在胰腺癌靶區(qū)勾畫中磁共振彌散加權(quán)成像（MR-DWI）與增強電子計算機斷層掃描（CT）的對比研究
發(fā)布時間：2018-09-03 08:29
【摘要】：【目的】旨在進一步研究探討胰腺癌、肝臟與區(qū)域淋巴結(jié)轉(zhuǎn)移瘤在增強電子計算機增強掃描(Computed tomography,CT)及磁共振彌散加權(quán)成像(Magnetic Resonance Diffusion Weighted Imaging,MR-DWI)上的區(qū)別,使胰腺癌放療靶區(qū)勾畫更具精確性,為指導(dǎo)臨床放療提供理論依據(jù),指導(dǎo)臨床放療實踐�！痉椒ā咳虢M患者為38例,入組條件:KPS(Karnofsky Performance Status,功能狀態(tài)評分)評分60分;未行針對胰腺癌的相關(guān)治療;患者體內(nèi)無金屬異物,可行磁共振檢查;患者對增強造影劑不過敏且知情并同意;經(jīng)組織病理學(xué)或者臨床確診為胰腺癌患者。所有患者均行增強CT及MRI定位掃描。依據(jù)不同圖像進行逐層靶區(qū)體積勾畫(表示為:GTVCT、GTVDWI),測量腫瘤最大截面長徑測量(表示為:d CT、dDWI)、肝轉(zhuǎn)移瘤(表示為:NCT肝、NMRI肝)及5-8mm、8mm淋巴結(jié)轉(zhuǎn)移瘤(表示為:NCT5-8淋巴、NMRI5-8淋巴、NCT8淋巴、NMRI8淋巴)。將相應(yīng)數(shù)據(jù)進行統(tǒng)計分析,采用配對t檢驗或秩和檢驗對計量資料進行統(tǒng)計學(xué)分析。【結(jié)果】1、患者特征:入組患者38例,男、女分別為20/18人。入組患者平均年齡59.1歲。腫瘤位于胰腺頭頸部20例,胰腺體尾部18例。19例為局部進展期,19例伴有肝臟等轉(zhuǎn)移。行增強CT和MR-DWI的平均檢查間隔時間為4.3天。2、胰腺原發(fā)腫瘤比較:基于增強CT、MR-DWI所勾畫的腫瘤靶區(qū)體積大小,分別為54.95cm3(12.41cm3-266.29cm3)、41.67cm3(5.66cm3-235.41cm3),均值差值13.28cm3(8.26cm3-18.29cm3),使用配對wilcoxon檢驗分析得出兩組數(shù)據(jù)有統(tǒng)計學(xué)差異。依據(jù)增強CT及MR-DWI所測量的腫瘤最大界面長徑分別為4.18cm(1.76cm-7.3cm)、3.94cm(1.48cm-7.33cm),均值差值為0.24cm(0.18cm-0.30cm)。配對t檢驗分析得出p0.001,結(jié)果有統(tǒng)計學(xué)差異。表明MR-DWI所測量的腫瘤靶區(qū)體積及腫瘤最大界面長徑較增強CT小。3、胰腺癌肝臟轉(zhuǎn)移比較:有肝臟轉(zhuǎn)移患者19例,占比50%。依據(jù)增強CT與MR-DWI圖像分別檢出肝臟轉(zhuǎn)移瘤為83vs112枚,CT檢出只量占MR-DWI檢出量的74%,MR-DWI檢出可覆蓋全部增強CT檢出。經(jīng)配對wilcoxon秩和檢驗分析得出p0.001,二者之間有顯著統(tǒng)計學(xué)差異,表明DWI對胰腺癌肝轉(zhuǎn)移有更高檢出率。4、區(qū)域淋巴結(jié)轉(zhuǎn)移比較:依據(jù)增強CT與MR-DWI圖像,分別檢出8mm區(qū)域淋巴結(jié)轉(zhuǎn)移者46vs56枚,增強CT檢出量只有MR-DWI檢出量的82%。依據(jù)增強CT與MR-DWI圖像分別檢出5-8mm區(qū)域淋巴結(jié)為103vs200枚,增強CT檢出量只有MR-DWI檢出量的52%,且MR-DWI檢出可覆蓋全部增強CT檢出。使用配對wilcoxon檢驗得p值均小于0.001。N_(CT5-8淋巴)、N_(DWI5-8淋巴)與N_(CT8淋巴)、N_(DWI8淋巴)之間均有統(tǒng)計學(xué)差異,表明MR-DWI對區(qū)域淋巴結(jié)檢出有較高敏感性,但臨床診斷特異性還有待深入研究。【結(jié)論】基于MR-DWI所測量的腫瘤靶區(qū)體積及腫瘤最大界面長徑較增強CT小,肝轉(zhuǎn)移及區(qū)域淋巴結(jié)檢出較增強CT敏感。在制定胰腺癌放療計劃時,參考MR-DWI可使得靶區(qū)邊界更加清晰,對于肝臟及區(qū)域淋巴結(jié)轉(zhuǎn)移檢出敏感性顯著高于CT檢查,有助于臨床治療方案的確定和放療計劃的修正,當(dāng)然還需要進一步深入研究MR-DWI檢出率的特異性。參照病理的進一步對照研究是有必要的。
[Abstract]:[Objective] To investigate the difference between enhanced computed tomography (CT) and magnetic Resonance Diffusion Weighted Imaging (MR-DWI) in pancreatic cancer, liver and regional lymph node metastases, so as to make the target area delineation more accurate and guide the clinical practice. [Methods] 38 patients with KPS (Karnofsky Performance Status) score of 60 points, no treatment for pancreatic cancer, no metallic foreign body in the body, feasible magnetic resonance imaging, and no sensitivity to contrast agents, were enrolled in the study. All patients underwent enhanced CT and MRI localization scan. The target volume was delineated layer by layer according to different images (GTVCT, GTVDWI), the maximum cross-sectional length of the tumor was measured (expressed as: D CT, dDWI), hepatic metastases (expressed as: NCT liver, NMRI liver) and lymph node metastasis of 5-8 mm, 8 mm. Tumor metastasis (expressed as NCT 5-8 lymph node, NMRI 5-8 lymph node, NCT 8 lymph node, NMRI 8 lymph node). Statistical analysis of the corresponding data was carried out by paired t test or rank sum test. [Results] 1. Patient characteristics: 38 patients in the study group, 20/18 men, women respectively. The