本文選題：擴(kuò)散加權(quán)成像 + 體素內(nèi)不相干運(yùn)動成像�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較體素內(nèi)不相干運(yùn)動(IVIM)磁共振成像雙指數(shù)模型、拉伸指數(shù)模型與傳統(tǒng)擴(kuò)散加權(quán)成像(DWI)單指數(shù)模型各相關(guān)參數(shù)在乳腺良、惡性病變的鑒別診斷中的價值,并由ROC曲線確定各參數(shù)診斷良、惡性病變的最佳閾值,并進(jìn)一步分析IVIM各參數(shù)與乳腺癌預(yù)后因子及分子分型之間的相關(guān)性。方法:回顧性分析257例于天津醫(yī)科大學(xué)腫瘤醫(yī)院行乳腺M(fèi)RI檢查并經(jīng)病理證實的乳腺病變患者(共276個病灶,其中包括197個惡性病變,79個良性病變),同時選取正常的乳腺組織作為對照組。所有患者均行MRI常規(guī)檢查及IVIM(多b值DWI)檢查。由單指數(shù)模型、雙指數(shù)模型及拉伸指數(shù)模型分別獲得并分析各個病變的表觀擴(kuò)散系數(shù)(ADC),慢速表觀擴(kuò)散系數(shù)(slow ADC),快速表觀擴(kuò)散系數(shù)(fast ADC),灌注分?jǐn)?shù)(f),擴(kuò)散分布指數(shù)(DDC)及擴(kuò)散異質(zhì)性指數(shù)(α)。各參數(shù)在正常乳腺對照組、乳腺良性病變組及惡性病變組中的差異采用K個獨(dú)立樣本檢驗進(jìn)行分析,P0.05認(rèn)為差異有統(tǒng)計學(xué)意義;進(jìn)一步行兩兩比較(惡性組VS良性組,惡性組VS正常對照組,良性組VS正常對照組)采用Mann-Whitney U檢驗,P0.02認(rèn)為差異有統(tǒng)計學(xué)意義。采用受試者工作特征(ROC)曲線評價各參數(shù)對乳腺良、惡性病變的診斷效能并確定診斷惡性病變的最佳閾值及其在該閾值下各參數(shù)診斷的敏感性、特異性及準(zhǔn)確性。分析187個乳腺癌的病理類型及免疫組化指標(biāo),將10例導(dǎo)管內(nèi)癌及151例浸潤性導(dǎo)管癌納入第二部分的研究,采用非參數(shù)U檢驗及Kruskall-Wallis檢驗進(jìn)一步分析IVIM各參數(shù)在乳腺癌分子分型、預(yù)后因子之間的差異。結(jié)果:由常規(guī)DWI得到的ADC值和由IVIM模型得到的slow ADC、fast ADC、f、DDC及α在正常乳腺組織、乳腺良性病變及惡性病變中差異均有統(tǒng)計學(xué)意義(P0.001),進(jìn)一步兩兩比較,乳腺惡性病變與良性病變及正常腺體組織中ADC、slow ADC、fast ADC、f、DDC和α差異均有統(tǒng)計學(xué)意義(P0.001),且ADC、slow ADC、f、DDC和α在正常乳腺組織、乳腺良性病變、惡性病變中依次減低,fast ADC值在正常乳腺組織、乳腺良性病變、惡性病變中依次升高;ADC、slow ADC、DDC和α在乳腺正常腺體組織和乳腺良性病變之間差異有統(tǒng)計學(xué)意義(P0.001)。由ROC曲線得到ADC、slow ADC、fast ADC、f、DDC和α診斷乳腺良、惡性病變的最佳診斷閾值分別為1.105×10-3mm2/s、0.883×10-3mm2/s、4.750×10-3mm2/s、0.215、1.025×10-3mm2/s和0.842,診斷的敏感性分別為87.2%、90.3%、68.5%、64.5%、81.6%、76.0%,特異性分別為74.4%、74.4%、54.4%、75.9%、79.5%、67.9%,ROC曲線下面積(AUC)分別為0.865、0.861、0.611、0.742、0.850和0.735。與傳統(tǒng)的DWI比較,slow ADC值的敏感性(90.3%)較ADC值(87.2%)高,DDC的特異性(79.5%)較ADC值(74.4%)高,但差異均無統(tǒng)計學(xué)意義。雙指數(shù)模型中slow ADC值與fast ADC值聯(lián)合診斷的曲線下面積為0.882;拉伸指數(shù)模型DDC與α聯(lián)合診斷的曲線下面積為0.853,差異均無統(tǒng)計學(xué)意義。Ki-67低表達(dá)組乳腺癌slow ADC值高于Ki-67高表達(dá)組(P值為0.045);Her-2過表達(dá)型乳腺癌較其他類型乳腺癌患者的slow ADC值更高(P值為0.014);乳腺浸潤性導(dǎo)管癌較導(dǎo)管內(nèi)癌slow ADC、f、DDC及ADC值更低(P值分別為0.013,0.028,0.01,0.003)。結(jié)論:傳統(tǒng)DWI和IVIM磁共振成像對乳腺良、惡性病變的診斷均具有較高價值,IVIM雙指數(shù)模型中slow ADC值與fast ADC值聯(lián)合診斷效能較高。IVIM相關(guān)參數(shù)對預(yù)測乳腺癌的Ki-67指數(shù)、分子分型及病理浸潤與否具有潛在的價值。
[Abstract]:Objective: To compare the value of the two exponential model of the incoherent motion (IVIM) magnetic resonance imaging, the parameters of the tensile index model and the traditional diffusion-weighted imaging (DWI) single index model in the differential diagnosis of benign and malignant breast lesions, and to determine the best threshold for the diagnosis of benign and malignant lesions by the ROC curve, and to further analyze the IVIM The correlation between the parameters and the prognostic factors and molecular typing of breast cancer. Methods: a retrospective analysis of 257 cases of breast lesions in the Cancer Hospital of Medical University Of Tianjin (276 lesions, including 197 malignant lesions, 79 benign diseases), and normal breast tissue as control, were performed in 257 cases of the breast cancer hospital in Medical University Of Tianjin. MRI routine examination and IVIM (multi b value DWI) examination were performed in all patients. The apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (slow ADC), rapid apparent diffusion coefficient (fast ADC), perfusion fraction (f), diffusion distribution index (DDC) and diffusion difference were obtained from single index model, double exponential model and tensile index model respectively. Qualitative index (alpha). The