磁共振功能成像診斷膀胱癌肌層浸潤(rùn)價(jià)值的研究
發(fā)布時(shí)間：2018-07-21 12:33
【摘要】：背景和目的 膀胱癌是泌尿系統(tǒng)最常見的惡性腫瘤。臨床上根據(jù)T分期不同將膀胱癌分為非肌層浸潤(rùn)性膀胱癌（Tis、Ta、T1期）和肌層浸潤(rùn)性膀胱癌（T2-T4期）。非肌層浸潤(rùn)性膀胱癌的治療采用經(jīng)尿道膀胱腫瘤電切術(shù)（transurethral resection ofbladder tumor，TURBT），肌層浸潤(rùn)性膀胱癌的治療為根治性膀胱切除術(shù)。因此，術(shù)前正確判斷膀胱癌是否浸潤(rùn)肌層對(duì)于臨床治療具有重要意義。MRI是判斷膀胱壁肌層是否浸潤(rùn)最準(zhǔn)確的方法，擴(kuò)散加權(quán)成像（diffusion weighted imaging，DWI）及動(dòng)態(tài)增強(qiáng)磁共振（dynamic contrast-enhanced magnetic resonance imaging，DCE-MRI）作為磁共振功能成像能夠?qū)崿F(xiàn)形態(tài)與功能相結(jié)合，補(bǔ)充了常規(guī)MRI的不足。DWI與DCE-MRI可能有助于判斷膀胱壁肌層是否浸潤(rùn)。本研究的目的是分析常規(guī)MRI及DWI、DCE-MRI在判斷膀胱癌肌層浸潤(rùn)中的應(yīng)用，通過(guò)與常規(guī)MRI對(duì)比，探討DWI、DCE-MRI序列判斷膀胱癌肌層浸潤(rùn)的價(jià)值。 資料和方法 收集鄭州大學(xué)附屬腫瘤醫(yī)院2012.10～2014.2期間65例膀胱癌病例進(jìn)行分析。所有病例進(jìn)行了常規(guī)MRI序列和DWI序列及DCE-MRI序列檢查。由兩位醫(yī)生盲法閱片，分別根據(jù)常規(guī)MRI序列和常規(guī)MRI+DWI序列以及常規(guī)MRI+DWI+DCE-MRI序列對(duì)膀胱癌肌層浸潤(rùn)進(jìn)行判斷。應(yīng)用受試者工作特征（receiver operating characteristic，ROC）曲線分析單獨(dú)使用常規(guī)MRI序列、常規(guī)MRI+DWI序列以及常規(guī)MRI+DWI+DCE-MRI序列時(shí)診斷膀胱癌肌層浸潤(rùn)的能力。測(cè)量病灶鄰近膀胱壁肌層表觀擴(kuò)散系數(shù)（apparent diffusion coefficient，ADC）值，利用ROC曲線分析膀胱癌浸潤(rùn)肌層的ADC值，得出閾值并計(jì)算利用閾值膀胱癌肌層浸潤(rùn)的準(zhǔn)確度、敏感度以及特異度。 結(jié)果 65例膀胱癌患者，其中40例為肌層浸潤(rùn)性膀胱癌，25例為非肌層浸潤(rùn)性膀胱癌。甲醫(yī)師使用常規(guī)MRI序列判斷膀胱癌肌層浸潤(rùn)時(shí)的曲線下面積（areaunder curve，AUC）為0.859，準(zhǔn)確度為75.0%，敏感度為77.5%，特異度為72.0%，常規(guī)MRI+DWI序列時(shí)AUC為0.907，準(zhǔn)確度為83.1%，，敏感度為85.0%，特異度為80.0%，常規(guī)MRI+DWI+DCE-MRI時(shí)AUC為0.944，準(zhǔn)確度為92.3%，敏感度為95.0%，特異度為88.0%，三者AUC之差具有統(tǒng)計(jì)學(xué)意義（p=0.031＜0.05）；乙醫(yī)師使用常規(guī)MRI序列時(shí)的AUC為0.861，準(zhǔn)確度為73.8%，敏感度為75.0%，特異度為72.0%，，常規(guī)MRI+DWI序列時(shí)AUC為0.917，準(zhǔn)確度為83.1%，敏感度為82.5%，特異度為84.0%，常規(guī)MRI+DWI+DCE-MRI時(shí)AUC為0.936，準(zhǔn)確度為90.8%，敏感度為90.0%，特異度為92.0%，三者AUC之差具有統(tǒng)計(jì)學(xué)意義（p=0.026＜0.05）。膀胱癌患者中浸潤(rùn)的肌層ADC值為1.52±0.15×10-3mm2/s，未浸潤(rùn)肌層為2.21±0.39×10-3mm2/s。以1.61×10-3mm2/s為閾值時(shí)，診斷膀胱癌肌層浸潤(rùn)的敏感度、特異度分別為91.2%和90.4%。 結(jié)論 與常規(guī)MRI相比，常規(guī)MRI+DWI+DCE-MRI序列能夠提高診斷膀胱癌肌層浸潤(rùn)的準(zhǔn)確度。定量測(cè)量膀胱壁肌層的ADC值對(duì)判斷肌層浸潤(rùn)有一定的參考價(jià)值，以膀胱癌病灶臨近肌層ADC值1.61×10-3mm2/s為閾值時(shí)診斷膀胱癌肌層浸潤(rùn)的敏感度及特異度較高。
[Abstract]:Background and objective bladder cancer is the most common malignant tumor in the urinary system. According to T stage, bladder cancer was divided into non-myometrial invasive bladder carcinoma (Tis-Tahl T1 stage) and myometrial invasive bladder carcinoma (T2-T4 stage). The treatment of non-myometrial invasive bladder cancer was performed by transurethral resection of bladder tumor (transurethral resection ofbladder tumor TURBT), and radical cystectomy was performed for myometrial invasive bladder cancer. Therefore, it is important for clinical treatment to correctly judge whether bladder cancer infiltrates muscle layer before operation. MRI is the most accurate method to judge whether bladder wall muscle layer is infiltrating or not. Diffusion weighted (diffusion weighted imaging (DWI) and dynamic enhanced magnetic resonance imaging (dynamic contrast-enhanced magnetic resonance imaging DCE-MRI) can be used to combine the morphology and function of Mr functional imaging. DWI and DCE-MRI may be helpful in judging whether the bladder wall muscle layer is infiltrating or not. The purpose of this study was to analyze the application of conventional MRI and DWICE-MRI in the diagnosis of myometrium invasion in bladder cancer, and to explore the value of DWII-DCE-MRI sequence in judging the myometrial invasion of bladder cancer by comparing with conventional MRI. Materials and methods 65 cases of bladder cancer were collected and analyzed during the period of 2012.10 ~ 2014.2 in affiliated Cancer Hospital of Zhengzhou University. All cases were examined by conventional MRI sequence, DWI