average age of the patients in the study group was 59.1 years. The mean interval between contrast-enhanced CT and MR-DWI was 4.3 days.2. Compared with primary pancreatic tumors, the size of the tumor target area based on contrast-enhanced CT and MR-DWI was 54.95 cm 3 (12.41 cm 3-266.29 cm 3), 41.67 cm 3 (5.66 cm 3-235.41 cm 3), respectively. The maximum tumor interface length measured by enhanced CT and MR-DWI was 4.18 cm (1.76 cm-7.3 cm), 3.94 cm (1.48 cm-7.33 cm), and the mean difference was 0.24 cm (0.18 cm-0.30 cm). Compared with contrast-enhanced CT, MR-DWI showed that the tumor target volume and the maximum tumor interface length were smaller. 3. Compared with contrast-enhanced CT, 19 patients with hepatic metastasis had hepatic metastasis, accounting for 50%. According to contrast-enhanced CT and MR-DWI, 83 vs 112 hepatic metastases were detected, only 74% of them were detected by CT, and the detection of MR-DWI could cover all of them. Strong CT was detected. The paired Wilcoxon rank sum test showed that p0.001 was significantly different between the two, indicating that DWI had a higher detection rate of liver metastasis of pancreatic cancer. 4. Regional lymph node metastasis was compared. According to enhanced CT and MR-DWI images, 46 vs56 lymph node metastases were detected in 8 mm region, and only 82% of enhanced CT was detected by MR-DWI. According to contrast-enhanced CT and MR-DWI images, 103 vs 200 lymph nodes were detected in 5-8 mm region, only 52% of them were detected by contrast-enhanced CT, and the detection of MR-DWI could cover all the enhanced CT. The p value of matched Wilcoxon test was less than 0.001.N_ (CT5-8 lymph), N_ (DWI 5-8 lymph) and N_ (CT8 lymph), N_ (DWI 8 lymph) were statistically significant. The difference shows that MR-DWI is more sensitive to regional lymph node detection, but the specificity of clinical diagnosis remains to be further studied. [Conclusion] The volume of tumor target and the maximum diameter of tumor interface measured by MR-DWI are smaller than that by contrast-enhanced CT, and the detection of liver metastasis and regional lymph node is more sensitive than that by contrast-enhanced CT. WI can make the target boundary clearer, and the sensitivity of detection of liver and regional lymph node metastasis is significantly higher than that of CT. It is helpful to determine the clinical treatment plan and revise the radiotherapy plan. Of course, further study on the specificity of MR-DWI detection rate is needed.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.2;R735.9
本文編號：2219438
[Abstract]:[Objective] To investigate the difference between enhanced computed tomography (CT) and magnetic Resonance Diffusion Weighted Imaging (MR-DWI) in pancreatic cancer, liver and regional lymph node metastases, so as to make the target area delineation more accurate and guide the clinical practice. [Methods] 38 patients with KPS (Karnofsky Performance Status) score of 60 points, no treatment for pancreatic cancer, no metallic foreign body in the body, feasible magnetic resonance imaging, and no sensitivity to contrast agents, were enrolled in the study. All patients underwent enhanced CT and MRI localization scan. The