發(fā)布時(shí)間：2018-06-18 13:26

  本文選題：前列腺癌 + 體素內(nèi)不相干運(yùn)動成像�。� 參考：《蘇州大學(xué)》2016年碩士論文

【摘要】：第一部分前列腺IVIM-DWI的b值優(yōu)化探討目的對前列腺IVIM-DWI的b值組合進(jìn)行優(yōu)化,探討IVIM-DWI定量參數(shù)在前列腺癌診斷中的作用。方法回顧性分析本院2015年2月至11月間行前列腺常規(guī)MRI和IVIM-DWI掃描并經(jīng)穿刺病理證實(shí)的47例前列腺病例資料,其中前列腺癌23例,良性前列腺增生24例。納入標(biāo)準(zhǔn):(1)同時(shí)行前列腺常規(guī)MRI和IVIM-DWI檢查,檢查技術(shù)符合本研究要求,檢查參數(shù)保持一致;(2)經(jīng)超聲引導(dǎo)下穿刺活檢證實(shí)為前列腺癌或良性前列腺組織;(3)前列腺M(fèi)RI檢查前1月內(nèi)均未進(jìn)行前列腺穿刺活檢;(4)前列腺M(fèi)RI檢查前未進(jìn)行任何針對前列腺疾病的治療;(5)前列腺M(fèi)RI檢查和病理檢查的間隔時(shí)間小于6周。排除標(biāo)準(zhǔn):(1)MRI掃描圖像資料不完整,圖像質(zhì)量不符合本研究的要求;(2)腫瘤體積過小,瘤灶在IVIM-DWI圖像上邊界不清,無法準(zhǔn)確設(shè)置ROI;(3)病理結(jié)果描述區(qū)域與MRI圖像不匹配。IVIM-DWI檢查設(shè)置四組b值進(jìn)行掃描,具體為:(1)0,10,100,200,1000;(2)0,10,50,100,200,1000;(3)0,10,20,50,100,200,1000;(4)0,10,20,50,100,200,500,1000。在所獲IVIM-DWI圖像上根據(jù)穿刺病理報(bào)告結(jié)合PI-RADS v2評分標(biāo)準(zhǔn)在活檢取材相對應(yīng)部位分別設(shè)置前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)的ROI,分別測量四組不同b值的IVIM-DWI定量參數(shù),包括擴(kuò)散系數(shù)D、灌注分?jǐn)?shù)f和偽擴(kuò)散系數(shù)D*。采用方差分析比較各組b值的前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)測得參數(shù)間的差異,兩兩間差異性檢驗(yàn)采用LSD-t檢驗(yàn),P0.05,為具有統(tǒng)計(jì)學(xué)差異。結(jié)果第(1)組b值(0,10,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.67±0.11)×10-3mm2/s、(26.95±4.75)%、(12.88±4.93)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.35±0.16)×10-3mm2/s、(27.79±3.47)%、(15.6±2.82)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.79±0.29)×10-3mm2/s、(25.19±4.3)%、(13.47±4.84)×10-3mm2/s;第(2)組b值(0,10,50,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.68±0.14)×10-3mm2/s、(26.45±4.73)%、(13.1±4.44)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.36±0.17)×10-3mm2/s、(27.3±4.06)%、(15.41±3.46)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.85±0.29)×10-3mm2/s、(23.9±3.54)%、(12.22±4.61)×10-3mm2/s;第(3)組b值(0,10,20,50,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.68±0.12)×10-3mm2/s、(25.59±4.84)%、(13.75±5.08)×10-3mm2/s、,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.38±0.16)×10-3mm2/s、(26.78±3.86)%、(15.55±2.82)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.8±0.31)×10-3mm2/s、(23.98±5.2)%、(13.55±5.27)×10-3mm2/s;第(4)組b值(0,10,20,50,100,200,500,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.67±0.13)×10-3mm2/s、(28.58±5.93)%、(12.43±5.55)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.33±0.16)×10-3mm2/s、(28.2±3.16)%、(14.38±3.15)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.81±0.35)×10-3mm2/s、(28±6.93)%、(11.41±5.64)×10-3mm2/s。各組癌區(qū)的D值均低于非癌區(qū),差異有統(tǒng)計(jì)學(xué)意義(P0.05),且中央腺體非癌區(qū)的D值低于外周帶非癌區(qū)的D值,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。f值和D*值在前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)間的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論在本研究部分選擇的四組b值行3.0T前列腺IVIM-DWI掃描所獲的IVIM參數(shù)(D值、f值和D*值)中,僅D值在前列腺癌區(qū)與非癌區(qū)間的差異具有統(tǒng)計(jì)學(xué)意義,可用于前列腺癌與非癌區(qū)的診斷與鑒別診斷;且第(1)組b值(0,10,100,200,1000)所選的b值數(shù)最少,掃描時(shí)間最短,建議在前列腺IVIM-DWI掃描中推薦使用。第二部分前列腺IVIM-DWI成像的一致性分析目的評價(jià)在不同時(shí)間、不同設(shè)備和重復(fù)測量時(shí)前列腺IVIM-DWI所測定量參數(shù)值(D值、f值和D*值)間的一致性,以明確其作為前列腺多中心研究評價(jià)指標(biāo)的可行性。方法2015年12月在我院招募健康成年男性志愿者15例,進(jìn)行前列腺IVIM-DWI定量參數(shù)測值的一致性研究,年齡23-30歲。納入標(biāo)準(zhǔn):(1)健康成年男性,無前列腺疾病史,無前列腺疾病相關(guān)臨床癥狀;(2)前列腺IVIM-DWI檢查技術(shù)符合本研究要求,檢查參數(shù)保持一致。排除標(biāo)準(zhǔn):(1)IVIM-DWI圖像質(zhì)量不佳,影響觀察和分析;(2)嚴(yán)重幽閉恐懼癥患者;(3)磁共振成像禁忌癥;(4)前列腺IVIM-DWI檢查顯示前列腺有異常信號改變者。