發(fā)布時間：2018-06-18 13:26

  本文選題：前列腺癌 + 體素內不相干運動成像��； 參考：《蘇州大學》2016年碩士論文

【摘要】：第一部分前列腺IVIM-DWI的b值優(yōu)化探討目的對前列腺IVIM-DWI的b值組合進行優(yōu)化,探討IVIM-DWI定量參數(shù)在前列腺癌診斷中的作用。方法回顧性分析本院2015年2月至11月間行前列腺常規(guī)MRI和IVIM-DWI掃描并經(jīng)穿刺病理證實的47例前列腺病例資料,其中前列腺癌23例,良性前列腺增生24例。納入標準:(1)同時行前列腺常規(guī)MRI和IVIM-DWI檢查,檢查技術符合本研究要求,檢查參數(shù)保持一致;(2)經(jīng)超聲引導下穿刺活檢證實為前列腺癌或良性前列腺組織;(3)前列腺MRI檢查前1月內均未進行前列腺穿刺活檢;(4)前列腺MRI檢查前未進行任何針對前列腺疾病的治療;(5)前列腺MRI檢查和病理檢查的間隔時間小于6周。排除標準:(1)MRI掃描圖像資料不完整,圖像質量不符合本研究的要求;(2)腫瘤體積過小,瘤灶在IVIM-DWI圖像上邊界不清,無法準確設置ROI;(3)病理結果描述區(qū)域與MRI圖像不匹配。IVIM-DWI檢查設置四組b值進行掃描,具體為:(1)0,10,100,200,1000;(2)0,10,50,100,200,1000;(3)0,10,20,50,100,200,1000;(4)0,10,20,50,100,200,500,1000。在所獲IVIM-DWI圖像上根據(jù)穿刺病理報告結合PI-RADS v2評分標準在活檢取材相對應部位分別設置前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)的ROI,分別測量四組不同b值的IVIM-DWI定量參數(shù),包括擴散系數(shù)D、灌注分數(shù)f和偽擴散系數(shù)D*。采用方差分析比較各組b值的前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)測得參數(shù)間的差異,兩兩間差異性檢驗采用LSD-t檢驗,P0.05,為具有統(tǒng)計學差異。結果第(1)組b值(0,10,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.67±0.11)×10-3mm2/s、(26.95±4.75)%、(12.88±4.93)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.35±0.16)×10-3mm2/s、(27.79±3.47)%、(15.6±2.82)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.79±0.29)×10-3mm2/s、(25.19±4.3)%、(13.47±4.84)×10-3mm2/s;第(2)組b值(0,10,50,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.68±0.14)×10-3mm2/s、(26.45±4.73)%、(13.1±4.44)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.36±0.17)×10-3mm2/s、(27.3±4.06)%、(15.41±3.46)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.85±0.29)×10-3mm2/s、(23.9±3.54)%、(12.22±4.61)×10-3mm2/s;第(3)組b值(0,10,20,50,100,200,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.68±0.12)×10-3mm2/s、(25.59±4.84)%、(13.75±5.08)×10-3mm2/s、,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.38±0.16)×10-3mm2/s、(26.78±3.86)%、(15.55±2.82)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.8±0.31)×10-3mm2/s、(23.98±5.2)%、(13.55±5.27)×10-3mm2/s;第(4)組b值(0,10,20,50,100,200,500,1000)前列腺癌區(qū)的D值、f值、D*值分別為(0.67±0.13)×10-3mm2/s、(28.58±5.93)%、(12.43±5.55)×10-3mm2/s,中央腺體非癌區(qū)的D值、f值、D*值分別為(1.33±0.16)×10-3mm2/s、(28.2±3.16)%、(14.38±3.15)×10-3mm2/s,外周帶非癌區(qū)的D值、f值、D*值分別為(1.81±0.35)×10-3mm2/s、(28±6.93)%、(11.41±5.64)×10-3mm2/s。各組癌區(qū)的D值均低于非癌區(qū),差異有統(tǒng)計學意義(P0.05),且中央腺體非癌區(qū)的D值低于外周帶非癌區(qū)的D值,差異有統(tǒng)計學意義(P0.05)。f值和D*值在前列腺癌區(qū)、中央腺體非癌區(qū)和外周帶非癌區(qū)間的差異無統(tǒng)計學意義(P0.05)。結論在本研究部分選擇的四組b值行3.0T前列腺IVIM-DWI掃描所獲的IVIM參數(shù)(D值、f值和D*值)中,僅D值在前列腺癌區(qū)與非癌區(qū)間的差異具有統(tǒng)計學意義,可用于前列腺癌與非癌區(qū)的診斷與鑒別診斷;且第(1)組b值(0,10,100,200,1000)所選的b值數(shù)最少,掃描時間最短,建議在前列腺IVIM-DWI掃描中推薦使用。第二部分前列腺IVIM-DWI成像的一致性分析目的評價在不同時間、不同設備和重復測量時前列腺IVIM-DWI所測定量參數(shù)值(D值、f值和D*值)間的一致性,以明確其作為前列腺多中心研究評價指標的可行性。方法2015年12月在我院招募健康成年男性志愿者15例,進行前列腺IVIM-DWI定量參數(shù)測值的一致性研究,年齡23-30歲。納入標準:(1)健康成年男性,無前列腺疾病史,無前列腺疾病相關臨床癥狀;(2)前列腺IVIM-DWI檢查技術符合本研究要求,檢查參數(shù)保持一致。排除標準:(1)IVIM-DWI圖像質量不佳,影響觀察和分析;(2)嚴重幽閉恐懼癥患者;(3)磁共振成像禁忌癥;(4)前列腺IVIM-DWI檢查顯示前列腺有異常信號改變者。本研究獲得本院倫理委員會批準并在其監(jiān)督下進行,所有研究對象均已簽署知情同意書。