發(fā)布時(shí)間：2018-03-13 14:07

  本文選題：鼻咽癌　切入點(diǎn)：彌散加權(quán)成像　出處：《川北醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討3.0T磁共振多b值彌散加權(quán)成像（Diffusion-weightedMagnetic Resonance Imaging，DW-MRI）在評(píng)價(jià)鼻咽癌（nasopharyngealcarcinoma，NPC）頸部淋巴結(jié)轉(zhuǎn)移的價(jià)值。 材料和方法：對(duì)45例經(jīng)病理活檢證實(shí)的NPC及15例良性淋巴結(jié)增大患者行常規(guī)MR及多b值DWI（b=600、800、1000s/mm2）檢查，參照?qǐng)D像質(zhì)量評(píng)分標(biāo)準(zhǔn)對(duì)多b值DWI圖像進(jìn)行評(píng)分，圖像質(zhì)量分為四個(gè)等級(jí)：差（1），中等（2），良好（3），好（4）。測(cè)量NPC、頸部轉(zhuǎn)移性淋巴結(jié)及良性淋巴結(jié)不同b值的ADC值，采用SPSS13.0統(tǒng)計(jì)軟件包對(duì)所測(cè)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：1、b值為600、800、1000s/mm2圖像質(zhì)量評(píng)分結(jié)果分別為2.84±0.767、3.2±0.588、2.89±0.714，b值為800s/mm2時(shí)圖像質(zhì)量評(píng)分最高。b值為800s/mm2與b值為600s/mm2和1000s/mm2比較差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05），但b值為600s/mm2和1000s/mm2兩組間無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 2、隨著b值增加，NPC、頸部轉(zhuǎn)移性淋巴結(jié)及良性淋巴結(jié)ADC值逐漸下降，NPC與轉(zhuǎn)移性淋巴結(jié)ADC值比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05），而在轉(zhuǎn)移性淋巴結(jié)與良性淋巴結(jié)ADC值比較有統(tǒng)計(jì)學(xué)差異（P＜0.05）。b值為800s/mm2對(duì)于鑒別良惡性淋巴結(jié)能力最佳，其ROC曲線下面積為0.891，截?cái)嘀禐?.938×10-3mm2/s，，靈敏度為100%，特異度為83.3%。 結(jié)論：3.0T DW-MRI技術(shù)有助于診斷NPC轉(zhuǎn)移性淋巴結(jié)，對(duì)提高鼻咽癌N分期有重要作用。b值取800s/mm2時(shí)，DWI圖像質(zhì)量較好，且良惡性淋巴結(jié)鑒別診斷能力最佳。 目的：探討3.0T磁共振彌散加權(quán)成像（Diffusion-weighted MagneticResonance Imaging，DW-MRI）在評(píng)估鼻咽癌（Nasopharyngeal Carcinoma，NPC)放化療（Chemoradiotherapy，CRT)療效的價(jià)值，預(yù)測(cè)鼻咽癌的放化療敏感性。 材料與方法：收集32例經(jīng)病理證實(shí)的NPC患者，行常規(guī)MR及多b值DWI檢查，選取b值為800s/mm2測(cè)量放化療前與放化療5周時(shí)NPC及轉(zhuǎn)移性淋巴結(jié)ADC值；在軸位T1WI增強(qiáng)掃描上測(cè)量放化療前與放化療5周時(shí)NPC及轉(zhuǎn)移性淋巴結(jié)最大者體積（V）。以放化療后1月作為療效評(píng)價(jià)標(biāo)準(zhǔn)將NPC分為低敏感與高敏感組，比較放化療5周時(shí)NPC低敏感組與高敏感組ADC值、治療前后ADC值變化率（△ADC）及體積消退率（△V）的差異；分析影響NPC放化療敏感性的相關(guān)因素。 結(jié)果：1、NPC及轉(zhuǎn)移性淋巴結(jié)最大者放化療前體積分別為15.46±9.67cm3、7.96±2.68cm3，放化療5周時(shí)體積分別為5.39±4.53cm3、0.85±0.76cm3，△V分別為（67.28±11.69）%、（91.00±6.83）%。NPC及轉(zhuǎn)移性淋巴結(jié)體積在放化療前與放化療5周時(shí)差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 2、放化療5周時(shí)，NPC及頸部轉(zhuǎn)移性淋巴結(jié)ADC值均明顯升高。NPC及轉(zhuǎn)移性淋巴結(jié)放化療前ADC值分別為（0.856±0.084）×10-3mm2/s、（0.876±0.144）×10-3mm2/s，放化療5周時(shí)ADC值分別為（1.735±0.168）×10-3mm2/s、（1.830±0.162）×10-3mm2/s，△ADC分別為（104.46±26.97）%、（116.14±30.76）%。