本文選題：前列腺癌 + 擴散加權成像　； 參考：《上海交通大學》2014年碩士論文

【摘要】：目的：骨是否發(fā)生轉(zhuǎn)移對前列腺癌的臨床分期非常重要，目前用于骨轉(zhuǎn)移診斷的成像方式有MRI，骨掃描，CT、PET/CT等，分析MRI診斷前列腺癌骨轉(zhuǎn)移的價值，并對MRI與核素骨掃描診斷前列腺癌骨轉(zhuǎn)移進行比較，進而選擇最優(yōu)的成像手段，明確前列腺癌的分期，利于治療方式的合理選擇，提高病人的預后。 材料與方法：收集我院2011年1月-2013年6月經(jīng)病理證實為前列腺癌病人252例，全部患者均行常規(guī)MRI、DWI、增強MRI和全身骨掃描。分析盆腔影像，分別獲得MRI、骨掃描對前列腺骨轉(zhuǎn)移診斷的敏感度、特異度、準確度、陽性預測值、陰性預測值。 結果：80%的前列腺癌骨轉(zhuǎn)移病人的PSA50ng/ml，而92%的前列腺癌無骨轉(zhuǎn)移病人的PSA50ng/ml。磁共振診斷前列腺癌骨轉(zhuǎn)移的敏感度、特異度、準確度、陽性預測值（PPV）、陰性預測值(NPV)分別為96.2%,100%,99.2%,100%,99%；全身骨掃描診斷前列腺癌骨轉(zhuǎn)移的敏感度、特異度、準確度、陽性預測值、陰性預測值分別為85.1%,84.3%,84.5%,60%,95.4%。 結論： 1、 MRI診斷前列腺癌骨轉(zhuǎn)移的特異度及陽性預測值高，對盆腔骨轉(zhuǎn)移灶的顯示優(yōu) 于骨掃描。 2、骨掃描顯示范圍廣，有利于評估全身骨轉(zhuǎn)移的情況。 3、 MRI與骨掃描可以實現(xiàn)優(yōu)勢互補，利于前列腺癌的準確臨床分期。 4、 MRI冠狀位與矢狀位圖像的補充可以有效提高病灶的檢出率。 目的：通過常規(guī)MRI與功能磁共振成像，探討MRI對前列腺癌精囊腺侵犯與否的診斷價值，主要通過分析精囊腺的ADC值的差異對精囊侵犯與否的鑒別價值及常規(guī)磁共振，增強磁共振及擴散加權磁共振成像對精囊侵犯的診斷價值。 材料與方法：收集我院2011年1月-2013年6月經(jīng)病理證實為前列腺癌病人252例504個精囊腺，全部患者均行常規(guī)、DWI和增強MR成像。分別獲取前列腺癌灶及雙側(cè)精囊腺的ADC值，并進行獨立樣本t檢驗；并計算常規(guī)MRI、常規(guī)+增強MRI,常規(guī)+DWI-MRI及綜合應用常規(guī)+增強+DWI診斷前列腺癌精囊腺侵犯的特異度、敏感度及準確度。 結果：受侵犯精囊腺（SVI）、受侵犯精囊腺所在前列腺癌灶、強化且未受侵犯側(cè)精囊腺及強化且未受侵犯側(cè)精囊腺所在前列腺癌灶的ADC值分別為(0.98±0.02)x10-3mm2/s,(0.81±0.14)x10-3mm2/s,(1.59±0.04)x10-3mm2/s,(1.01±0.12)x10-3mm2/s。受侵犯精囊腺的ADC值明顯低于非受侵強化精囊腺的ADC值（P0.05），，受侵犯精囊所在前列腺癌灶ADC值低于有強化但未受侵犯精囊所在前列腺癌灶的ADC值（P0.05），受侵犯精囊所在前列腺癌灶的ADC值低于受侵犯精囊腺的ADC值（P0.05）。常規(guī)MRI、磁共振增強、擴散加權成像以及兩者的聯(lián)合對前列腺癌精囊腺轉(zhuǎn)移的特異度分別為93.1%、97.8%、99.7%、99.7%；診斷敏感度分別為100%、100%、94.5%、100%；準確度分別為93.6%、98%、99.4%,99.8%。陽性預測值分別為54%，78.7%，97.2%，97.3%，陰性預測值分別為100%，100%，99.5%，100%。 結論： 1、精囊腺的ADC值的差異有助于判斷前列腺癌是否有精囊腺侵犯。 2、磁共振各序列聯(lián)合應用更有利于對前列腺癌精囊轉(zhuǎn)移的準確診斷。
[Abstract]:Objective: the metastasis of bone is very important for the clinical staging of prostate cancer. At present, the imaging modalities of bone metastasis are MRI, bone scan, CT, PET/CT and so on. The value of MRI in the diagnosis of bone metastasis of prostate cancer is analyzed, and the comparison of MRI and nuclide bone scan in the diagnosis of prostate cancer is made and the best imaging method is selected. The staging of prostate cancer is conducive to the rational choice of treatment and the prognosis of patients.
Materials and methods: 252 cases of prostate cancer confirmed by pathology in our hospital in January 2011 -2013 6 period were confirmed as 252 cases of prostate cancer. All patients underwent routine MRI, DWI, enhanced MRI and whole body bone scan. The pelvic images were analyzed to obtain MRI and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scan on the diagnosis of prostate bone metastasis.
Results: the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the PSA50ng/ml. magnetic resonance imaging (PPV) and negative predictive value (NPV) were 96.2%, 100%, 99.2%, 100%, 99% of the patients with prostate cancer without bone metastases in the diagnosis of bone metastases of the prostate cancer. The bone metastases of the prostate cancer were diagnosed by PSA50ng/ml. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 85.1%, 84.3%, 84.5%, 60%, 95.4%. respectively.
Conclusion:
