本文選題：磁共振成像 + 彌散加權(quán)成像��； 參考：《濟(jì)南大學(xué)》2014年碩士論文

【摘要】：目的1.評(píng)價(jià)DWI對(duì)胸段食管癌縱隔淋巴結(jié)轉(zhuǎn)移的檢出能力。 2.探討ADC值對(duì)良惡性淋巴結(jié)鑒別診斷的意義。 材料與方法 1.患者資料：收集分析2013年6月-2014年1月在山東省腫瘤防治研究院就診并擬行手術(shù)治療的胸段食管癌初診患者45例，術(shù)前均經(jīng)胃鏡或食管鏡以刷檢細(xì)胞學(xué)和（或）活檢病理證實(shí)為鱗癌或可疑鱗癌。所有患者術(shù)前均未經(jīng)任何抗腫瘤治療且具備完整、精確的臨床及病理資料。所有病例均在術(shù)前一周內(nèi)行MRI常規(guī)及彌散加權(quán)成像掃描。 2.檢查方法：掃描設(shè)備：PHILIPS Achieva3.0T MR掃描儀。掃描參數(shù)：1）橫斷面T1WI序列：TR/TE10/2ms，層厚/間距4/1mm，F(xiàn)OV375mm，矩陣352X160；2）橫斷面T2WI序列：TR/TE1.5s/80ms，層厚/間距4/1mm，F(xiàn)OV375mm，矩陣352X160；3）橫斷面SPAIR序列：TR/TE1.4s/70ms，層厚/間距4/1mm，F(xiàn)OV375mm，矩陣352X160；4）冠狀位T2WI序列：TR/TE1.8s/80ms，層厚/間距4/1mm，F(xiàn)OV375mm，矩陣352X160；5）DWI序列：TR/TE2.6s/52ms，層厚/間距4/1mm，F(xiàn)OV375mm，矩陣352X160，擴(kuò)散加權(quán)敏感系數(shù)b值分別取0，200s/mm2，400s/mm2，600s/mm2，800s/mm2。掃描范圍從頸椎第4椎體上緣到腰椎第2椎體下緣。掃描時(shí)被掃描者雙腳戴上鞋套，頭部配戴耳機(jī)，取仰臥位、雙臂放于身體兩側(cè)，安放、固定體部線(xiàn)圈，以頭足位進(jìn)入主磁場(chǎng)，掃描同時(shí)應(yīng)用呼吸門(mén)控設(shè)備。 3.觀(guān)察指標(biāo):應(yīng)用飛利浦?jǐn)?shù)字影像工作站，觀(guān)察淋巴結(jié)的形態(tài)、大小、信號(hào)強(qiáng)度及ADC值。測(cè)量并記錄淋巴結(jié)的位置、形態(tài)、大小、信號(hào)強(qiáng)度及ADC值。由兩位從事MRI診斷工作的主任醫(yī)師獨(dú)立閱片，對(duì)存在不同意見(jiàn)的結(jié)果進(jìn)行共同討論取得一致意見(jiàn)后作為最終結(jié)果。 4.淋巴結(jié)分組及轉(zhuǎn)移淋巴結(jié)的DWI診斷標(biāo)準(zhǔn)：食管癌術(shù)中進(jìn)行廣泛淋巴結(jié)清掃，，以日本食管疾病學(xué)會(huì)制定的標(biāo)準(zhǔn)對(duì)淋巴結(jié)進(jìn)行分組及編號(hào)，對(duì)術(shù)中清掃淋巴結(jié)進(jìn)行分組送檢，記錄每位患者的淋巴結(jié)轉(zhuǎn)移數(shù)目。上縱隔淋巴結(jié)包括105、106F、106R、106L、106TL、106TR、113和114組淋巴結(jié)，中縱隔包括107、108、109及112組淋巴結(jié)，下縱隔包括110和111組淋巴結(jié)。所掃到的淋巴結(jié)在DWI圖像上呈明顯高信號(hào)，且其測(cè)量的ADC值與病變部位所測(cè)得的ADC值相差不大，就被認(rèn)定為疑似轉(zhuǎn)移淋巴結(jié)。 5.統(tǒng)計(jì)學(xué)分析采用SPSS17.0軟件進(jìn)行數(shù)據(jù)處理。計(jì)量資料數(shù)據(jù)以（x±s表示），ADC值與淋巴結(jié)轉(zhuǎn)移之間的關(guān)系采用t檢驗(yàn)，DWI診斷的食管癌縱隔淋巴結(jié)轉(zhuǎn)移與手術(shù)后經(jīng)病理證實(shí)的淋巴結(jié)轉(zhuǎn)移進(jìn)行比較并采用配對(duì)t檢驗(yàn)方式進(jìn)行檢驗(yàn)，P0.05為差異有統(tǒng)計(jì)學(xué)意義。采用ROC曲線(xiàn)確定ADC值鑒別診斷食管癌淋巴結(jié)轉(zhuǎn)移的閾值，計(jì)算相應(yīng)的敏感度、特異度、陰性預(yù)測(cè)值、陽(yáng)性預(yù)測(cè)值及準(zhǔn)確率。 結(jié)果 1.臨床資料及病理結(jié)果：本組病例男性28例，女性17例；年齡50～75歲，平均年齡62.5歲，按AJCC-UICC國(guó)際食管癌TNM分期系統(tǒng)（2009）分段標(biāo)準(zhǔn)，胸中段食管癌18例，胸下段食管癌27例。