NPC及轉(zhuǎn)移性淋巴結(jié)ADC值在放化療前與放化療5周時(shí)比較均有統(tǒng)計(jì)學(xué)差異（P＜0.05）。 3、放化療5周時(shí)NPC高敏感組ADC值、△ADC及△V分別為（1.793±0.101）×10-3mm2/s、（117.83±16.80）%、（71.26±11.68）%，低敏感組依次分別為（1.609±0.219）×10-3mm2/s、（75.06±20.32）%、（61.46±9.27）%。 ADC值、△ADC及△V在高、低敏感組之間均有統(tǒng)計(jì)學(xué)差異（P＜0.05），△ADC為鑒別低敏感與高敏感組最佳指標(biāo)，其截?cái)嘀禐?8.125%，ROC曲線下面積為0.973，靈敏度為95.5%，特異度為90%。 4、非線性Logistic回歸分析影響NPC放化療敏感性的相關(guān)臨床因素（性別、年齡、治療方式、T分期及△ADC），結(jié)果顯示△ADC是影響鼻咽癌放化療敏感程度的獨(dú)立預(yù)后因素，其相對(duì)風(fēng)險(xiǎn)度為1.155，放化療5周時(shí)NPC△ADC越大，腫瘤對(duì)放化療的敏感性越高。 結(jié)論：DWI對(duì)于評(píng)價(jià)NPC放化療療效有重要作用。放化療5周時(shí)鼻咽癌ADC值、△V及△ADC都能有效預(yù)測(cè)鼻咽癌放化療敏感性�！鰽DC是預(yù)測(cè)NPC放化療敏感性的最佳指標(biāo)及獨(dú)立預(yù)后因素。
[Abstract]:Objective: To evaluate the value of 3.0T B Diffusion-weightedMagnetic Resonance Imaging (DW-MRI) in evaluating cervical lymph node metastasis of nasopharyngeal carcinoma (nasopharyngealcarcinoma).
Materials and methods: 45 patients with biopsy proven NPC and 15 cases of benign lymph node enlargement patients underwent conventional MR and b value DWI (b=6008001000s/mm2) examination, reference standard for evaluation of image quality score of B DWI image, the image quality is divided into four levels: (1), moderate (2), good (3), good (4). The measurement of NPC, lymph node metastasis and benign lymph nodes with different b value ADC value package for statistical analysis of the measured data using SPSS13.0 statistical software.
Results: 1, B score value of 6008001000s/mm2 image quality were 2.84 + 0.767,3.2 + 0.588,2.89 + 0.714, B = 800s/mm2 image quality score the highest.B value for the 800s/mm2 and b value of 600s/mm2 and 1000s/mm2 were statistically significant (P < 0.05), but the b value of 600s/mm2 and 1000s/mm2 between the two groups were statistical significance (P > 0.05).
2, with the increase of B value, NPC, lymph node metastasis and benign lymph node ADC values decreased, there was no significant difference between NPC and ADC value of metastatic lymph nodes (P > 0.05), and in metastatic lymph nodes and benign lymph node ADC values were statistically significant difference (P < 0.05).B value of 800s/mm2 for differential diagnosis of benign and malignant lymph nodes. The optimum, the area under the ROC curve was 0.891, the cut-off value of 0.938 * 10-3mm2/s, the sensitivity was 100%, specificity was 83.3%.