sequence and DCE-MRI sequence. The myometrium invasion of bladder cancer was judged by conventional MRI sequence, conventional DWI sequence and conventional DWI DCE-MRI sequence. The ability of using conventional (receiver operating sequences, conventional DWI sequences and conventional DWI DCE-MRI sequences to diagnose the invasion of the muscular layer of bladder cancer was analyzed by using the operating characteristics of the subjects. The apparent diffusion coefficient (apparent diffusion) of the muscle layer adjacent to the bladder wall was measured. The ADC value of the infiltrating layer of bladder cancer was analyzed by using the ROC curve. The threshold value was obtained and the accuracy, sensitivity and specificity of the infiltration of the muscle layer of the bladder cancer were calculated. Results 65 cases of bladder cancer, including 40 cases of myometrial invasive bladder cancer, 25 cases of non-myometrial invasive bladder cancer. The areaunder curved-AUC, accuracy, sensitivity, specificity and specificity were 0.859, 77.5, 72.0, 0.907, 83.1, 85.0 and 80.0 respectively. The AUC of DCE-MRI was 0.944, the accuracy was 92.3, the sensitivity was 95.0 and the specificity was 88.0. The difference of AUC among them was statistically significant (p0.031 < 0.05). The AUC, accuracy, sensitivity and specificity of routine MRI DWI were 0.917, 83.1, 82.5 and 84.0 respectively. The AUC of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 0.936, the sensitivity of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 82.5, the specificity was 84.0, the sensitivity of DCE-MRI was 0.936, the specificity of DWI was 72.0, the accuracy of DWI was 0.917, the accuracy of DWI was 83.1, the sensitivity of DCE-MRI was 0.936. The sensitivity was 90.0 and the specificity was 92.0. The difference of AUC among the three groups was statistically significant (p0.026 < 0.05). The ADC value of infiltrated muscle layer was 1.52 鹵0.15 脳 10 ~ (-3) mm ~ (-2) / s and that of uninfiltrated muscle layer was 2.21 鹵0.39 脳 10 ~ (-3) mm ~ 2 / s in bladder cancer patients. When the threshold value was 1. 61 脳 10-3mm2/s, the sensitivity and specificity of detecting myometrial invasion of bladder cancer were 91.2% and 90.4%, respectively. Conclusion compared with conventional MRI, conventional DWI DCE-MRI sequence can improve the accuracy of diagnosing myometrial invasion of bladder cancer. Quantitative measurement of ADC value of bladder wall muscle layer has certain reference value for judging myometrial infiltration. When the value of ADC near muscle layer of bladder cancer is 1. 61 脳 10-3mm2/s as threshold, the sensitivity and specificity of diagnosing myometrium infiltration of bladder cancer are higher.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14;R445.2
本文編號(hào)：2135540
[Abstract]:Background and objective bladder cancer is the most common malignant tumor in the urinary system. According to T stage, bladder cancer was divided into non-myometrial invasive bladder carcinoma (Tis-Tahl T1 stage) and myometrial invasive bladder carcinoma (T2-T4 stage). The treatment of non-myometrial invasive bladder cancer was performed by transurethral resection of bladder tumor (transurethral resection ofbladder tumor TURBT), and radical cystectomy was performed for myometrial invasive bladder cancer. Therefore, it is important for clinical treatment to correctly judge whether bladder cancer infiltrates muscle layer before operation. MRI is the most accurate method to judge whether bladder wall muscle layer is infiltrating or not. Diffusion weighted (diffusion weighted imaging (DWI) and dynamic enhanced magnetic resonance imaging (dynamic contrast-enhanced magnetic resonance imaging DCE-MRI) can be used to combine the morphology and function