本文選題：擴(kuò)散加權(quán)成像　切入點(diǎn)：磁共振成像　出處：《華中科技大學(xué)》2016年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分 小視野及常規(guī)視野DWI在非肌層及肌層侵襲性膀胱癌中的應(yīng)用目的：比較小視野彌散加權(quán)成像(reduced field-of-view diffusion-weighted imaging, rFOV DWI)與常規(guī)視野彌散加權(quán)成像(full field-of-view diffusion-weighted imaging, fFOV DWI)在肌層及非肌層侵襲性膀胱癌中的圖像質(zhì)量、診斷準(zhǔn)確性及表觀彌散系數(shù)(apparent diffusion coefficient, ADC)的應(yīng)用價(jià)值。材料與方法：經(jīng)華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院倫理委員會(huì)批準(zhǔn),39例膀胱癌病人共60個(gè)腫瘤病灶分別行rFOV DWI、fFOV DWI及常規(guī)MRI成像。所有腫瘤均得到了病理學(xué)分期及組織學(xué)分級(jí)的結(jié)果。兩位放射學(xué)診斷學(xué)者對(duì)兩種DWI圖的質(zhì)量采用四分法分別進(jìn)行評(píng)分。另外,兩名腹部放射學(xué)診斷醫(yī)生分別對(duì)三組影像圖像(T2WI, T2WI+fFOV DWI及T2WI+rFOV DWI)在不知道病理結(jié)果的情況下分別進(jìn)行膀胱癌分期的診斷,并對(duì)膀胱癌分期為T(mén)2或以上的診斷信心進(jìn)行評(píng)分。兩種DWI圖像質(zhì)量的評(píng)估采用維氏符號(hào)秩次檢驗(yàn)：每組圖像的診斷準(zhǔn)確性、敏感性及特異性的比較采用McNemar檢驗(yàn)；診斷效能用受試者工作曲線(receiver operating characteristic curves, ROC)下面積表示；用Mann-Whitney U檢驗(yàn)來(lái)比較不同膀胱癌分期及分級(jí)的ADC值的差別。結(jié)果：rFOV DWI的圖像質(zhì)量(平均3.62)明顯高于fFOV DWI的(平均2.98,p 0.001)。T2WI, T2WI+ fFOV DWI及T2WI+rFOV DWI對(duì)膀胱癌分期的診斷準(zhǔn)確性分別為57%、70%和78%。加rFOV DWI后診斷T2及以上分期的準(zhǔn)確性及特異度的診斷效能明顯提高了(p0.05)。無(wú)論是rFOV DWI還是fFOV DWI,肌層侵襲性膀胱癌及高級(jí)別膀胱癌的ADC值均明顯低于非肌層侵襲性及低級(jí)別膀胱癌的ADC值(P0.01)。結(jié)論：rFOV DWI無(wú)論在圖像質(zhì)量上還是在診斷準(zhǔn)確性上均優(yōu)于fFOV DWI,在常規(guī)MRI檢出病灶的基礎(chǔ)上行r-FOV DWI,對(duì)評(píng)估腫瘤是否浸潤(rùn)肌層很有價(jià)值。兩種DWI序列的ADC值可能有助于鑒別肌層侵襲性膀胱癌及非肌層侵襲性膀胱癌,可能有助于區(qū)別高級(jí)別膀胱癌及低級(jí)別膀胱癌。第二部分不同數(shù)學(xué)模型擴(kuò)散加權(quán)成像在膀胱癌分期及分級(jí)中的應(yīng)用研究目的：探討不同數(shù)學(xué)模型(單指數(shù)模型、雙指數(shù)模型及拉伸指數(shù)模型)擴(kuò)散加權(quán)成像在膀胱癌分期及分級(jí)中的應(yīng)用價(jià)值。材料與方法：經(jīng)華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院倫理委員會(huì)批準(zhǔn),37例膀胱癌病人共51個(gè)腫瘤病灶分別行常規(guī)MRI及多b值DWI成像。所有腫瘤均得到了病理學(xué)分期及組織學(xué)分級(jí)的結(jié)果。兩位放射學(xué)診斷學(xué)者在不知道病理結(jié)果的情況下分別對(duì)膀胱癌進(jìn)行多b值DWI不同數(shù)學(xué)模型的數(shù)據(jù)測(cè)量。兩位測(cè)量者間所測(cè)值一致性由Bland Altman來(lái)分析。用Mann-Whitney U檢驗(yàn)來(lái)比較不同膀胱癌分期及分級(jí)的單指數(shù)模型量化值A(chǔ)DC、雙指數(shù)模型量化值D(真性擴(kuò)散系數(shù),the true diffusioncoefficient)、D*(灌注相關(guān)的假性擴(kuò)散系數(shù),perfusion-related pseudo-diffusion coefficient)、f(灌注分?jǐn)?shù),Perfusion fraction)及拉伸指數(shù)模型量化值DDC(分布擴(kuò)散系數(shù),the distributed diffusion coefficient)和α(不均質(zhì)性指數(shù),heterogeneity index)的差別。另外,用受試者工作曲線(receiver operating characteristic, ROC)來(lái)判斷每個(gè)量化指標(biāo)在鑒別高低級(jí)別膀胱癌及肌層侵襲性和非肌層侵襲性膀胱癌中診斷效能。結(jié)果： 兩位測(cè)量者間的一致性較好。肌層侵襲性膀胱癌或高級(jí)別膀胱癌的ADC、D及DDC值明顯低于非肌層侵襲性膀胱癌或低級(jí)別膀胱癌的相應(yīng)值(P=-0.002,0.003和0.007；P=0.014,0.002和0.033)。而D*、f和α值在鑒別診斷膀胱癌的分期及組織學(xué)分級(jí)上卻沒(méi)有明顯統(tǒng)計(jì)學(xué)差異。ADC、D及DDC值鑒別膀胱癌的分期的ROC曲線下面積(the areas under the receiver operating characteristic curves, Az)分別為0.751、0.747及0.726：在鑒別膀胱癌組織學(xué)分級(jí)上的Az分別為0.733、0.796和0.702；ADC、D及DDC值鑒別膀胱癌的分期及分級(jí)的Az兩兩比較均無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論：ADC、D和DDC值可以有效地鑒別膀胱癌是肌層侵襲性還是非肌層侵襲性,同時(shí)也可以有效地鑒別膀胱癌是高級(jí)別還是低級(jí)別；但是,它們的Az即診斷效能卻沒(méi)有明顯的差異。三種指數(shù)模型的DWI成像均可以用來(lái)有效地對(duì)鑒別膀胱癌的分期及組織學(xué)分級(jí)。