本文選題：前列腺　切入點：擴散加權成像　出處：《中國人民解放軍醫(yī)學院》2017年博士論文　論文類型：學位論文

【摘要】：第一部分不同b值DWI圖像及ADC值在前列腺移行區(qū)癌診斷中的價值目的:探討b值為 1000、2000和3000s/mm2時擴散加權成像(diffusion-weighted imaging,DWI)圖像和表觀擴散系數(shù)(apparent diffusion coefficient, ADC)值在前列腺移行區(qū)(transition zone, TZ)癌診斷中的價值。材料與方法:本項前瞻性研究獲得了倫理委員會的批準。依據(jù)納入和排除標準,納入的患者接受前列腺3.0T磁共振掃描,掃描序列包括T2WI、DWI(b=1000, 2000和3000 s/mm2)和T1WI。2名放射科醫(yī)生采用以下三種方案分析患者的MRI圖像,達成一致后對可疑病灶進行評分,方案A: T2WI和DWI圖像(b= 1000s/mm2);方案B: T2WI和DWI 圖像(b = 2000s/mm2);方案C: T2WI和DWI 圖像(b = 3000s/mm2)。同時測量b值為1000、2000和3000s/mm2時可疑病灶的ADC值。采用獨立樣本t檢驗和Mann-Whitney U檢驗比較不同b值時,TZ癌和良性前列腺組織間ADC值的差異。采用受試者工作特征(receiveroperating characteristic, ROC)曲線分析不同方案以及不同b值時ADC值的診斷效能。結果:本研究共納入49例患者,經(jīng)超聲引導下穿刺活檢證實TZ癌25例,良性前列腺組織24例。方案C的曲線下面積(areaunderthecurves,AUC)顯著高于方案A和方案B(p= 0.0029, 0.0492)。b值為1000s/mm2、2000s/mm2和3000s/mm2時,TZ癌的ADC值均顯著低于良性前列腺組織(p= 0.002,p0.001和p0.001)。不同b值時,ADC值診斷TZ癌的AUC分別為:0.718、0.839和0.887。b值為3000s/mm2和2000s/mm2時ADC值的AUC差異不具有統(tǒng)計學意義,p= 0.308。結論:3.0TMRI掃描儀上,DWI圖像在b值為3000s/mm2時對TZ癌的診斷效能最高。在定量分析中,b值為2000 s/mm2和3000 s/mm2的ADC值對TZ癌的診斷效能高于b值為1000s/mm2 時。第二部分高b值ADC值在診斷前列腺移行區(qū)癌中對PI-RADS v2的附加價值研究目的:探討前列腺移行區(qū)(transition zone, TZ)癌診斷中ADC值對第2版的前列腺成像報告和數(shù)據(jù)系統(tǒng)(Prostate Imaging Reporting and Data System version 2, PI-RADS v2)是否具有附加價值。材料與方法:本項前瞻性研究獲得了倫理委員會的批準。依據(jù)納入和排除標準,納入的患者接受前列腺3.0T磁共振掃描。2名放射科醫(yī)生獨立分析患者的MRI圖像,依據(jù)PI-RADS v2指南對可疑病灶評分并測量可疑病灶的ADC值。以超聲引導下穿刺活檢的病理結果為金標準。分別采用kappa系數(shù)和組內相關系數(shù)(ICC)評估PI-RADS v2評分和ADC值測量的觀察者間一致性。采用二元logistic回歸和受試者工作特征(receiver operating characteristic, ROC)曲線分析ADC值聯(lián)合PI-RADS v2 以及單獨使用PI-RADS v2對TZ癌的診斷效能。結果:本研究共納入49例患者,其中TZ癌25例,良性前列腺組織24例。在兩名觀察者之間,PI-RADSv2評分表現(xiàn)出良好的一致性(κ= 0.753), ADC值表現(xiàn)出極好的一致性(ICC = 0.988)。ADC值聯(lián)合PI-RADS v2診斷TZ癌的AUC顯著高于單獨使用PI-RADS v2時(觀察者A: 0.861 vs 0.748, p= 0.0475;觀察者B: 0.863 vs 0.723, =0.0224) 。結論:ADC值與PI-RADS v2聯(lián)合使用可以顯著提高PI-RADS v2對TZ癌的診斷效能。第三部分DCE-MRI定量參數(shù)對ADC值診斷前列腺移行區(qū)癌的附加價值研究目的:探討前列腺移行區(qū)(transitionzone,TZ)癌診斷中DCE-MRI定量參數(shù)對ADC值是否具有附加價值。材料與方法:本項前瞻性研究獲得了倫理委員會的批準。依據(jù)納入和排除標準,納入的患者接受前列腺3.0T磁共振平掃和動態(tài)增強掃描。2名放射科醫(yī)生分析患者的MRI圖像,達成一致后測量可疑病灶的ADC值、Ktrans、Kep和Ve值。以超聲引導下穿刺活檢的病理結果為金標準。采用Mann-Whitney U檢驗比較TZ癌和良性前列腺組織之間各參數(shù)的差異。采用二元logistic回歸和受試者工作特征(receiver operating characteristic, ROC)曲線分析Ktrans、Kep和Ve值聯(lián)合ADC值后對TZ癌的診斷效能。結果:本研究共納入49例患者,其中TZ癌25例,良性前列腺組織24例。TZ癌的ADC值和Kep值顯著低于良性前列腺組織(p 0.001,p = 0.032),Ktrans和Ve值在兩組的差異不具有統(tǒng)計學意義(p= 0.085,p=0.610)。Ktrans聯(lián)合ADC值、Kep聯(lián)合ADC值和Ve聯(lián)合ADC值診斷TZ癌的AUC與單獨使用ADC值沒有顯著差異(p = 0.858,0.699和0.709)。結論:Ktrans值、Kep值和Ve值與ADC值聯(lián)合均不能提高ADC值對TZ癌的診斷效能。
[Abstract]:The first part of different b value and ADC value in the DWI image area to shift value of diagnosis of prostate carcinoma: To investigate the value of B was 10002000 and 3000s/mm2 diffusion weighted imaging (diffusion-weighted imaging DWI) apparent diffusion coefficient (apparent diffusion images and tables coefficient, ADC) value in prostate transitional zone (transition zone TZ) cancer diagnosis. Materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, in patients receiving 3.0T prostate magnetic resonance scanning, scanning sequences included T2WI, DWI (b=1000, 2000 and 3000 s/mm2) and T1WI.2 radiologists using the following three schemes of MRI image analysis after the agreement of patients, wasassessed suspicious lesions, T2WI and DWI A: images (b= 1000s/mm2); B: T2WI scheme and DWI images (b = 2000s/mm2); C: T2WI scheme and DWI images (b = 3000s/m M2). Simultaneous measurement of B value of 10002000 and 3000s/mm2 of suspicious lesions ADC value. By using independent sample t test and Mann-Whitney U test comparison of different b value, different ADC value TZ cancer and benign prostate tissue. The receiver operating characteristic (receiveroperating characteristic, ROC) of different schemes and different b values the ADC value of the diagnostic efficiency curves. Results: the study included 49 patients with ultrasound guided biopsy confirmed 25 cases of TZ carcinoma, 24 cases of benign prostate tissue. The area under the curve C (areaunderthecurves, AUC) was significantly higher than that of plan A and B (p= 0.0029, 0.0492).B = 