本文選題：體素內(nèi)不相干運(yùn)動(dòng) + 磁共振成像�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:通過多個(gè)b值體素內(nèi)不相干運(yùn)動(dòng)(intravoxel incoherent motion,IVIM)磁共振擴(kuò)散加權(quán)成像(diffusion-weighted imaging,DWI)雙指數(shù)模型分析比較胰腺癌、慢性胰腺炎以及癌周相對(duì)正常胰腺組織的常規(guī)DWI表觀擴(kuò)散系數(shù)(Apparent diffusion coefficient,ADC)與多個(gè)b值IVIM-DWI的衍生參數(shù)純擴(kuò)散系數(shù)(pure diffusion coefficient,D)、假性擴(kuò)散系數(shù)(pseudo-diffusion coefficient,D*)和灌注分?jǐn)?shù)(perfusion fraction,f)之間是否存在差異,探討上述4個(gè)參數(shù)對(duì)區(qū)分胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的最佳診斷臨界值及其診斷效能。研究方法:入選2015年12月至2017年1月在我院經(jīng)病理活檢確診和(或)臨床確診并經(jīng)隨訪1-6個(gè)月證實(shí)為胰腺癌及慢性胰腺炎的患者共55例,分為胰腺癌組、慢性胰腺炎組,將癌周相對(duì)正常胰腺組織設(shè)為對(duì)照。所有MRI檢查均在Philips Achieva 3.0TTX磁共振掃描儀上進(jìn)行,掃描的序列包括T2WI、T1WI、動(dòng)態(tài)增強(qiáng)成像(Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)及常規(guī)橫軸位DWI(b值為0和700s/mm2)。對(duì)所有病例再加行IVIM掃描(b值設(shè)置為0、20、40、70、100、200、400、700、1000s/mm2)。通過 Philips 的后處理工作站處理常規(guī)ADC圖并設(shè)置感興趣區(qū)(Region of interest,ROI,包括病變及癌周相對(duì)正常胰腺組織)獲得ADC值;利用Philips公司開發(fā)的軟件(IVIM v1.0,For Philips Data Only)對(duì)IVIM-DWI圖像行后處理分析,得出病變及癌周相對(duì)正常胰腺組織的D值、D*值及f值,以及生成相應(yīng)的參數(shù)偽彩圖。結(jié)果采用單因素方差分析和t檢驗(yàn)比較胰腺癌組、慢性胰腺炎組及癌周相對(duì)正常胰腺組織組間的ADC值、D值、D*值及f值的差異;利用受試者工作特征(receiver operating characteristic,ROC)曲線來計(jì)算曲線下面積(area under curve,AUC),分析ADC值、D值、D*值和f值4個(gè)參數(shù)區(qū)分胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的敏感度、特異度及診斷價(jià)值。結(jié)果:1、本研究對(duì)象中胰腺癌35例,手術(shù)病理證實(shí)23例,經(jīng)臨床確診并隨訪1-6月證實(shí)12例;慢性胰腺炎20例,手術(shù)病理證實(shí)11例,經(jīng)臨床確診并隨訪1-6月證實(shí)9例。2、單因素方差分析結(jié)果顯示,胰腺癌組、慢性胰腺炎組及癌周相對(duì)正常胰腺組織組的D值(F=0.045,p=0.956)比較無統(tǒng)計(jì)學(xué)意義,ADC值(F=3.937,p=0.022)、D*值(F=97.125,p0.001)和 f 值(F=118.917,p0.001)比較均有統(tǒng)計(jì)學(xué)意義。進(jìn)一步進(jìn)行LSD兩兩比較,D值胰腺癌組、慢性胰腺炎組及癌周相對(duì)正常胰腺組織組間均無統(tǒng)計(jì)學(xué)意義(1.29±0.27vs1.31±0.21×10-3mm2/s,p=0.776;1.29±0.27 vs 1.30 ± 0.21 X 10-3mm2/s,p=0.955;1.31 ± 0.21 vs 1.30 ± 0.21 X 10-3mm2/S,p=0.796);ADC值除了胰腺癌組與癌周相對(duì)正常胰腺組織組外其余兩兩比較均無統(tǒng)計(jì)學(xué)意義(1.31 ±0.29 vs1.53±0.44X 10-3mm2/s,p=0.008;1.31±0.29 vs 1.38±0.33×10-3mm2/s,p=0.494;1.38±0.33 vs1.53±0.44×10-3mm2/s,p=0.32);D*值除了胰腺癌組與慢性胰腺炎組外其余兩兩比較均有統(tǒng)計(jì)學(xué)意義(21.34±9.34 vs24.97±8.09×10-3mm2/s,p=0.324;21.34±9.34 vs57.38±16.19×10-3mm2/s,p0.001;24.97±8.09 vs 57.38±16.19×10-3mm2/s,p0.001);f值胰腺癌組、慢性胰腺炎組及癌周相對(duì)正常胰腺組織組間均有統(tǒng)計(jì)學(xué)意義(0.26±0.054 vs 0.36±0.022,p0.001;0.26±0.054 vs 0.40±0.037,p0.001;0.36±0.022 vs 0.40±0.037,p0.001)。3、胰腺癌組、慢性胰腺炎組及癌周相對(duì)正常胰腺組織組D值與ADC值比較均有差異性,有統(tǒng)計(jì)學(xué)意義(t=-2.784,p0.05;t=-13.095,p0.001;t=-3.386,p0.05),ADC值均大于D值。4、D、ADC、D*、f值對(duì)區(qū)分胰腺癌與癌周相對(duì)正常胰腺組織的AUC分別為0.542、0.705、0.996及0.999,其診斷的最佳臨界值分別為1.28×10-3mm2/s、1.30×10-3mm2/s、37.33X 10-3mm2/s、0.34,對(duì)應(yīng)診斷的敏感度分別為 58.2%、81.8%、100%、100%,特異度分別為60.0%、62.9%、97.1%、97.1%,D*、f值的診斷效果較好。