所有志愿者在同一天采用3.0T(Ingenia,Philips)MR成像系統(tǒng)行前列腺IVIM-DWI檢查,在間隔16天后由同一操作者分別采用3.0T(Ingenia,Philips)(與前次檢查為同一設備)和3.0T(TX,Philips)MR成像系統(tǒng)重復上述IVIM-DWI檢查,掃描參數(shù)相同。b值采用第一部分研究所推薦的組合(0,10,100,200,1000)。在每次IVIM-DWI檢查所獲前列腺軸位圖像上,對前列腺最大面積層面的前列腺中央腺體和外周帶區(qū)域設置ROI(每例設置ROI的位置和大小盡量保持一致),分別測量IVIM參數(shù)(包括擴散系數(shù)D、灌注分數(shù)f和偽擴散系數(shù)D*),且在3.0T(Ingenia,Philips)MR成像系統(tǒng)第一次IVIM-DWI掃描所獲前列腺圖像上按照上述ROI設置方法對IVIM參數(shù)(D值、f值和D*值)進行重復測量。上述IVIM-DWI檢查及IVIM參數(shù)測量均由同一研究者完成。采用配對樣本t檢驗比較不同時間、不同設備及重復測量所獲IVIM各參數(shù)值間的差異,P0.05,為差異有統(tǒng)計學意義。計算組內相關系數(shù)(ICC),其值介于0~1之間,0表示不可信,1表示完全可信,一般認為低于0.4表示相關性低,大于0.75表示信度好,相關性高。采用Bland-Altman法對上述不同時間、不同設備及重復測量所獲IVIM各參數(shù)值間的差異進行一致性分析。結果3.0T(Ingenia,Philips)MR成像系統(tǒng)第一次前列腺IVIM-DWI檢查測得的中央腺體D值、f值、D*值分別為(1.35±0.22)×10-3mm2/s,(33.33±7.28)%,(14.28±4.05)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.32±0.14)×10-3mm2/s,(34.15±7.34)%,(13.09±3.20)×10-3mm2/s;第二次檢查測得的中央腺體D值、f值、D*值分別為(1.34±0.16)×10-3mm2/s,(31.67±5.34)%,(14.21±3.53)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.35±0.09)×10-3mm2/s,(34.05±8.36)%,(12.94±4.41)×10-3mm2/s;3.0T(TX,Philips)MR成像系統(tǒng)測得的中央腺體D值、f值、D*值分別為(1.42±0.19)×10-3mm2/s,(33.81±5.77)%,(33.81±5.77)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.31±0.28)×10-3mm2/s,(32.83±10.34)%,(12.43±3.80)×10-3mm2/s;3.0T(Ingenia,Philips)MR成像系統(tǒng)所獲前列腺IVIM-DWI圖像進行重復測量所測得的中央腺體D值、f值、D*值分別為(1.31±0.11)×10-3mm2/s,(34.64±7.70)%,(13.98±4.01)×10-3mm2/s,外周帶D值、f值、D*值分別為(1.32±0.16)×10-3mm2/s,(33.20±5.41)%,(13.46±2.67)×10-3mm2/s。前列腺IVIM-DWI檢查在不同時間、不同設備及重復測量所測得的D值、f值及D*值間的差異均無統(tǒng)計學意義(P0.05)。不同時間中央腺體測得的D值、f值、D*值的ICC分別為(0.823,0.460,0.520),外周帶測得的D值、f值、D*值的ICC分別為(0.934,0.601,0.630);不同設備中央腺體測得的D值、f值、D*值的ICC分別為(0.910,0.462,0.735),外周帶測得的D值、f值、D*值的ICC分別為(0.836,0.523,0.662);重復測量中央腺體測得的D值、f值、D*值的ICC分別(0.794,0.769,0.566),外周帶測得的D值、f值、D*值的ICC分別為(0.849,0.803,0.871),上述測得的D值間(ICC大于0.75)的相關性最好。Bland-Altman散點圖顯示D值分布較D*值和f值更集中,提示在3.0T MR設備前列腺IVIM-DWI檢查時,D值在不同時間、不同設備和重復測量所獲IVIM定量參數(shù)各測量值間的一致性區(qū)間較小,可重復性較好。結論本部分研究結果顯示在3.0T MR設備前列腺IVIM-DWI檢查時不同時間、不同設備及重復測量所測得的前列腺IVIM定量參數(shù)值間差異沒有統(tǒng)計學意義,D值間(ICC大于0.75)的相關性最好,各參數(shù)間的一致性較好,其中D值較D*和f值的一致性好,由此表明在3.0T MR設備前列腺IVIM-DWI檢查時不同時間、不同設備及重復測量所測得的前列腺IVIM定量參數(shù)值間的一致性較好,IVIM定量參數(shù)可作為前列腺多中心研究的評價指標。
[Abstract]:Part one optimization of the b value of the prostate IVIM-DWI objective to optimize the b value combination of the prostate IVIM-DWI and to explore the role of IVIM-DWI quantitative parameters in the diagnosis of prostate cancer. Methods a retrospective analysis of 47 cases of prostate cases from February 2015 to November with routine prostate MRI and IVIM-DWI scan and pathologically confirmed prostate cases were analyzed retrospectively. Materials, of which 23 cases of prostate cancer and 24 cases of benign prostatic hyperplasia were included. (1) routine MRI and IVIM-DWI examination of prostate were performed simultaneously. The examination technique accorded with the requirements of this study, the examination parameters remained consistent; (2) the ultrasound guided biopsy confirmed the prostate cancer or benign prostatic tissue; (3) the MRI examination of the prostate was not carried out