本組45例患者中，有13例發(fā)生淋巴結(jié)轉(zhuǎn)移轉(zhuǎn)移率為28.9%；共清掃淋巴結(jié)585枚，平均每例患者清掃13枚，發(fā)生轉(zhuǎn)移者147枚，淋巴結(jié)轉(zhuǎn)移度為25.1%。 2.DWI對(duì)胸段食管癌縱隔轉(zhuǎn)移淋巴結(jié)的診斷效能：按照既定診斷標(biāo)準(zhǔn)，術(shù)前DWI診斷為轉(zhuǎn)移的淋巴結(jié)176枚；術(shù)后病理證實(shí)為轉(zhuǎn)移的淋巴結(jié)131枚。DWI對(duì)胸段食管癌淋巴結(jié)轉(zhuǎn)移與手術(shù)病理診斷淋巴結(jié)轉(zhuǎn)移差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.46，P＞0.05）。DWI診斷淋巴結(jié)轉(zhuǎn)移的敏感性、特異性、準(zhǔn)確性、陽(yáng)性和陰性預(yù)測(cè)值分別為89.1%、93.4%、92.3%、74.4%和96%。DWI對(duì)食管癌縱隔淋巴結(jié)轉(zhuǎn)移的診斷價(jià)值優(yōu)于常規(guī)序列；彌散成像灰階反轉(zhuǎn)圖像顯示淋巴結(jié)轉(zhuǎn)移更加直觀(guān)。 3.胸段食管癌縱隔淋巴結(jié)轉(zhuǎn)移的DWI表現(xiàn)：接受檢查的患者DWI上，脂肪、肌肉、血管等結(jié)構(gòu)呈低信號(hào)強(qiáng)度，轉(zhuǎn)移性淋巴結(jié)及原發(fā)灶為明顯高信號(hào)強(qiáng)度。甲狀腺、椎體及附件、肋骨為中等或略高信號(hào)強(qiáng)度。轉(zhuǎn)移性淋巴結(jié)的ADC值（[1.71±0.12）×10-3mm2／s]，低于非轉(zhuǎn)移性淋巴結(jié)[（2.61±0.15）×10-3mm2／s]，差異有統(tǒng)計(jì)學(xué)差異（t=7.26，P0．05）。 結(jié)論 1.DWI診斷食管癌縱隔淋巴結(jié)轉(zhuǎn)移與手術(shù)病理診斷淋巴結(jié)轉(zhuǎn)移差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.46，P＞0.05）。DWI診斷淋巴結(jié)轉(zhuǎn)移的敏感性、特異性、準(zhǔn)確性、陽(yáng)性和陰性預(yù)測(cè)值分別為89.1%、93.4%、92.3%、74.4%和96%。DWI對(duì)食管癌縱隔淋巴結(jié)轉(zhuǎn)移的診斷價(jià)值優(yōu)于常規(guī)序列；磁共振DWI對(duì)食管癌縱隔淋巴結(jié)轉(zhuǎn)移的診斷具有重要價(jià)值。 2.食管癌轉(zhuǎn)移性淋巴結(jié)的ADC值顯著低于非轉(zhuǎn)移性淋巴結(jié)。
[Abstract]:Objective 1. to evaluate the detection ability of DWI in mediastinal lymph node metastasis of thoracic esophageal carcinoma.
2. to explore the significance of ADC in differential diagnosis of benign and malignant lymph nodes.
Materials and methods
1. patients' data were collected and analyzed in 45 cases of early diagnosis of thoracic esophageal cancer in Shandong tumor prevention and Treatment Institute of Shandong in June 2013 and January. All patients were treated by gastroscope or esophagoscope by cytology and (or) biopsy pathology as squamous or suspected squamous cell carcinoma. All patients were not treated with any antitumor treatment before operation and Complete and accurate clinical and pathological data were available. All patients underwent routine MRI and diffusion weighted imaging within one week before operation.