Conclusion: 3.0T DW-MRI technology is helpful for the diagnosis of NPC metastatic lymph nodes, and plays an important role in improving N staging of nasopharyngeal carcinoma. When.B value is 800s/mm2, DWI image quality is better, and the differential diagnosis ability of benign and malignant lymph nodes is the best.
Objective: To investigate the value of Diffusion-weighted MagneticResonance Imaging (DW-MRI) in evaluating the efficacy of radiotherapy and chemotherapy (Chemoradiotherapy, CRT) in patients with nasopharyngeal carcinoma (3.0T), and to predict the sensitivity of nasopharyngeal carcinoma to radiotherapy and chemotherapy.
Materials and methods: 32 patients with pathologically confirmed NPC patients underwent conventional MR and b value DWI, select the b value for 800s/mm2 measurements before chemoradiotherapy and chemotherapy 5 weeks NPC and metastatic lymph node ADC; enhanced scan measurement before chemotherapy and chemotherapy in 5 weeks and NPC transfer the largest volume of lymph node in the axial T1WI (V) in January. After radiotherapy and chemotherapy as curative effect evaluation criteria of NPC were divided into low sensitivity and Gao Min group, compared with chemotherapy 5 weeks NPC low sensitive group and Gao Min group before and after treatment ADC value, ADC value change rate (ADC) and volume regression the rate difference (delta V); to analyze the factors influencing the NPC sensitivity of radiotherapy and chemotherapy.
Results: 1, NPC and metastatic lymph node maximum volume before chemotherapy were 15.46 + 9.67cm3,7.96 + 2.68cm3, chemotherapy 5 weeks volume were 5.39 + 4.53cm3,0.85 + 0.76cm3, V respectively (67.28 + 11.69)% and (91 + 6.83)%.NPC and metastatic lymph node size in chemotherapy before radiotherapy and chemotherapy for 5 weeks the difference was statistically significant (P < 0.05).
2, 5 weeks of chemotherapy, NPC and lymph node metastasis of ADC increased obviously in.NPC and metastatic lymph node radiotherapy and chemotherapy before ADC = (0.856 + 0.084) * 10-3mm2/s (0.876 + 0.144) * 10-3mm2/s, chemotherapy 5 weeks ADC = (1.735 + 0.168) * 10-3mm2/s, (1.830 + 0.162) * 10-3mm2/s, Delta ADC respectively (104.46 + 26.97)% and (116.14 + 30.76) in chemotherapy and chemotherapy in 5 weeks, there were statistically significant differences in%.NPC and metastatic lymph node ADC (P < 0.05).
3, chemotherapy for 5 weeks and NPC Gao Min group ADC, Delta ADC and delta V respectively (1.793 + 0.101) * 10-3mm2/s (117.83 + 16.80)% and (71.26 + 11.68)%, low sensitivity group respectively (1.609 + 0.219) * 10-3mm2/s (75.06 + 20.32)%. (61.46 + 9.27)%. The value of ADC, Delta ADC and delta V in the high and low sensitive groups were statistically significant (P < 0.05), ADC for the identification of low sensitivity and Gao Min was the best index, the cut-off value of 98.125%, the area under the ROC curve was 0.973, sensitivity was 95.5%, specificity was 90%.
4, the related clinical factors of nonlinear Logistic regression analysis of effects of NPC chemotherapy sensitivity (gender, age, treatment, T staging and delta ADC, Delta ADC) results are independent prognostic factors of sensitivity to chemoradiotherapy in nasopharyngeal carcinoma, the relative risk was 1.155, chemotherapy 5 weeks NPC Delta ADC more and the sensitivity of the tumor to chemotherapy is high.
Conclusion: DWI plays an important role in evaluating the efficacy of radiotherapy and chemotherapy. NPC chemotherapy 5 weeks of nasopharyngeal carcinoma ADC, Delta V and delta ADC can effectively predict the sensitivity of radiotherapy and chemotherapy. Nasopharyngeal carcinoma is the best predictor of ADC factors NPC chemotherapy sensitivity and prognosis independently.

【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.63

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