D、ADC、D*、f值對(duì)鑒別診斷胰腺癌與慢性胰腺炎的AUC分別為0.580、0.589、0.624、0.976,診斷最佳臨界值分別為 1.28×10-3mm2/s、1.28×10-3mm2/s、22.8×10-3mm2/s、0.33,對(duì)應(yīng)診斷的敏感度及特異度分別為75%、75%、60%、95%和 60%、57.1%、71.4%、94.3%,D、ADC、D*值的診斷價(jià)值較低。D、ADC、D*、f值對(duì)區(qū)分慢性胰腺炎、癌周相對(duì)正常胰腺組織的AUC分別為0.518、0.692、0.985、0.866,診斷最佳臨界值分別為 1.32×10-3mm2/s、1.33×10-3mm2/s、38.9×10-3mm2/s、0.36,對(duì)應(yīng)診斷的敏感度分別為49.1%、72.7%、96.4%、89.1%,特異度分別為75%、75%、95.0%、70.0%,ADC及D值的診斷價(jià)值較低。結(jié)論:1、胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的ADC值、D*值、f值存在差異,提示ADC值、D*值、f值對(duì)胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的識(shí)別有一定的價(jià)值。2、胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的ADC值均大于D值,而D值反映的是組織的純擴(kuò)散,證實(shí)常規(guī)ADC值存在擴(kuò)散以外的其它信息。3、D*、f值識(shí)別胰腺癌與癌周相對(duì)正常胰腺組織的診斷效能較好,其診斷最佳臨界值分別為 37.33X10-3mm2/s、0.34(AUC=0.996、0.999,p0.001),敏感度和特異度分別為100%、100%和97.1%、97.1%;f值鑒別診斷胰腺癌與慢性胰腺炎的診斷效能最佳,其診斷最佳臨界值為0.33,敏感度和特異度分別為95%、94.3%;D*值、f值識(shí)別慢性胰腺炎、癌周相對(duì)正常胰腺組織的診斷效能較好,其診斷最佳臨界值分別為38.9×10-3mm2/s、0.36,敏感度和特異度分別為96.4%、89.1%和95%、70%。D*、f值識(shí)別胰腺癌、慢性胰腺炎及癌周相對(duì)正常胰腺組織的診斷效能均較常規(guī)ADC值更好。
[Abstract]:Objective: To compare the conventional DWI apparent diffusivity (Apparent diffusion coefficient) of pancreatic cancer, chronic pancreatitis, and normal pancreatic tissue by multiple B intravoxel incoherent motion (IVIM) magnetic resonance diffusion weighted imaging (diffusion-weighted imaging, DWI) model. C) is the difference between the derivative parameters (pure diffusion coefficient, D), the pseudodiffusion coefficient (pseudo-diffusion coefficient, D*) and the perfusion fraction (perfusion fraction) with multiple b values IVIM-DWI, and discusses the best diagnosis of the 4 parameters for the differentiation of pancreatic adenocarcinoma, chronic pancreatitis and the relative normal pancreatic tissue. A total of 55 cases of pancreatic cancer and chronic pancreatitis were identified in our hospital from December 2015 to January 2017 by biopsy and (or) clinically confirmed and followed up for 1-6 months, divided into the pancreatic cancer group, the chronic pancreatitis group, and the normal pancreatic tissue as control. All MRI tests were performed. The findings were performed on the Philips Achieva 3.0TTX magnetic resonance scanner. The sequences of the scans included T2WI, T1WI, dynamic enhanced imaging (Dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI), and conventional transverse axial DWI. Through the Philips post processing workstation, the routine ADC map was processed and the region of interest (Region of interest, ROI, including the lesions and the normal pancreatic tissue) was obtained, and the ADC value was obtained by the software (IVIM v1.0, For Philips) developed by Philips company (IVIM v1.0, For Philips). The D value, D* value and F value of the adenoid tissue, and the corresponding parameter pseudo color images. Results the ADC value, the D value, the D* value