本研究獲得本院倫理委員會批準(zhǔn)并在其監(jiān)督下進(jìn)行,所有研究對象均已簽署知情同意書。所有志愿者在同一天采用3.0T(Ingenia,Philips)MR成像系統(tǒng)行前列腺IVIM-DWI檢查,在間隔16天后由同一操作者分別采用3.0T(Ingenia,Philips)(與前次檢查為同一設(shè)備)和3.0T(TX,Philips)MR成像系統(tǒng)重復(fù)上述IVIM-DWI檢查,掃描參數(shù)相同。b值采用第一部分研究所推薦的組合(0,10,100,200,1000)。在每次IVIM-DWI檢查所獲前列腺軸位圖像上,對前列腺最大面積層面的前列腺中央腺體和外周帶區(qū)域設(shè)置ROI(每例設(shè)置ROI的位置和大小盡量保持一致),分別測量IVIM參數(shù)(包括擴(kuò)散系數(shù)D、灌注分?jǐn)?shù)f和偽擴(kuò)散系數(shù)D*),且在3.0T(Ingenia,Philips)MR成像系統(tǒng)第一次IVIM-DWI掃描所獲前列腺圖像上按照上述ROI設(shè)置方法對IVIM參數(shù)(D值、f值和D*值)進(jìn)行重復(fù)測量。上述IVIM-DWI檢查及IVIM參數(shù)測量均由同一研究者完成。采用配對樣本t檢驗(yàn)比較不同時(shí)間、不同設(shè)備及重復(fù)測量所獲IVIM各參數(shù)值間的差異,P0.05,為差異有統(tǒng)計(jì)學(xué)意義。計(jì)算組內(nèi)相關(guān)系數(shù)(ICC),其值介于0~1之間,0表示不可信,1表示完全可信,一般認(rèn)為低于0.4表示相關(guān)性低,大于0.75表示信度好,相關(guān)性高。采用Bland-Altman法對上述不同時(shí)間、不同設(shè)備及重復(fù)測量所獲IVIM各參數(shù)值間的差異進(jìn)行一致性分析。結(jié)果3.0T(Ingenia,Philips)MR成像系統(tǒng)第一次前列腺IVIM-DWI檢查測得的中央腺體D值、f值、D*值分別為(1.35±0.22)×10-3mm2/s,(33.33±7.28)%,(14.28±4.05)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.32±0.14)×10-3mm2/s,(34.15±7.34)%,(13.09±3.20)×10-3mm2/s;第二次檢查測得的中央腺體D值、f值、D*值分別為(1.34±0.16)×10-3mm2/s,(31.67±5.34)%,(14.21±3.53)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.35±0.09)×10-3mm2/s,(34.05±8.36)%,(12.94±4.41)×10-3mm2/s;3.0T(TX,Philips)MR成像系統(tǒng)測得的中央腺體D值、f值、D*值分別為(1.42±0.19)×10-3mm2/s,(33.81±5.77)%,(33.81±5.77)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.31±0.28)×10-3mm2/s,(32.83±10.34)%,(12.43±3.80)×10-3mm2/s;3.0T(Ingenia,Philips)MR成像系統(tǒng)所獲前列腺IVIM-DWI圖像進(jìn)行重復(fù)測量所測得的中央腺體D值、f值、D*值分別為(1.31±0.11)×10-3mm2/s,(34.64±7.70)%,(13.98±4.01)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.32±0.16)×10-3mm2/s,(33.20±5.41)%,(13.46±2.67)×10-3mm2/s。前列腺IVIM-DWI檢查在不同時(shí)間、不同設(shè)備及重復(fù)測量所測得的D值、f值及D*值間的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。不同時(shí)間中央腺體測得的D值、f值、D*值的ICC分別為(0.823,0.460,0.520),外周帶測得的D值、f值、D*值的ICC分別為(0.934,0.601,0.630);不同設(shè)備中央腺體測得的D值、f值、D*值的ICC分別為(0.910,0.462,0.735),外周帶測得的D值、f值、D*值的ICC分別為(0.836,0.523,0.662);重復(fù)測量中央腺體測得的D值、f值、D*值的ICC分別(0.794,0.769,0.566),外周帶測得的D值、f值、D*值的ICC分別為(0.849,0.803,0.871),上述測得的D值間(ICC大于0.75)的相關(guān)性最好。Bland-Altman散點(diǎn)圖顯示D值分布較D*值和f值更集中,提示在3.0T MR設(shè)備前列腺IVIM-DWI檢查時(shí),D值在不同時(shí)間、不同設(shè)備和重復(fù)測量所獲IVIM定量參數(shù)各測量值間的一致性區(qū)間較小,可重復(fù)性較好。結(jié)論本部分研究結(jié)果顯示在3.0T MR設(shè)備前列腺IVIM-DWI檢查時(shí)不同時(shí)間、不同設(shè)備及重復(fù)測量所測得的前列腺IVIM定量參數(shù)值間差異沒有統(tǒng)計(jì)學(xué)意義,D值間(ICC大于0.75)的相關(guān)性最好,各參數(shù)間的一致性較好,其中D值較D*和f值的一致性好,由此表明在3.0T MR設(shè)備前列腺IVIM-DWI檢查時(shí)不同時(shí)間、不同設(shè)備及重復(fù)測量所測得的前列腺IVIM定量參數(shù)值間的一致性較好,IVIM定量參數(shù)可作為前列腺多中心研究的評價(jià)指標(biāo)。
[Abstract]:Part one optimization of the b value of the prostate IVIM-DWI objective to optimize the b value combination of the prostate IVIM-DWI and to explore the role of IVIM-DWI quantitative parameters in the diagnosis of prostate cancer. Methods a retrospective analysis of 47 cases of prostate cases from February 2015 to November with routine prostate MRI and IVIM-DWI scan and pathologically confirmed prostate cases were analyzed retrospectively. Materials, of which 23 cases of prostate cancer and 24 cases of benign prostatic hyperplasia were included. (1) routine MRI and IVIM-DWI examination of prostate were performed simultaneously. The examination technique accorded with the requirements of this study, the examination parameters remained