in January. Prostate biopsy; (4) no treatment for prostate disease before prostate MRI examination; (5) the interval between MRI and pathological examination of the prostate is less than 6 weeks. (1) the image data of the MRI scan is incomplete and the image quality does not meet the requirements of this study; (2) the tumor size is too small and the tumor range is not on the IVIM-DWI image boundary. In Qing, ROI can not be set accurately; (3) the pathology result description area and the MRI image mismatch.IVIM-DWI examination set four groups of B values to scan, specifically: (1) 0,101002001000; (2) 0,10,501002001000; (3) 0,10,20,501002001000; (4) 0,10,20,501002005001000. in the obtained IVIM-DWI image according to the biopsy pathology report combined PI-RADS v2. The scoring criteria set the prostate cancer area, the central glandular non cancer area and the peripheral ROI of the peripheral zone, respectively, to measure the IVIM-DWI quantitative parameters of four groups of different b values, including the diffusion coefficient D, the perfusion fraction f and the pseudo diffusion coefficient D*., which were compared with the b value of the prostate cancer area and the central glandular non cancer area. The difference between the parameters measured in the non cancer zone and the peripheral zone, the 22 difference test using LSD-t test, P0.05, was statistically different. Results (1) the D value of the b value (0,101002001000), F value, D* value was (0.67 + 0.11) x 10-3mm2/s, (26.95 + 4.75)%, (12.88 + 4.93) x 10-3mm2/s, D value, F value of the central gland non cancer area, D*. The values were (1.35 + 0.16) x 10-3mm2/s, (27.79 + 3.47)%, (15.6 + 2.82) x 10-3mm2/s, D value, F value of non cancer zone, D* value (1.79 + 0.29) x 10-3mm2/s, (25.19 + 4.3)%, (13.47 + 4.84) x 10-3mm2/s, b value (0,10,501002001000) in group B (0,10,501002001000) of prostate cancer area, F value, D* values were respectively. (13.1 + 4.44) * 10-3mm2/s, the D value, F value of the central glandular non cancerous region, D* value (1.36 + 0.17) * 10-3mm2/s, (27.3 + 4.06)%, (15.41 + 3.46) x 10-3mm2/s, F value, D* value (1.85 + 0.29) * 10-3mm2/s, (23.9 + 3.54)%, (12.22 +) * 10-3mm2/s; D value, F value, and D* value were (0.68 + 0.12) x 10-3mm2/s, (25.59 + 4.84)%, (13.75 + 5.08) x 10-3mm2/s, D value, F value of central glandular non cancer area, D* value (1.38 + 0.16) x 10-3mm2/s, (26.78 + 3.86)%, (15.55 + 2.82) * 10-3mm2/s, F value, F values, respectively, F values, respectively 0-3mm2/s; (4) group B value (0,10,20,501002005001000), D value, F value, D* value (0.67 + 0.13) x 10-3mm2/s, (28.58 + 5.93)%, (12.43 + 5.55) x 10-3mm2/s, D value, F value, D* value of the central glandular region (1.33 + 0.16) * 10-3mm2/s, (28.2 + 3.16)%, (14.38 + 3.15) * *, peripheral band non cancer value, values, values, values, values, The values of D* were (1.81 + 0.35) x 10-3mm2/s, (28 + 6.93)% and (11.41 + 5.64) x 10-3mm2/s., and the D values were lower than those in non cancerous regions. The difference was statistically significant (P0.05), and