本文選題：頸部　切入點：淋巴結　出處：《蘭州大學》2017年碩士論文

【摘要】：目的(1)比較DWI、PET-CT、CT及超聲在頸部淋巴結病變鑒別中的診斷效能,為臨床合理選擇影像學檢查提供依據(jù);(2)評價DWI在頸部淋巴結病變鑒別診斷中的價值;(3)探討PET-CT中SUVmax值聯(lián)合CT短徑值雙定量分析在頸部淋巴結病變良、惡性鑒別中的價值;(4)評價DWI在頸部轉(zhuǎn)移性淋巴結放療療效評價中的臨床應用價值。方法回顧性分析190例頸部淋巴結病變患者,其中61例行頸部DWI檢查、23例行18F-FDG PET-CT檢查、42例行頸部CT平掃及增強檢查、64例行頸部超聲檢查,共檢出淋巴結378枚,所有淋巴結病變性質(zhì)均經(jīng)病理確診或臨床治療隨訪證實。功能影像在頸部淋巴結病變鑒別診斷中的評價價值:(1)采用?2檢驗比較DWI、18F-FDG PET-CT、CT以及超聲四種不同影像學檢查方法的診斷效能;(2)繪制淋巴結ADC值的ROC曲線,獲得DWI診斷惡性淋巴結病變的最佳閾值;(3)采用?2檢驗比較PET-CT SUVmax值聯(lián)合CT短徑值雙定量分析與單獨SUVmax值、單獨CT短徑值診斷頸部淋巴結病變的效能,并繪制SUVmax值與CT短徑值的ROC曲線,確定惡性淋巴結病變的最佳診斷閾值;(4)采用兩獨立樣本t檢驗評價20例頸部轉(zhuǎn)移性淋巴結患者放療前后淋巴結ADC值的差異。結果(1)四種影像學檢查方法中,DWI診斷的敏感性、特異性、準確性、陽性預測值及陰性預測值均高于其他三種檢查方法,其Kappa值=0.696(P0.01),與病理/隨訪結果間的一致性較好;PET-CT各項診斷指標低于DWI但高于CT和超聲,其Kappa值=0.524(P0.01),與病理/隨訪結果間的一致性較好;超聲檢查的各項診斷指標高于CT檢查,其Kappa值=0.47(P0.05),與病理/隨訪結果間的一致性程度中等;CT檢查各項診斷指標最低,Kappa值=0.304(P0.05),與病理/隨訪結果間的一致性程度較低;(2)惡性病變組ADC均值為(0.848±0.087)×10-3mm2/s,良性病變組ADC均值為(1.144±0.164)×10-3mm2/s,惡性病變組ADC均值低于良性病變組(t=10.51,P0.01);繪制ADC值的ROC曲線圖,得到惡性淋巴結病變的最佳ADC診斷閾值為0.965×10-3mm2/s,診斷的敏感度為97.4%、特異度為91.3%、準確性為93.85%,曲線下面積(AUC)為0.98±0.01(P0.01);(3)SUVmax值≥1.94聯(lián)合CT短徑值≥0.66cm作為惡性淋巴結病變的診斷閾值,其敏感度為87%、特異度為89.5%、準確性為87.7%,高于單獨PET SUVmax值與單獨CT短徑值;(4)放療前淋巴結的平均ADC值為(0.791±0.063)×10-3mm2/s,放療后淋巴結的平均ADC值為(1.284±0.131)×10-3mm2/s,放療后ADC值明顯升高,差異有統(tǒng)計學意義(t=18.07,P0.01)。結論(1)超聲、CT等傳統(tǒng)影像學檢查方法僅從形態(tài)學來判斷淋巴結病變的性質(zhì)存在較大的局限性,DWI、PET-CT功能成像技術能通過淋巴結信號變化或代謝變化更加準確地評價頸部淋巴結病變,而DWI較PET-CT診斷的準確性更高;(2)惡性淋巴結病變的ADC值顯著小于良性淋巴結病變,DWI通過ADC值測量提高了頸部淋巴結良、惡性病變的鑒別診斷效能;ADC值擬合ROC曲線所確定的閾值有助于淋巴結良、惡性的鑒別,0.965×10-3mm2/s可作為惡性淋巴結病變的診斷閾值;(3)PET-CT淋巴結SUVmax值(≥1.94)聯(lián)合CT短徑值(≥0.66cm)作為PET-CT雙定量分析標準的敏感性、特異性、準確性明顯高于單獨PET SUVmax值與單獨CT短徑值,PET-CT雙定量分析可顯著提高頸部淋巴結病變的診斷效能;(4)頸部惡性淋巴結放療后ADC值明顯升高,DWI可作為監(jiān)測惡性淋巴結放療療效的有效的無創(chuàng)性方法。
[Abstract]:The purpose of (1) DWI, PET-CT, CT and ultrasound in the differential diagnosis efficacy of node lesions in the cervical lymph node, for clinical rational choice of imaging basis; (2) in the differential diagnosis of lesions and evaluate the value of DWI in cervical lymph nodes; (3) to investigate the PET-CT value of SUVmax combined with CT short diameter double quantitative value in the analysis of cervical lymph node lesions of benign and malignant, the identification of value; (4) evaluation of DWI metastatic lymph node radiotherapy to evaluate the clinical value of the neck. Methods: a retrospective analysis of 190 cases of cervical lymph node lesions, including 61 cases of cervical DWI examination, 23 cases underwent 18F-FDG PET-CT examination, 42 cases of cervical CT scan and enhancement scan, 64 cases of neck ultrasonography, 378 lymph nodes were detected, all lymph node lesions were confirmed by pathology or clinical follow-up. Differential diagnosis of the lesions of functional imaging in cervical lymph nodes: (1) the 2 Inspection? 18F-FDG PET-CT, DWI test, CT and ultrasound of four different imaging methods in the diagnosis of effectiveness; (2) ROC curve of lymph node ADC value, obtain the optimal threshold of DWI diagnosis of malignant lymph nodes; (3) using the 2 test to compare the PET-CT? SUVmax value and CT value of quantitative analysis and double short diameter a separate SUVmax, single CT short diameter value diagnosis of cervical lymph node lesions efficacy, and draw the ROC curve and the SUVmax value of CT short diameter value, the best diagnostic threshold of malignant lymph nodes; (4) using two independent sample t test to evaluate 