2. check methods: scanning equipment: PHILIPS Achieva3.0T MR scanner. Scanning parameters: 1) cross section T1WI sequence: TR/TE10/2ms, layer thickness / spacing 4/1mm, FOV375mm, matrix 352X160; 2) cross section T2WI sequence: TR/TE1.5s/80ms, layer thickness / interval 4/1mm, FOV375mm, matrix, 3) cross section sequence: thickness / spacing M, FOV375mm, matrix 352X160; 4) coronal T2WI sequence: TR/TE1.8s/80ms, layer thickness / spacing 4/1mm, FOV375mm, matrix 352X160; 5) DWI sequence: TR/TE2.6s/52ms, layer thickness / interval 4/1mm, FOV375mm, matrix, diffusion weighted sensitivity coefficients respectively from the upper edge of the cervical vertebra to the waist to the waist The lower edge of the vertebral second vertebral body. When scanned, the scanned people wear the shoes with their feet and the headphones, take the supine position, put the arms on both sides of the body, put the body coils in the body, enter the main magnetic field with the head foot position, and apply the breathing door control equipment at the same time.
3. observation index: using PHILPS digital image workstation to observe the morphology, size, signal intensity and ADC value of lymph nodes, measure and record the location, shape, size, signal intensity and ADC value of the lymph nodes. The chief physician who is engaged in the diagnosis of MRI is independent to read the film, and makes a common discussion on the results of different opinions. See back as the final result.
The DWI diagnostic criteria for 4. lymph node groups and metastatic lymph nodes: extensive lymph node dissection during esophageal cancer surgery. The lymph nodes were grouped and numbered by the standards set by the Japanese Society for esophageal disease. The lymph nodes were divided into groups and the number of lymph node metastases in each patient was recorded. The upper mediastinal lymph nodes included 105106F, 106R, 106L, 106TL, 106TR, 113, and 114 groups of lymph nodes, middle mediastinum, including 107108109 and 112 groups of lymph nodes, the inferior mediastinum included 110 and 111 groups of lymph nodes. The lymph nodes that were swept were obviously high signal on the DWI image, and the measured ADC values were not quite different from the ADC values measured by the lesion, and they were identified as suspected metastatic lymph nodes.
5. statistical analysis was carried out by SPSS17.0 software. The data was measured by (x + s). The relationship between the ADC value and lymph node metastasis was examined by t test. The lymph node metastasis of the mediastinal lymph node diagnosed by DWI was compared with the lymph node metastasis confirmed by pathology and tested by paired t test. P0.05 was the difference. The ROC curve was used to determine the threshold value of ADC value in differential diagnosis of lymph node metastasis of esophageal cancer, and the corresponding sensitivity, specificity, negative predictive value, positive predictive value and accuracy were calculated.
Result
1. clinical data and pathological results: 28 cases in this group, 17 cases in women, 50~75 years old, with an average age of 62.5 years. According to the standard of AJCC-UICC international esophageal cancer TNM staging system (2009), 18 cases of middle thoracic esophagus carcinoma and 27 cases of lower thoracic esophagus carcinoma. 13 cases of lymph node metastasis rate were 28.9% in 45 cases of this group. 585 patients were fawning, 13 patients were removed in each case, 147 patients had metastasis, and the lymph node metastasis rate was 25.1%.
Diagnostic efficacy of 2.DWI for mediastinal metastatic lymph nodes of thoracic esophageal carcinoma: according to established diagnostic criteria, 176 metastatic lymph nodes were diagnosed by preoperative DWI, and 131.DWI for lymph node metastases confirmed by pathology were not statistically significant (t=0.46, P > 0.05).DWI diagnosis for lymph node metastasis of thoracic esophageal cancer. The sensitivity, specificity, accuracy, positive and negative predictive values of lymph node metastases were 89.1%, 93.4%, 92.3%, 74.4% and 96%.DWI were better than conventional sequences in the diagnosis of mediastinal lymph node metastasis of esophageal cancer, and the diffusion imaging gray scale reversal images showed that lymph node metastasis was more intuitive.
The DWI manifestations of the mediastinal lymph node metastasis of 3. thoracic esophageal carcinoma: the structure of fat, muscle, and blood vessels was low signal intensity on DWI, and the metastatic lymph nodes and primary foci were high signal intensity. The thyroid, vertebral and appendages were medium or slightly high intensity. The ADC value of the metastatic lymph nodes ([1.71 + 0.12) x / 10-3mm2 S] was lower than that of non metastatic lymph nodes [(2.61 + 0.15) x 10-3mm2 / s], the difference was statistically significant (t=7.26, P0.05).
conclusion
1.DWI diagnosis of esophageal carcinoma mediastinal lymph node metastasis and pathological diagnosis of lymph node metastasis was not statistically significant (t=0.46, P > 0.05).DWI diagnosis of lymph node metastasis sensitivity, specificity, accuracy, positive and negative predictive values of 89.1%, 93.4%, 92.3%, 74.4% and 96%.DWI for the diagnosis of esophageal carcinoma mediastinal lymph node metastasis is better than usual. Magnetic resonance DWI is of great value in the diagnosis of mediastinal lymph node metastasis of esophageal carcinoma.
2. the ADC value of metastatic lymph nodes of esophageal cancer was significantly lower than that of non metastatic lymph nodes.

【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R735.1;R445.2

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