1, the specificity and positive predictive value of MRI in diagnosing bone metastases of prostate cancer is high.
Bone scan.
2, bone scan shows a wide range and helps to assess bone metastases in the whole body.
3, MRI and bone scan can complement each other and facilitate the accurate clinical staging of prostate cancer.
4, MRI coronal and sagittal images can effectively improve the detection rate of lesions.
Objective: To explore the diagnostic value of MRI on the adenocarcinoma of the seminal vesicle by conventional MRI and functional magnetic resonance imaging (fMRI), and to evaluate the value of the differential value of the ADC value of the seminal vesicle on the differentiation of the seminal vesicle and the conventional magnetic resonance (MRI), and to enhance the diagnostic value of magnetic resonance and diffusion-weighted magnetic resonance imaging on the encroachment of the seminal vesicle.
Materials and methods: 252 cases of 504 seminal vesicles were collected from 252 cases of prostate cancer confirmed by pathology in 6 period of -2013 January 2011. All patients underwent routine, DWI and enhanced MR imaging. The ADC values of prostate cancer and bilateral seminal vesicles were obtained respectively. The independent sample t test was performed, and routine MRI, routine + enhanced MRI, conventional +DWI-MRI and heald were calculated. The specificity, sensitivity and accuracy of routine and enhanced +DWI in the diagnosis of prostate cancer seminal vesicle invasion were compared.
Results: the invasive seminal vesicle gland (SVI), the prostate cancer in the encroachment of the seminal vesicle, the ADC value of the enhanced and unencroached seminal vesicle and the enhanced and unencroached side seminal vesicle of the prostate cancer were (0.98 + 0.02) x10-3mm2/s, (0.81 + 0.14) x10-3mm2/s, (1.59 + 0.04) x10-3mm2/s, and (1.01 + 0.12) x10-3mm2/s. (1.01 +) x10-3mm2/s. by the ADC of the encroachment of the seminal vesicle The value of the ADC value (P0.05) was lower than that of the non invaded seminal vesicle. The ADC value of the prostate cancer area in the encroachment seminal vesicle was lower than that of the enhanced but unencroached seminal vesicle ADC (P0.05). The ADC value of the prostate cancer lesion located in the encroachment seminal vesicle was lower than the ADC value of the encroached seminal vesicle (P0.05). The specificity of the combination of the images and the two was 93.1%, 97.8%, 99.7%, 99.7%, respectively, and the diagnostic sensitivity was 100%, 100%, 94.5%, 100% respectively, and the accuracy was 93.6%, 98%, 99.4%, respectively, and the predictive values of 99.8%. were respectively 54%, 78.7%, 97.2%, and negative predictive values respectively, 100%.
Conclusion:
1, the difference in ADC value of seminal vesicle helps to determine whether there is a seminal vesicle invasion in prostate cancer.
2, combined application of MRI sequences is more conducive to accurate diagnosis of prostate cancer seminal vesicle metastasis.

【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.25;R445.2

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