the D value of the central glandular non cancerous region was lower than the D value in the non cancerous region of the peripheral zone. The difference was statistically significant (P0.05).F value and D* value in the prostate cancer area, the central glandular non cancerous region and the outer region. There was no significant difference in the difference between the non cancer interval and the non cancerous interval (P0.05). Conclusion in the four groups of B values selected in this study, the IVIM parameters (D, F and D*) of the 3.0T prostate IVIM-DWI scan were statistically significant in the difference between the prostate cancer and the non cancer areas, and could be used for the diagnosis and differential diagnosis of the prostate and non cancer areas. And the b value (0,101002001000) of group (1) group (0,101002001000) is the least and the shortest scanning time. It is recommended to be used in the IVIM-DWI scan of the prostate. The consistency analysis of IVIM-DWI imaging in part second of the prostate is used to evaluate the parameter values (D, F, and D*) at different time, different equipment and repeated measurements of the prostatic gland in the prostatic gland. Conformance, to determine the feasibility of the prostatic multicenter study. Methods 15 healthy adult male volunteers were recruited in our hospital in December 2015 to conduct a conformance study of the quantitative parameters of the prostate IVIM-DWI parameters, aged 23-30 years. (1) a healthy adult male, a history of no prostate disease, and no prostate disease related Clinical symptoms; (2) the IVIM-DWI examination of the prostate coincide with the requirements of this study, and the examination parameters remain consistent. Exclusion criteria: (1) poor IVIM-DWI image quality, influence observation and analysis; (2) patients with severe claustrophobia; (3) contraindications to magnetic resonance imaging; (4) prostate IVIM-DWI examination showed abnormal signal changes in the prostate. All the subjects had signed the informed consent. All the volunteers used the 3.0T (Ingenia, Philips) MR imaging system for the prostate IVIM-DWI examination on the same day, and the same operator used 3.0T (Ingenia, Philips) (the same device with the previous examination) and 3 at the same day after 16 days. The T (TX, Philips) MR imaging system repeats the above IVIM-DWI examination with the same.B value of the scan parameters recommended by the first part of the study (0,101002001000). ROI on the central prostate gland and the peripheral zone of the prostate at the maximum area of the prostate (each set of ROI locations) on the prostate axis image obtained at each IVIM-DWI examination. The IVIM parameters (including diffusion coefficient D, perfusion fraction f and pseudo diffusion coefficient D*) were measured respectively, and repeated measurements were carried out on the IVIM parameters (D values, values and values) in the prostate images obtained by the first IVIM-DWI scan of the 3.0T (Ingenia, Philips) MR imaging system. M