consistent; (2) the ultrasound guided biopsy confirmed the prostate cancer or benign prostatic tissue; (3) the MRI examination of the prostate was not carried out in January. Prostate biopsy; (4) no treatment for prostate disease before prostate MRI examination; (5) the interval between MRI and pathological examination of the prostate is less than 6 weeks. (1) the image data of the MRI scan is incomplete and the image quality does not meet the requirements of this study; (2) the tumor size is too small and the tumor range is not on the IVIM-DWI image boundary. In Qing, ROI can not be set accurately; (3) the pathology result description area and the MRI image mismatch.IVIM-DWI examination set four groups of B values to scan, specifically: (1) 0,101002001000; (2) 0,10,501002001000; (3) 0,10,20,501002001000; (4) 0,10,20,501002005001000. in the obtained IVIM-DWI image according to the biopsy pathology report combined PI-RADS v2. The scoring criteria set the prostate cancer area, the central glandular non cancer area and the peripheral ROI of the peripheral zone, respectively, to measure the IVIM-DWI quantitative parameters of four groups of different b values, including the diffusion coefficient D, the perfusion fraction f and the pseudo diffusion coefficient D*., which were compared with the b value of the prostate cancer area and the central glandular non cancer area. The difference between the parameters measured in the non cancer zone and the peripheral zone, the 22 difference test using LSD-t test, P0.05, was statistically different. Results (1) the D value of the b value (0,101002001000), F value, D* value was (0.67 + 0.11) x 10-3mm2/s, (26.95 + 4.75)%, (12.88 + 4.93) x 10-3mm2/s, D value, F value of the central gland non cancer area, D*. The values were (1.35 + 0.16) x 10-3mm2/s, (27.79 + 3.47)%, (15.6 + 2.82) x 10-3mm2/s, D value, F value of non cancer zone, D* value (1.79 + 0.29) x 10-3mm2/s, (25.19 + 4.3)%, (13.47 + 4.84) x 10-3mm2/s, b value (0,10,501002001000) in group B (0,10,501002001000) of prostate cancer area, F value, D* values were respectively. (13.1 + 4.44) * 10-3mm2/s, the D value, F value of the central glandular non cancerous region, D* value (1.36 + 0.17) * 10-3mm2/s, (27.3 + 4.06)%, (15.41 + 3.46) x 10-3mm2/s, F value, D* value (1.85 + 0.29) * 10-3mm2/s, (23.9 + 3.54)%, (12.22 +) * 10-3mm2/s; D value, F value, and D* value were (0.68 + 0.12) x 10-3mm2/s, (25.59 + 4.84)%, (13.75 + 5.08) x 10-3mm2/s, D value, F value of central glandular non cancer area, D* value (1.38 + 0.16) x 10-3mm2/s, (26.78 + 3.86)%, (15.55 + 2.82) * 10-3mm2/s, F value, F values, respectively, F values, respectively 0-3mm2/s; (4) group B value (0,10,20,501002005001000), D value, F value, D* value (0.67 + 0.13) x 10-3mm2/s, (28.58 + 5.93)%, (12.43 + 5.55) x 10-3mm2/s, D value, F value, D* value of the central glandular region (1.33 + 0.16) * 10-3mm2/s, (28.2 + 3.16)%, (14.38 + 3.15) * *, peripheral band non cancer value, values, values, values, values, The values of D* were (1.81 + 0.35) x 10-3mm2/s, (28 + 6.93)% and (11.41 + 5.64) x 10-3mm2/s., and the D values were lower than those in non cancerous regions. The difference was statistically significant (P0.05), and the D value of the central glandular non cancerous region was lower than the D value in the non cancerous region of the peripheral zone. The difference was statistically