20 cases of cervical lymph node metastases of lymph nodes before and after radiotherapy in patients with different ADC the value of the results. (1) four imaging methods in diagnosis of DWI, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were higher than the other three methods, the Kappa value of =0.696 (P0.01), consistent with the pathological / follow-up results between PET- is better; CT the diagnosis index of less than DWI but higher than that of CT and ultrasound, the value of Kappa =0.524 (P0.01), consistent with the pathological / follow-up results between good; the diagnosis index of ultrasound is higher than that of CT examination, the value of Kappa =0.47 (P0.05), and pathological / follow-up results between the degree of consistency in the diagnosis; check the minimum CT index, the value of Kappa =0.304 (P0.05), and pathological / follow-up results consistency between the low level; (2) malignant group mean ADC (0.848 + 0.087) * 10-3mm2/s, the benign group mean ADC (1.144 + 0.164) * 10-3mm2/s, malignant degeneration group ADC is lower than the mean of benign lesion group (t=10.51, P0.01); to draw the ROC curves of ADC values, the optimal threshold of ADC in the diagnosis of malignant lymph node lesions is 0.965 * 10-3mm2/s, the diagnostic sensitivity was 97.4%, specificity was 91.3%, accuracy was 93.85%, the area under the curve (AUC) was 0.98 + 0.01 (P0.01); (3) the SUVmax value is more than 1.94 CT Short diameter value is more than 0.66cm as a diagnostic threshold of malignant lymph node lesions, the sensitivity was 87%, specificity was 89.5%, accuracy was 87.7%, higher than the PET SUVmax value and CT value of short diameter; (4) the average ADC value of lymph nodes before radiotherapy (0.791 + 0.063) * 10-3mm2/s, the average ADC radiotherapy after the lymph node value is (1.284 + 0.131) * 10-3mm2/s, ADC after radiotherapy was significantly higher, the difference was statistically significant (t=18.07, P0.01). Conclusion (1) ultrasound, only from morphology to judge the limitation of large properties of lymph node lesions DWI examination method for traditional CT imaging, PET-CT function imaging can more accurately evaluate the cervical lymph node pathological changes or metabolic signal changes in lymph nodes, while DWI was the PET-CT diagnostic accuracy is higher; (2) malignant lymph node lesions in ADC was significantly less than benign lymph node lesions, DWI through ADC measurement to improve benign cervical lymph nodes The differential diagnosis of malignant lesions, efficacy; ADC value fitting ROC curve determined by the threshold is helpful to differentiate malignant benign lymph nodes, 0.965 * 10-3mm2/s, can be used as a diagnostic threshold of malignant lymph nodes; (3) PET-CT lymph node SUVmax (more than 1.94) combined with CT short diameter value (more than 0.66cm) as PET-CT the double standard of quantitative analysis of sensitivity, specificity, accuracy was significantly higher than that of single PET SUVmax value and CT value of short diameter, PET-CT double quantitative analysis can significantly improve the diagnostic efficacy of cervical lymph node lesions; (4) cervical malignant lymph nodes after radiotherapy, the ADC value was significantly increased, DWI can be used to monitor the effective non malignant lymph nodes invasive method of radiotherapy.

【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445;R730.44

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