target volume was delineated layer by layer according to different images (GTVCT, GTVDWI), the maximum cross-sectional length of the tumor was measured (expressed as: D CT, dDWI), hepatic metastases (expressed as: NCT liver, NMRI liver) and lymph node metastasis of 5-8 mm, 8 mm. Tumor metastasis (expressed as NCT 5-8 lymph node, NMRI 5-8 lymph node, NCT 8 lymph node, NMRI 8 lymph node). Statistical analysis of the corresponding data was carried out by paired t test or rank sum test. [Results] 1. Patient characteristics: 38 patients in the study group, 20/18 men, women respectively. The average age of the patients in the study group was 59.1 years. The mean interval between contrast-enhanced CT and MR-DWI was 4.3 days.2. Compared with primary pancreatic tumors, the size of the tumor target area based on contrast-enhanced CT and MR-DWI was 54.95 cm 3 (12.41 cm 3-266.29 cm 3), 41.67 cm 3 (5.66 cm 3-235.41 cm 3), respectively. The maximum tumor interface length measured by enhanced CT and MR-DWI was 4.18 cm (1.76 cm-7.3 cm), 3.94 cm (1.48 cm-7.33 cm), and the mean difference was 0.24 cm (0.18 cm-0.30 cm). Compared with contrast-enhanced CT, MR-DWI showed that the tumor target volume and the maximum tumor interface length were smaller. 3. Compared with contrast-enhanced CT, 19 patients with hepatic metastasis had hepatic metastasis, accounting for 50%. According to contrast-enhanced CT and MR-DWI, 83 vs 112 hepatic metastases were detected, only 74% of them were detected by CT, and the detection of MR-DWI could cover all of them. Strong CT was detected. The paired Wilcoxon rank sum test showed that p0.001 was significantly different between the two, indicating that DWI had a higher detection rate of liver metastasis of pancreatic cancer. 4. Regional lymph node metastasis was compared. According to enhanced CT and MR-DWI images, 46 vs56 lymph node metastases were detected in 8 mm region, and only 82% of enhanced CT was detected by MR-DWI. According to contrast-enhanced CT and MR-DWI images, 103 vs 200 lymph nodes were detected in 5-8 mm region, only 52% of them were detected by contrast-enhanced CT, and the detection of MR-DWI could cover all the enhanced CT. The p value of matched Wilcoxon test was less than 0.001.N_ (CT5-8 lymph), N_ (DWI 5-8 lymph) and N_ (CT8 lymph), N_ (DWI 8 lymph) were statistically significant. The difference shows that MR-DWI is more sensitive to regional lymph node detection, but the specificity of clinical diagnosis remains to be further studied. [Conclusion] The volume of tumor target and the maximum diameter of tumor interface measured by MR-DWI are smaller than that by contrast-enhanced CT, and the detection of liver metastasis and regional lymph node is more sensitive than that by contrast-enhanced CT. WI can make the target boundary clearer, and the sensitivity of detection of liver and regional lymph node metastasis is significantly higher than that of CT. It is helpful to determine the clinical treatment plan and revise the radiotherapy plan. Of course, further study on the specificity of MR-DWI detection rate is needed.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.2;R735.9
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