significant (P0.05).F value and D* value in the prostate cancer area, the central glandular non cancerous region and the outer region. There was no significant difference in the difference between the non cancer interval and the non cancerous interval (P0.05). Conclusion in the four groups of B values selected in this study, the IVIM parameters (D, F and D*) of the 3.0T prostate IVIM-DWI scan were statistically significant in the difference between the prostate cancer and the non cancer areas, and could be used for the diagnosis and differential diagnosis of the prostate and non cancer areas. And the b value (0,101002001000) of group (1) group (0,101002001000) is the least and the shortest scanning time. It is recommended to be used in the IVIM-DWI scan of the prostate. The consistency analysis of IVIM-DWI imaging in part second of the prostate is used to evaluate the parameter values (D, F, and D*) at different time, different equipment and repeated measurements of the prostatic gland in the prostatic gland. Conformance, to determine the feasibility of the prostatic multicenter study. Methods 15 healthy adult male volunteers were recruited in our hospital in December 2015 to conduct a conformance study of the quantitative parameters of the prostate IVIM-DWI parameters, aged 23-30 years. (1) a healthy adult male, a history of no prostate disease, and no prostate disease related Clinical symptoms; (2) the IVIM-DWI examination of the prostate coincide with the requirements of this study, and the examination parameters remain consistent. Exclusion criteria: (1) poor IVIM-DWI image quality, influence observation and analysis; (2) patients with severe claustrophobia; (3) contraindications to magnetic resonance imaging; (4) prostate IVIM-DWI examination showed abnormal signal changes in the prostate. All the subjects had signed the informed consent. All the volunteers used the 3.0T (Ingenia, Philips) MR imaging system for the prostate IVIM-DWI examination on the same day, and the same operator used 3.0T (Ingenia, Philips) (the same device with the previous examination) and 3 at the same day after 16 days. The T (TX, Philips) MR imaging system repeats the above IVIM-DWI examination with the same.B value of the scan parameters recommended by the first part of the study (0,101002001000). ROI on the central prostate gland and the peripheral zone of the prostate at the maximum area of the prostate (each set of ROI locations) on the prostate axis image obtained at each IVIM-DWI examination. The IVIM parameters (including diffusion coefficient D, perfusion fraction f and pseudo diffusion coefficient D*) were measured respectively, and repeated measurements were carried out on the IVIM parameters (D values, values and values) in the prostate images obtained by the first IVIM-DWI scan of the 3.0T (Ingenia, Philips) MR imaging system. M parameters are measured by the same researchers. Using paired sample t test, the difference between different time, different equipment and repeated measurements of IVIM parameters, P0.05, is statistically significant. The correlation coefficient within the computing group (ICC) is between 0~1, 0 is unbelievable, 1 is fully credible, generally believed to be less than 0.4. The correlation was low and greater than 0.75 indicated that the reliability was good and the correlation was high. The Bland-Altman method was used to make a consistent analysis of the differences between the values of IVIM parameters obtained at different times, different equipment and repeated measurements. Results the value of D, F, D* values of the first IVIM-DWI examination of the 3.0T (Ingenia, Philips) MR imaging system was (1.), and the value of D* was (1.). 