本文選題：前列腺癌 + LAVA動態(tài)增強��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：第一部分前列腺癌3.0T MR動態(tài)增強掃描特征 目的：分析前列腺癌3.0T MR動態(tài)增強掃描特征，探討動態(tài)增強檢查對前列腺癌的診斷價值及其與Gleason評分的相關(guān)性。 材料和方法：前瞻性納入我院2012年8月至2013年8月的85例臨床擬診前列腺癌（Prostate cancer，PCa）患者，年齡47-83歲，平均70歲。所有病例均采用GESigna HDx3.0T磁共振掃描儀及心臟相控線圈。行常規(guī)掃描（橫斷面T1WI、T2WI、T2WI FS、冠狀面T2WI、矢狀面T2WI）和LAVA多期動態(tài)增強掃描。分析信號強度-時間（SI-T）曲線類型，并進一步計算到達峰值時間（Tmax）、最大強化程度（SImax%）和最快強化率（Rmax）。對前列腺進行標準化分區(qū)，比較穿刺證實陽性組（癌區(qū)）與陰性組（非癌區(qū)）各參數(shù)之間的差異，并評價其與Gleason分級的相關(guān)性。 結(jié)果：活檢發(fā)現(xiàn)前列腺癌59例，26例未檢出腫瘤證據(jù)，共有507個分區(qū)得到組織學(xué)證實，陽性組250個（Gleason評分2-6分者36個，Gleason評分7-10分者214個），陰性組257個。陽性組SI-T曲線以廓清型為主，陰性組SI-T曲線以上升型和平臺型為主。陽性組的Tmax、SImax%、Rmax分別為（69.49±22.53）s、1.74±0.43、7.83±3.80，陰性組的Tmax、SImax%、Rmax分別為（175.61±52.64）s、1.05±0.35、1.86±1.10，差異均具有統(tǒng)計學(xué)意義（t=-24.24、16.34、17.75，P均＜0.01）。前列腺癌中高分化腺癌組（Gleason評分2-6分）的Tmax、SImax%、Rmax分別為（89.19±31.72）s、1.58±0.46、5.21±3.34，中低分化腺癌組（Gleason評分7-10分）的Tmax、SImax%、Rmax分別為（64.25±14.68）s、1.76±0.43、8.25±3.70，二者間差異均具有統(tǒng)計學(xué)意義（t=7.09、-8.74、-7.83，P均＜0.01）。前列腺癌的Tmax與Gleason評分呈負相關(guān)關(guān)系（r=-0.471，P＜0.01），SImax%、Rmax均與Gleason評分呈正相關(guān)關(guān)系（r=0.472、0.537，P均＜0.01）。 結(jié)論：LAVA多期動態(tài)增強掃描在前列腺癌的診斷中具有重要價值，多表現(xiàn)為早期明顯強化，動態(tài)增強掃描參數(shù)與Gleason分級具有相關(guān)性，能夠無創(chuàng)性評估PCa的生物學(xué)特性，有助于臨床治療方案的選擇及評估預(yù)后。 第二部分前列腺癌3.0T MRS與DWI掃描的相關(guān)性研究 目的：分析前列腺癌的（Cho+Cre）/Cit比值與ADC值，研究二者的相關(guān)性，并與病理結(jié)果對照，探討其對前列腺癌的診斷價值。 材料和方法：前瞻性納入我院2012年8月至2013年8月的29例臨床擬診前列腺癌患者，年齡52-79歲，平均68歲。所有病例均采用GE Signa HDx3.0T磁共振掃描儀及心臟相控線圈。分別行常規(guī)掃描（橫斷面T1WI、T2WI、T2WI FS、冠狀面T2WI、矢狀面T2WI）和MRS、DWI掃描。MRS掃描采用PRESS序列，掃描完成后用本機自帶軟件進行數(shù)據(jù)后處理；DWI采用EPI序列，自動生成ADC圖。對前列腺進行標準化分區(qū)，得到陽性組（癌區(qū)）與陰性組（非癌區(qū)）的（Cho+Cre）/Cit比值與ADC值，應(yīng)用ROC曲線下面積評價其準確性，并對二者進行相關(guān)性分析。 結(jié)果：活檢發(fā)現(xiàn)前列腺癌16例，13例未檢出腫瘤證據(jù)，共有174個分區(qū)得到組織學(xué)證實，陽性組73個，陰性組101個。穿刺陽性組與陰性組的平均（Cho+Cre）/Cit比值分別為2.59±1.89、0.71±0.15，二者差異具有顯著的統(tǒng)計學(xué)意義（t=3.56，P＜0.01），將（Cho+Cre）/Cit值作為預(yù)測穿刺陽性的指標，利用SPSS19.0繪制ROC曲線，曲線下面積為0.93（P=0.000），最佳臨界值為（Cho+Cre）/Cit=1.04，此時預(yù)測穿刺陽性的敏感度為87.5%，特異度為92.3%。穿刺陽性組與陰性組的平均ADC值分別為（0.86±0.20）×10-3mm2/s、（1.13±0.12）×10-3mm2/s，，二者差異有統(tǒng)計學(xué)意義（t=-6.02，P＜0.01），將ADC值作為預(yù)測疑診前列腺癌患者穿刺陽性率的指標，并繪制ROC曲線，曲線下面積為0.89（P=0.000），最佳臨界值為1.06×10-3mm2/s，此時預(yù)測穿刺陽性的敏感度為87.5%，特異度為77.3%。前列腺癌的（Cho+Cre）/Cit比值與ADC值呈負相關(guān)關(guān)系（r=-0.71，P＜0.01）。 結(jié)論：3.0T磁共振MRS及DWI掃描有助于前列腺癌的診斷及鑒別診斷，本研究中（Cho+Cre）/Cit比值高于1.04、ADC值低于1.06×10-3mm2/s是診斷前列腺癌較適宜的界值，且（Cho+Cre）/Cit比值和ADC值二者間具有相關(guān)性。
[Abstract]:Part one features of 3.0T MR dynamic enhanced scan for prostate cancer
Objective: to analyze the characteristics of 3.0T MR dynamic contrast-enhanced scan in prostate cancer, and to explore the diagnostic value of dynamic enhanced examination for prostate cancer and its correlation with Gleason score.
