is significant difference between different time points tumor ADC value (P0.05), the ADC value in the course of treatment was gradually increasing, in the treatment of early.2.32 patients showed significant differences in the sensitive group and non sensitive group were 20 cases and 12 cases of sensitivity. 鎰熺粍鍜岄潪鏁忔劅緇勪笉鍚屾椂闂磋妭鐐圭殑鑲跨槫ADC鍊兼瘮杈冨潎鍏鋒湁鏄捐憲緇熻瀛﹀樊寮，

本文編號：1730569