第三部分BOLD成像R2*值在膀胱癌分期及分級(jí)的初步應(yīng)用研究目的：本研究的目的是探討B(tài)OLD成像中R2*值在鑒別膀胱癌分期及分級(jí)中的應(yīng)用價(jià)值。材料與方法：本研究經(jīng)過(guò)了華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院倫理委員會(huì)批準(zhǔn),所有納入研究的病人均簽署了知情同意書(shū)。92例懷疑膀胱癌的病人進(jìn)行了常規(guī)MRI掃描及T2*Mapping序列掃描,經(jīng)過(guò)篩查最終納入分析的病人數(shù)為57例。57例病人共90個(gè)膀胱癌病灶,所有膀胱癌病灶均獲得了病理分期及組織學(xué)分級(jí)的結(jié)果。兩位放射學(xué)診斷學(xué)者在不知道病理結(jié)果的情況下對(duì)膀胱癌進(jìn)行R2*值的數(shù)據(jù)測(cè)量。兩位測(cè)量者間所測(cè)值一致性由Bland Altman來(lái)分析。用Mann-Whitney U檢驗(yàn)來(lái)比較不同膀胱癌分期及分級(jí)的R2*值的差別。另外,用受試者工作曲線(receiver operating characteristic, ROC)來(lái)判斷每個(gè)量化指標(biāo)在鑒別高低級(jí)別膀胱癌及肌層侵襲性和非肌層侵襲性膀胱癌中的診斷效能。結(jié)果：兩位測(cè)量者間的一致性較好。高、低級(jí)別膀胱癌的R2*值分別為20.97±8.91Hz、16.43±5.74 Hz,二者具有明顯統(tǒng)計(jì)學(xué)差異(P=-0.002)；肌層侵襲性及非肌層侵襲性膀胱癌的R2*值分別為21.35±8.96Hz、18.48±7.71Hz,二者比較具有統(tǒng)計(jì)學(xué)差異(P=-0.046)。R2*值鑒別診斷高低級(jí)別膀胱癌的ROC曲線下面積為0.703,鑒別肌層侵襲性膀胱癌及非肌層侵襲性膀胱癌的ROC曲線面積為0.636。結(jié)論：BOLD序列的R2*值可以很好地鑒別膀胱癌的分級(jí)及分期,可以為臨床醫(yī)生對(duì)膀胱癌的臨床治療方案的選擇提供有利的信息。
[Abstract]:The first part of the small field of view and conventional view of DWI in non muscle and muscle invasive bladder cancer in application: comparison of small vision diffusion weighted imaging (reduced field-of-view diffusion-weighted imaging, rFOV DWI) and the conventional view of diffusion weighted imaging (full field-of-view diffusion-weighted imaging, fFOV DWI) invasive bladder cancer image quality in muscle layer and muscle layer, diagnostic accuracy and apparent diffusion coefficient (apparent diffusion, coefficient, ADC) application value. Materials and methods: the Tongji Medical College of Huazhong University of Science and Technology, affiliated Tongji Hospital Ethics Committee approval, 39 cases of bladder cancer patients with a total of 60 tumors were rFOV DWI, fFOV DWI and conventional MRI imaging. All the tumors were the histological pathological staging and histological results. Using four methods, two scholars of the two kinds of radiological diagnosis of DWI map quality respectively. Score of two. In addition, the diagnosis of abdominal radiology doctor respectively for the three groups of images (T2WI, T2WI+fFOV DWI and T2WI+rFOV DWI) do not know in the absence of histopathologic findings were staging diagnosis of bladder cancer, and the staging of bladder cancer is T2 or more diagnostic confidence for a score. Evaluation of two kinds of DWI image quality the Vivtorinox signed rank test: the diagnostic accuracy of each image, compared with the sensitivity and specificity of the McNemar test; diagnostic efficiency with receiver operating curve (receiver operating characteristic curves, ROC) area under representation; with Mann-Whitney U test to compare different bladder cancer staging and grading of ADC value. The difference between the results: the image quality of rFOV DWI (average 3.62) was significantly higher than that of fFOV DWI (average 2.98 P, 0.001.T2WI), T2WI+ fFOV DWI and T2WI+rFOV DWI on the staging of bladder cancer diagnosis accuracy. As of 57%, 70% and 78%. and rFOV DWI after the diagnosis