Materials and methods: We prospectively included 85 patients with Prostate cancer (PCa) from August 2012 to August 2013, aged 47-83 years old, with an average of 70 years of age. All cases were treated with GESigna HDx3.0T MRI scanner and cardiac controlled coil. Routine scan (cross section T1WI, T2WI, T2WI FS, coronary T2WI, sagittal T2WI) And LAVA multi-phase dynamic enhanced scan. Analysis of signal intensity time (SI-T) curve type, and further calculate the peak time (Tmax), maximum intensification degree (SImax%) and the fastest intensification rate (Rmax). The standard partition of the prostate is carried out to compare the differences between the parameters of the positive group (cancer area) and the negative group (non cancer area), and evaluate the difference between the parameters of the positive group and the negative group (non cancer area). Correlation with Gleason classification.
Results: 59 cases of prostate cancer were detected by biopsy, and 26 cases had no evidence of tumor. A total of 507 zoning were confirmed by histology. The positive group was 250 (36 Gleason score 2-6, 214 of 7-10 scores) and 257 in the negative group. The SI-T curve in the positive group was mainly the clearance type, and the SI-T curve above the SI-T curve in the negative group was the dominant group. Tm of the positive group was Tm. Ax, SImax%, and Rmax were (69.49 + 22.53) s, 1.74 + 0.43,7.83 + 3.80, Tmax in the negative group, SImax%, and Rmax were (175.61 + 52.64) s and 1.05 + 0.35,1.86 + 1.10 respectively. The difference was statistically significant (t=-24.24,16.34,17.75, P < 0.01). 1.58 + 0.46,5.21 + 3.34, Tmax, SImax%, and Rmax of middle and low differentiated adenocarcinoma group (Gleason score 7-10) were (64.25 + 14.68) s and 1.76 + 0.43,8.25 + 3.70 respectively. The differences among two were statistically significant (t=7.09, -8.74, -7.83, P < 0.01). On score was positively correlated (r=0.472,0.537, P < 0.01).
Conclusion: LAVA multiphase dynamic enhanced scan is of important value in the diagnosis of prostate cancer. It is characterized by early obvious enhancement. The dynamic enhanced scan parameters are correlated with the Gleason classification. It can not be used to evaluate the biological characteristics of PCa, and help to select and evaluate the prognosis of the clinical treatment.
The second part of prostate cancer 3.0T MRS and DWI scan correlation study
Objective: to analyze the (Cho+Cre) /Cit ratio and ADC value of prostate cancer, and to study the correlation between these two factors and to compare with pathological findings and to explore their diagnostic value for prostate cancer.
Materials and methods: 29 cases of clinically diagnosed prostate cancer were prospectively included in our hospital from August 2012 to August 2013, aged 52-79 years old, with an average of 68 years of age. All cases were treated with GE Signa HDx3.0T magnetic resonance scanner and cardiac controlled coil. Routine scanning (cross section T1WI, T2WI, T2WI FS, coronary T2WI, sagittal T2WI) and MRS, DWI sweep were performed respectively. The.MRS scan uses the PRESS sequence, and after the scanning is completed, the data is processed with the software of the machine, and the ADC map is automatically generated by the EPI sequence. The standard partition of the prostate is carried out. The ratio of the positive group (cancer area) to the negative group (Cho+Cre) /Cit ratio and ADC value is obtained. The accuracy is evaluated with the area under the ROC curve, and the two are entered into the two. Correlation analysis.
Results: 16 cases of prostate cancer were detected by biopsy, and 13 cases had no evidence of tumor. A total of 174 zoning were confirmed by histology, 73 positive groups and 101 negative groups. The average (Cho+Cre) /Cit ratio of the positive group and negative group was 2.59 1.89,0.71 + 0.15 respectively. The difference of the two was statistically significant (t=3.56, P < 0.01), and (Cho+Cre) /Cit As the target of predicting the positive puncture, the ROC curve was plotted by SPSS19.0, the area under the curve was 0.93 (P=0.000), the best critical value was (Cho+Cre) /Cit=1.04, and the sensitivity of the positive puncture was 87.5%. The average ADC value of the 92.3%. puncture positive group and the negative group was (0.86 + 0.20) x 10-3mm2/s and (1.13 + 0.12) x 10-3mm2/s, respectively. The difference between the two was statistically significant (t=-6.02, P < 0.01). The ADC value was used as an index to predict the positive rate of prostate cancer, and the ROC curve was drawn, the area under the curve was 0.89 (P=0.000), the best critical value was 1.06 x 10-3mm2/s, at this time the sensitivity of the positive puncture was 87.5%, and the specificity was the /Cit ratio of the 77.3%. prostate cancer (Cho+Cre). There is a negative correlation between the value and the ADC value (r=-0.71, P < 0.01).
Conclusion: 3.0T MRI MRS and DWI scan are helpful for the diagnosis and differential diagnosis of prostate cancer. In this study (Cho+Cre), the ratio of /Cit is higher than 1.04, and the value of ADC is less than 1.06 * 10-3mm2/s is a better boundary value for the diagnosis of prostate cancer, and the (Cho+Cre) /Cit ratio and ADC value two have a correlation between them.
【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】：2014
【分類號】：R737.25;R445.2

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