of Mr functional imaging. DWI and DCE-MRI may be helpful in judging whether the bladder wall muscle layer is infiltrating or not. The purpose of this study was to analyze the application of conventional MRI and DWICE-MRI in the diagnosis of myometrium invasion in bladder cancer, and to explore the value of DWII-DCE-MRI sequence in judging the myometrial invasion of bladder cancer by comparing with conventional MRI. Materials and methods 65 cases of bladder cancer were collected and analyzed during the period of 2012.10 ~ 2014.2 in affiliated Cancer Hospital of Zhengzhou University. All cases were examined by conventional MRI sequence, DWI sequence and DCE-MRI sequence. The myometrium invasion of bladder cancer was judged by conventional MRI sequence, conventional DWI sequence and conventional DWI DCE-MRI sequence. The ability of using conventional (receiver operating sequences, conventional DWI sequences and conventional DWI DCE-MRI sequences to diagnose the invasion of the muscular layer of bladder cancer was analyzed by using the operating characteristics of the subjects. The apparent diffusion coefficient (apparent diffusion) of the muscle layer adjacent to the bladder wall was measured. The ADC value of the infiltrating layer of bladder cancer was analyzed by using the ROC curve. The threshold value was obtained and the accuracy, sensitivity and specificity of the infiltration of the muscle layer of the bladder cancer were calculated. Results 65 cases of bladder cancer, including 40 cases of myometrial invasive bladder cancer, 25 cases of non-myometrial invasive bladder cancer. The areaunder curved-AUC, accuracy, sensitivity, specificity and specificity were 0.859, 77.5, 72.0, 0.907, 83.1, 85.0 and 80.0 respectively. The AUC of DCE-MRI was 0.944, the accuracy was 92.3, the sensitivity was 95.0 and the specificity was 88.0. The difference of AUC among them was statistically significant (p0.031 < 0.05). The AUC, accuracy, sensitivity and specificity of routine MRI DWI were 0.917, 83.1, 82.5 and 84.0 respectively. The AUC of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 0.936, the sensitivity of DCE-MRI was 0.936, the accuracy of DWI was 90.8, the sensitivity of DWI was 82.5, the specificity was 84.0, the sensitivity of DCE-MRI was 0.936, the specificity of DWI was 72.0, the accuracy of DWI was 0.917, the accuracy of DWI was 83.1, the sensitivity of DCE-MRI was 0.936. The sensitivity was 90.0 and the specificity was 92.0. The difference of AUC among the three groups was statistically significant (p0.026 < 0.05). The ADC value of infiltrated muscle layer was 1.52 鹵0.15 脳 10 ~ (-3) mm ~ (-2) / s and that of uninfiltrated muscle layer was 2.21 鹵0.39 脳 10 ~ (-3) mm ~ 2 / s in bladder cancer patients. When the threshold value was 1. 61 脳 10-3mm2/s, the sensitivity and specificity of detecting myometrial invasion of bladder cancer were 91.2% and 90.4%, respectively. Conclusion compared with conventional MRI, conventional DWI DCE-MRI sequence can improve the accuracy of diagnosing myometrial invasion of bladder cancer. Quantitative measurement of ADC value of bladder wall muscle layer has certain reference value for judging myometrial infiltration. When the value of ADC near muscle layer of bladder cancer is 1. 61 脳 10-3mm2/s as threshold, the sensitivity and specificity of diagnosing myometrium infiltration of bladder cancer are higher.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14;R445.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 鄭冰;楊文增;崔振宇;王全勝;張偉;馬濤;魏若晶;;64層CT成像在膀胱癌診斷中的應(yīng)用(附208例分析)[J];中國(guó)醫(yī)藥指南;2013年07期
相關(guān)博士學(xué)位論文 前1條
1 李秋洋;膀胱腫瘤三維超聲造影與病理特征相關(guān)性的研究[D];中國(guó)人民解放軍軍醫(yī)進(jìn)修學(xué)院;2012年
本文編號(hào)：2135540
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