efficiency and specificity of T2 and above the staging accuracy was significantly improved (P0.05). Both the rFOV DWI or fFOV DWI, muscle invasive bladder cancer and high-grade bladder cancer ADC values were significantly lower than those of non muscle invasive bladder and low level cancer ADC (P0.01). Conclusion: rFOV DWI in terms of image quality or diagnostic accuracy is superior to fFOV DWI, based on r-FOV DWI lesions were detected in conventional MRI, to assess whether tumor infiltrating muscular layer is of great value. The ADC value of two DWI sequences may contribute to bladder cancer and non myometrial invasion in differentiating muscle invasive bladder cancer, may contribute to the difference between high-grade bladder cancer and low grade bladder cancer. In the second part, different mathematical model of application of diffusion weighted imaging in bladder cancer Objective: To investigate the staging and grading of different mathematical models (single finger The number of model, double exponential and stretched exponential model) application value of diffusion weighted imaging in the staging and grading of bladder cancer. Materials and methods: approved by the ethics committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, 37 cases of bladder cancer patients with a total of 51 lesions were examined with conventional MRI and b value of DWI imaging. All the tumors were the histological pathological staging and histological results. Two diagnostic radiology scholars in unaware of the pathological results of bladder cancer cases were multi B DWI values of different mathematical models of data measurement. Two measurement between the measured value to analyze the consistency by Bland Altman. Mann-Whitney U test to compare the different bladder cancer staging and grading of the single index model to quantify the value of quantitative ADC, double exponential model (true value of D diffusion coefficient, the true, D* (diffusioncoefficient) perfusion related pseudo diffusion coefficient, Perfusion-related pseudo-diffusion coefficient (f), Perfusion perfusion fraction, fraction) quantization and tensile index model DDC (the distributed diffusion distribution of diffusion coefficient, coefficient (alpha) and heterogeneity index, heterogeneity, index) the difference. In addition, receiver operating curve (receiver operating, characteristic, ROC) to determine the quantitative index of each invasive and non muscle invasive bladder cancer diagnosis in the differential diagnosis of bladder cancer and high level muscle. Results: the consistency between the two examiners. The better muscle invasive bladder cancer or high-grade bladder cancer ADC, D and DDC were significantly lower than the corresponding value of non muscle invasive bladder cancer or low grade bladder cancer (P=-0.002,0.003 and 0.007 P=0.014,0.002; and 0.033). D*, F and alpha value in the differential diagnosis of bladder cancer staging and histological grading was no statistically significant difference .ADC, D and DDC value