1000s/mm22000s/mm2 and 3000s/mm2, TZ cancer ADC were significantly lower than those in benign prostate tissue (p= 0.002, p0.001 and p0.001) at different b values and ADC values in diagnosis of TZ carcinoma of the AUC were: 0.718,0.839 and 0.887.b value of 3000s/ mm2 and 2000s/mm2 ADC The AUC difference was not statistically significant, p= 0.308. conclusion: 3.0TMRI scanner, DWI image in the b value of 3000s/mm2 for diagnosis of TZ cancer is the highest. In quantitative analysis, the b value is 2000 s/mm2 and 3000 s/mm2 ADC value of the diagnostic efficacy of TZ cancer is higher than that of the b value is 1000s/mm2. The second part is high the B ADC value in the diagnosis of prostate displacement added value objective to study the PI-RADS V2 for cancer in the prostate transitional zone (transition, zone, TZ) in the diagnosis of prostate cancer ADC imaging report on version second and data system (Prostate Imaging Reporting and Data System version 2, PI-RADS V2) has added value materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, independent analysis of MRI images were included in patients with prostate 3.0T magnetic resonance scanning.2 radiologists, according to PI-RADS V2 guide to the suspicious lesion score and measurement of suspicious lesions ADC value. Pathological biopsy guided by ultrasound results as the gold standard. We use the kappa coefficient and intraclass correlation coefficient (ICC) measurement of the inter observer consistency assessment PI-RADS V2 score and ADC value of two yuan. By using logistic regression and receiver job characteristics (receiver operating characteristic, ROC) ADC value curve analysis combined with PI-RADS V2 and PI-RADS V2 TZ alone for the cancer diagnostic efficacy. Results: This study included 49 patients, including 25 cases of TZ cancer and benign prostate tissue in 24 cases. Among the two observers, PI-RADSv2 score showed good consistency the (k = 0.753), the ADC value showed an excellent agreement (ICC = 0.988) value of.ADC combined with PI-RADS V2 in the diagnosis of cancer was significantly higher than that of AUC TZ using PI-RADS V2 alone (observer A: 0.861 vs 0.748, p= 0.0475; observer B: 0.863 vs 0.723, =0.0224). Conclusion: the value of ADC combined with PI-RADS V2 can significantly improve the diagnostic efficacy of PI-RADS V2 for TZ cancer. Objective additional diagnostic value of prostate transitional zone cancer DCE-MRI quantitative parameters of third ADC values: prostate transitional zone (transitionzone, TZ) in the diagnosis of cancer DCE-MRI quantitative parameters whether it has added value to ADC value. Materials and methods: This prospective study was approved by the ethics committee. According to the inclusion and exclusion criteria, patients scanned.2 radiologists MRI image analysis in patients with prostate 3.0T magnetic resonance scan and dynamic enhanced, suspicious lesions after the agreement of ADC measurement value, Ktrans Kep, and Ve. Pathological biopsy guided by ultrasound results as the gold standard. The difference between the Mann-Whitney U test to compare TZ cancer and benign prostate tissue with two parameters. Logistic regression and receiver operating characteristic (receiver operating characteristic, ROC Ktrans) Kep curve analysis and Ve value of diagnostic efficacy of combined ADC values of TZ cancer. Results: the study included 49 patients, including 25 cases of TZ carcinoma, 24 cases of benign prostate cancer.TZ ADC value and Kep value was significantly lower than that in benign prostate tissue (P 0.001, P = 0.032), Ktrans and Ve was not statistically significant difference in the two groups (p= 0.085, p=0.610.Ktrans) combined with ADC, combined with ADC Kep combined with ADC and Ve values in diagnosis of TZ cancer AUC and ADC alone had no significant difference (P value = 0.858,0.699 and 0.709). Conclusion: Ktrans value, Kep value and Ve value and could not significantly improve the diagnostic efficiency of TZ ADC cancer and ADC value.

【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R445.2;R737.25

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