本文選題：MRI　切入點：表觀彌散系數(shù)　出處：《福建醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的探討核磁共振表觀彌散系數(shù)(ADC)值的變化與鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)放療后殘留的關(guān)系。建立ADC值對鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)放療后殘留的預(yù)測閾值。 方法按入組及排除標(biāo)準(zhǔn)選取2009年3月～2009年10月間我院收治的36例原發(fā)鼻咽癌患者,行常規(guī)磁共振(magnetic resonance imaging, MRI )掃描和磁共振全身彌散加權(quán)成像(magnetic resonance whole body diffusion weighted imaging, MR WB-DWI),檢測放療前、放療開始后的第二周末頸部轉(zhuǎn)移性淋巴結(jié)的表觀彌散系數(shù)(apparent difusion coefficient, ADC)值。共有17枚頸部淋巴結(jié)治療前經(jīng)MRI檢查確認為NPC轉(zhuǎn)移,經(jīng)隨訪考慮為放療后殘留。共有39枚頸部淋巴結(jié)放療前經(jīng)MRI檢查確認為NPC轉(zhuǎn)移,并且在放療結(jié)束時完全退縮。設(shè)頸部轉(zhuǎn)移性淋巴結(jié)放療開始后的第二周末與放療前ADC值的差值為R,用受試者工作特性曲線(receiver operator characteristic curve, ROC)曲線找出R的最佳截斷值,用此截斷值將56枚鼻咽癌轉(zhuǎn)移性淋巴結(jié)分為兩組,比較兩組淋巴結(jié)殘留率是否有統(tǒng)計學(xué)差異。應(yīng)用logistic多元回歸分析頸部轉(zhuǎn)移性淋巴結(jié)R值、淋巴結(jié)大小、淋巴結(jié)壞死情況、年齡、性別、淋巴結(jié)所接受放療劑量與放療后淋巴結(jié)殘留的關(guān)系。結(jié)果頸部淋巴結(jié)殘留組的R值與頸部淋巴結(jié)無殘留組的R值的差異有顯著統(tǒng)計學(xué)意義(P=0.0000.001)。鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)R值的受試者工作特性曲線(receiver operator characteristic curve, ROC)下的面積為0.895。以R≤0.1965作為預(yù)測鼻咽非角化未分化型癌轉(zhuǎn)移性淋巴結(jié)放療后殘留的閾值,其特異性為97.4%,敏感性為64.7%。用此截斷值將56枚鼻咽癌轉(zhuǎn)移性淋巴結(jié)分為兩組,兩組淋巴結(jié)殘留率差異有顯著統(tǒng)計學(xué)意義(χC2 =23.59, P=0.0000.001)。logistic多元回歸分析發(fā)現(xiàn)鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)R值對于鼻咽癌轉(zhuǎn)移性頸淋巴結(jié)放療后殘留存在負相關(guān)關(guān)系(回歸系數(shù):-3.891) 結(jié)論鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)的R值能在一定程度上預(yù)測鼻咽癌頸部轉(zhuǎn)移性淋巴結(jié)放療后殘留。
[Abstract]:Objective to investigate the relationship between the change of apparent diffusion coefficient (ADC) and the residual of cervical metastatic lymph nodes after radiotherapy, and establish a predictive threshold of ADC value for residual radiotherapy of metastatic cervical lymph nodes after radiotherapy.
Methods from March 2009 to October 2009 in our hospital were selected according to inclusion and exclusion criteria of the 36 cases of primary nasopharyngeal carcinoma patients underwent conventional magnetic resonance (magnetic resonance imaging, MRI) scan and magnetic resonance imaging diffusion weighted imaging (magnetic resonance whole body diffusion weighted imaging, MR, WB-DWI) detection before radiotherapy, radiotherapy after the start of the second the weekend of metastatic cervical lymph nodes of apparent diffusion coefficient (apparent difusion, coefficient, ADC). There were 17 pieces of cervical lymph nodes before and after the treatment, MRI examination confirmed NPC transfer, followed by considering the residual after radiotherapy. There were 39 pieces of cervical lymph nodes before radiotherapy by MRI examination confirmed NPC and metastasis. Complete withdrawal at the end of radiotherapy. Lymph node metastasis after radiotherapy second weeks before radiotherapy and the difference of ADC value for the R receiver operating characteristic curve (receiver operator charac Teristic curve, ROC) the best cut-off curve to find the value of R, the 56 nasopharyngeal carcinoma metastatic lymph nodes were divided into two groups with the cut-off values, compared two groups of lymph node residual rate of whether there is a significant difference. Logistic regression analysis was applied to analyze metastatic cervical lymph nodes R, lymph node size, lymph node necrosis age, sex, relationship, lymph node received radiotherapy and after radiotherapy. The residual lymph node residual cervical lymph node of the value of R and cervical lymph node showed no residual group R values were statistically significant (P=0.0000.001). The receiver operating characteristic curve of neck lymph node metastasis of nasopharyngeal carcinoma R (the receiver operator characteristic curve, ROC) under the area of 0.895. to R is less than or equal to 0.1965 as a predictor of residual undifferentiated nasopharyngeal non keratinizing carcinoma metastatic lymph node after radiotherapy threshold, the specificity was 97.4%, sensitivity was 64.7%. with this The cutoff value of 56 pieces of nasopharyngeal carcinoma metastatic lymph nodes were divided into two groups, two groups of lymph node residual rate difference was statistically significant (C2 =23.59, P=0.0000.001).Logistic multiple regression analysis showed that nasopharyngeal carcinoma metastatic cervical lymph nodes R value for the negative correlation between the residual of neck lymph node metastasis of nasopharyngeal carcinoma after radiotherapy (regression coefficient: -3.891)
Conclusion the R value of metastatic lymph nodes in the neck of nasopharyngeal carcinoma can be used to predict the residual cervical metastasis of nasopharyngeal carcinoma to a certain extent after radiotherapy.

【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R739.63

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