35 + 0.22) * 10-3mm2/s, (33.33 + 7.28)%, (14.28 + 4.05) x 10-3mm2/s, D value of peripheral zone, F value, D* value (1.32 + 0.14) x 10-3mm2/s, (34.15 + 7.34)%, (13.09 + 3.20) x 10-3mm2/s, D value of central gland, F value and D* value measured by second examination. Value, D* value is (1.35 + 0.09) x 10-3mm2/s, (34.05 + 8.36)%, (12.94 + 4.41) x 10-3mm2/s, 3.0T (TX, Philips) MR imaging system has measured D value of central gland, F value, D* value is (1.42 + 0.19) x 10-3mm2/s, (33.81 + 5.77)%, (33.81 + 5.77) * 10-3mm2/s, peripheral zone value, respectively. 3 + 3.80) * 10-3mm2/s; 3.0T (Ingenia, Philips) MR imaging system has measured the D value of the central gland, F value, D* value (1.31 + 0.11) x 10-3mm2/s, (34.64 + 7.70)%, (13.98 + 4.01) x 10-3mm2/s, peripheral band D value, respectively, (1.32 + 0.16)%, (33.20 + 5.41)%, (13.46 + 2.67) There was no significant difference between the values of D, F and D* values measured at different time, different equipment and repeated measurements for the prostate IVIM-DWI in X 10-3mm2/s. (P0.05). The D value, F value, D* value of the central gland at different time were respectively (0.823,0.460,0.520), and the D values measured in the peripheral zone were respectively. The D value, the F value and the D* value of the central glands of different equipment are (0.910,0.462,0.735), the D values of the peripheral zone, the F value and the D* value are respectively (0.836,0.523,0.662), and the D values measured by the central glands are repeated, the F values, the values and the values are respectively measured. The best correlation between the above D values (ICC greater than 0.75) is the best.Bland-Altman scatter plot, which shows that the D value distribution is more concentrated than the D* value and F value. It is suggested that the D value of the 3.0T MR equipment in the prostate IVIM-DWI examination is at different time, and the consistency interval between the measured values of the IVIM quantitative parameters obtained by different equipment and repeated measurements is smaller, and the repeatability is better. The results of this part of the study showed that there was no statistical difference between different time, different equipment and repeated measurements of the prostate IVIM quantitative parameters in the prostate IVIM-DWI examination of 3.0T MR equipment. The correlation between the D values (ICC greater than 0.75) was the best, and the consistency of the parameters was better, and the consistency of the D value was better than the D* and F values. It shows that the consistency of the quantitative parameters of the prostate IVIM parameters measured by different equipment and repeated measurements at different time in the prostate IVIM-DWI examination of 3.0T MR equipment is better. The quantitative parameter of IVIM can be used as an evaluation index for the study of prostate multi center.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.2;R737.25;R697.3

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