and the F value of the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group were compared with the single factor variance analysis and t test, and the characteristics of the subjects (receiver operating characteristic, ROC) Qu Xianlai were used. Area under curve (AUC), ADC value, D value, D* value and F value were analyzed to distinguish the sensitivity, specificity and diagnostic value of 4 parameters of pancreatic cancer, chronic pancreatitis and the relative normal pancreatic tissue. Results: 1, 35 cases of pancreatic cancer in this study, 23 cases confirmed by hand pathology, 12 cases confirmed by clinical diagnosis and 1-6 months follow-up. 20 cases of pancreatitis, 11 cases confirmed by operation and pathology, 9 cases of.2 confirmed by clinical diagnosis and 1-6 months of follow-up. The results of single factor analysis of variance showed that there was no significant difference between the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group D value (F=0.045, p=0.956), ADC value (F=3.937, p=0.022), D* value (F=97.125, p0.001) and f (F=118.91) value (F=118.91) 7, p0.001) was statistically significant. Compared with LSD 22, there was no statistical significance between the D value pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group (1.29 + 0.27vs1.31 + 0.21 x 10-3mm2/s, p=0.776; 1.29 + 0.27 vs 1.30 + 0.21 X 10-3mm2/ s, p=0.955; 1.31 + 0.21 vs 1.30 + 0.21 96): there was no significant difference in ADC value between the pancreatic cancer group and the other 22 outside the normal pancreatic tissue group (1.31 + 0.29 vs1.53 + 0.44X 10-3mm2/s, p=0.008; 1.31 + 0.29 vs 1.38 + 0.33 x 10-3mm2/s, p=0.494; 1.38 + 0.33 vs1.53 + 0.44 x 10-3mm2/s, p=0.32), except for the remaining 22 of the pancreatic cancer group and the chronic pancreatitis group. The comparison was statistically significant (21.34 + 9.34 vs24.97 + 8.09 x 10-3mm2/s, p=0.324; 21.34 + 9.34 vs57.38 + 16.19 x 10-3mm2/s, p0.001; 24.97 + 8.09 vs 57.38 + 16.19 x 10-3mm2/s, p0.001); F value of pancreatic cancer group, chronic pancreatitis group and normal pancreatic tissue group had statistical significance (0.26 + 0.054 vs 0.36 + 0.022, p0.001; p0.001; p0.001; p0.001; p0.001; p0.001; p0.001; 0.054 vs 0.40 + 0.037, p0.001; 0.36 + 0.022 vs 0.40 + 0.037, p0.001).3, the D value of the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group was different from the ADC value. There were statistical significance (t=-2.784, P0.05; t=-13.095, p0.001; t=-3.386,). The AUC of the normal pancreatic tissue was 0.542,0.705,0.996 and 0.999 respectively. The best critical value of the diagnosis was 1.28 x 10-3mm2/s, 1.30 x 10-3mm2/s, 37.33X 10-3mm2/s, 0.34. The sensitivity of the corresponding diagnosis was 58.2%, 81.8%, 100%, 100% respectively, and the specificity was 60%, 62.9%, 97.1%, 97.1%, D*, F value was better.D, ADC, D*, F values, respectively. The