in differential diagnosis of bladder cancer staging area under the ROC curve (the areas under the receiver operating characteristic curves, Az) were 0.751,0.747 and 0.726 in the differential diagnosis of bladder cancer: histological grading of Az were 0.733,0.796 and 0.702 respectively; ADC, D and DDC value in differential diagnosis of bladder cancer staging and grading 22 Az were no statistically significant difference. Conclusion: ADC, D and DDC can effectively identify muscle invasive bladder cancer is still non muscle invasive, but also can effectively identify bladder cancer is high level or low level; however, their Az diagnostic efficacy had no significant difference. DWI imaging three index model can be used to effectively identify the grade of bladder cancer staging and organization. The third part of the BOLD R2* imaging value in bladder cancer staging and grading of the objective preliminary study: the purpose of this study is to explore the Discuss the BOLD imaging R2* value in differential diagnosis of bladder cancer staging and grading. Materials and methods: This study by Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology ethics committee approval, all the enrolled patients signed the informed consent.92 patients suspected bladder cancer underwent routine MRI scan and T2*Mapping sequence scanning. After the final screening of patients for 57 cases of.57 patients with a total of 90 bladder cancer lesions, all bladder cancer lesions were obtained in histological grade and tissue pathological staging results. Two diagnostic radiology scholars data R2* value measurement of bladder cancer in unaware of the pathological results under the condition of the two examiners. Between the measured value of consistency analysis by Bland Altman. Mann-Whitney U test to compare different bladder cancer staging and grading of R2* value difference. In addition, work with the subjects Curve (receiver operating characteristic, ROC) to determine the quantitative index of each invasive and non muscle invasive bladder cancer diagnostic efficacy in the diagnosis of bladder cancer and high level muscle. Results: the consistency between the two examiners better. High, low level of bladder cancer R2* = 20.97 + 8.91Hz. 16.43 + 5.74 Hz, two of them have statistically significant difference (P=-0.002); muscle invasive and non muscle invasive bladder cancer: R2* = 21.35 + 8.96Hz, 18.48 + 7.71Hz, two with statistically significant difference between the values of.R2* (P=-0.046) ROC curve area differential diagnosis of high and low grade of bladder cancer was 0.703 identification, myometrial invasion ROC curve area of bladder cancer and non muscle invasive bladder cancer was 0.636. conclusion: BOLD series R2* value can well identify classification and staging of bladder cancer, can for clinical treatment of bladder cancer clinicians The choice of the scheme provides favorable information.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R445.2;R737.14

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