difference of the parameters in the normal breast control group, the benign breast lesion group and the malignant lesion group was analyzed by K independent sample test, and P0.05 thought the difference was statistically significant. Further 22 comparison (malignant group VS benign group, malignant group VS normal control group, benign group VS normal control group) adopted Mann-Whitney U Test, P0.02 thought the difference was statistically significant. Using the ROC curve to evaluate the diagnostic effectiveness of the parameters for benign and malignant breast lesions and to determine the best threshold for the diagnosis of malignant lesions and the sensitivity, specificity and accuracy of the diagnosis of all parameters under this threshold. The pathological types and immune groups of 187 breast cancers were analyzed. 10 cases of intraductal carcinoma and 151 cases of invasive ductal carcinoma were included in the study. The non parametric U test and Kruskall-Wallis test were used to further analyze the differences between the IVIM parameters in the molecular classification of breast cancer and the prognostic factors. Results: the ADC values obtained from the conventional DWI and the slow ADC, fast ADC, F, DDC and alpha obtained from the IVIM model were obtained. There were significant differences in normal breast tissue, benign breast lesions and malignant lesions (P0.001). Further 22, the differences of ADC, slow ADC, fast ADC, F, DDC and alpha in benign lesions and normal gland tissues were statistically significant (P0.001), and ADC, slow ADC, and alpha in normal mammary tissues and mammary glands. Fast ADC values in normal breast tissue, benign breast lesions and malignant lesions were increased in turn, and ADC, slow ADC, DDC and alpha were statistically significant (P0.001) between normal mammary gland tissue and benign breast lesions (P0.001). The best diagnostic thresholds were 1.105 x 10-3mm2/s, 0.883 x 10-3mm2/s, 4.750 x 10-3mm2/s, 0.215,1.025 x 10-3mm2/s and 0.842, and the diagnostic sensitivity was 87.2%, 90.3%, 68.5%, 64.5%, 81.6%, 76%, respectively. The specificity of the specificity was 0.865,0.861,0.611,0.742,0.850 and the area under the ROC curve (AUC), respectively. Compared with the traditional DWI, the sensitivity of the slow ADC value (90.3%) was higher than that of the ADC value (87.2%), and the specificity of the DDC (79.5%) was higher than the ADC value (74.4%), but the difference was not statistically significant. The area under the curve under the joint diagnosis of slow ADC value and fast ADC was 0.882 in the double exponential model, and the area under the curve under the joint diagnosis of the tensile exponential model DDC and alpha was 0.853, The difference was not statistically significant in.Ki-67 low expression group, the value of slow ADC in breast cancer was higher than that in Ki-67 high expression group (P value was 0.045); Her-2 overexpressed breast cancer was higher on slow ADC than other types of breast cancer patients (P value was 0.014), and invasive ductal carcinoma of the breast was higher than that of ductal carcinoma slow ADC. Conclusion: traditional DWI and IVIM MRI are of high value for the diagnosis of benign and malignant breast lesions. The combination of slow ADC value and fast ADC value in IVIM double index model is of potential value for predicting Ki-67 index, molecular typing and pathological infiltration of breast cancer.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R737.9

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