AUC of the differential diagnosis of pancreatic cancer and chronic pancreatitis was 0.580,0.589,0.624,0.976 respectively. The best critical values were 1.28 x 10-3mm2/s, 1.28 x 10-3mm2/s, 22.8 x 10-3mm2/s, 0.33. The sensitivity and specificity of the corresponding diagnosis were 75%, 75%, 60%, 95% and 60%, 57.1%, 71.4%, 94.3%, D, ADC, D* value lower.D, ADC, D*, F value, respectively. To distinguish chronic pancreatitis, the AUC of the cancer weeks relative to the normal pancreatic tissue was 0.518,0.692,0.985,0.866 respectively. The best critical values were 1.32 x 10-3mm2/s, 1.33 x 10-3mm2/s, 38.9 x 10-3mm2/s, 0.36. The sensitivity of the diagnosis was 49.1%, 72.7%, 96.4%, 89.1% respectively, and the specificity was 75%, 75%, 95%, 70%, ADC and D values were compared. Conclusion: 1, the ADC value, D* value and F value of pancreatic cancer, chronic pancreatitis and normal pancreatic tissue are different. It suggests that the value of ADC, D*, and F value for the identification of pancreatic cancer, chronic pancreatitis and the relative normal pancreatic tissue is of certain value.2, and the ADC value of pancreatic cancer, slow pancreatitis and the relative normal pancreatic tissue is greater than the D value. The D value reflects the pure diffusion of the tissue, which confirms that the conventional ADC values other than the diffusion of information.3, D*, F value is better to identify pancreatic cancer and normal pancreatic tissue, and the best critical value of the diagnosis is 37.33X10-3mm2/s, 0.34 (AUC=0.996,0.999, p0.001), sensitivity and specificity are 100%, 100% and 97.1%, 97. respectively. 1%; F value differential diagnosis of pancreatic cancer and chronic pancreatitis is the best, with the best critical value of 0.33, sensitivity and specificity of 95%, 94.3%, D* value, F value to identify chronic pancreatitis, and the diagnostic efficiency is better than normal pancreatic tissue, and the best critical value of the diagnosis is 38.9 x 10-3mm2/s, 0.36, sensitivity and specificity, respectively. They were 96.4%, 89.1% and 95%, respectively. The diagnostic value of 70%.D* and F values for pancreatic cancer, chronic pancreatitis and normal pancreatic tissue were better than those of conventional ADC.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.9;R576;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 Riccardo De Robertis;Paolo Tinazzi Martini;Emanuele Demozzi;Flavia Dal Corso;Claudio Bassi;Paolo Pederzoli;Mirko D'Onofrio;;Diffusion-weighted imaging of pancreatic cancer[J];World Journal of Radiology;2015年10期

2 邢春華;陳宏偉;崔興宇;;腹部IVIM-DWI應(yīng)用研究及進(jìn)展[J];國際醫(yī)學(xué)放射學(xué)雜志;2015年04期

3 Jin-Gang Hao;Jia-Ping Wang;Ya-Lv Gu;Ming-Liang Lu;;Importance of b value in diffusion weighted imaging for the diagnosis of pancreatic cancer[J];World Journal of Gastroenterology;2013年39期

4 倪泉興;虞先o，

本文編號(hào)：1818766