parameters are measured by the same researchers. Using paired sample t test, the difference between different time, different equipment and repeated measurements of IVIM parameters, P0.05, is statistically significant. The correlation coefficient within the computing group (ICC) is between 0~1, 0 is unbelievable, 1 is fully credible, generally believed to be less than 0.4. The correlation was low and greater than 0.75 indicated that the reliability was good and the correlation was high. The Bland-Altman method was used to make a consistent analysis of the differences between the values of IVIM parameters obtained at different times, different equipment and repeated measurements. Results the value of D, F, D* values of the first IVIM-DWI examination of the 3.0T (Ingenia, Philips) MR imaging system was (1.), and the value of D* was (1.). 35 + 0.22) * 10-3mm2/s, (33.33 + 7.28)%, (14.28 + 4.05) x 10-3mm2/s, D value of peripheral zone, F value, D* value (1.32 + 0.14) x 10-3mm2/s, (34.15 + 7.34)%, (13.09 + 3.20) x 10-3mm2/s, D value of central gland, F value and D* value measured by second examination. Value, D* value is (1.35 + 0.09) x 10-3mm2/s, (34.05 + 8.36)%, (12.94 + 4.41) x 10-3mm2/s, 3.0T (TX, Philips) MR imaging system has measured D value of central gland, F value, D* value is (1.42 + 0.19) x 10-3mm2/s, (33.81 + 5.77)%, (33.81 + 5.77) * 10-3mm2/s, peripheral zone value, respectively. 3 + 3.80) * 10-3mm2/s; 3.0T (Ingenia, Philips) MR imaging system has measured the D value of the central gland, F value, D* value (1.31 + 0.11) x 10-3mm2/s, (34.64 + 7.70)%, (13.98 + 4.01) x 10-3mm2/s, peripheral band D value, respectively, (1.32 + 0.16)%, (33.20 + 5.41)%, (13.46 + 2.67) There was no significant difference between the values of D, F and D* values measured at different time, different equipment and repeated measurements for the prostate IVIM-DWI in X 10-3mm2/s. (P0.05). The D value, F value, D* value of the central gland at different time were respectively (0.823,0.460,0.520), and the D values measured in the peripheral zone were respectively. The D value, the F value and the D* value of the central glands of different equipment are (0.910,0.462,0.735), the D values of the peripheral zone, the F value and the D* value are respectively (0.836,0.523,0.662), and the D values measured by the central glands are repeated, the F values, the values and the values are respectively measured. The best correlation between the above D values (ICC greater than 0.75) is the best.Bland-Altman scatter plot, which shows that the D value distribution is more concentrated than the D* value and F value. It is suggested that the D value of the 3.0T MR equipment in the prostate IVIM-DWI examination is at different time, and the consistency interval between the measured values of the IVIM quantitative parameters obtained by different equipment and repeated measurements is smaller, and the repeatability is better. The results of this part of the study showed that there was no statistical difference between different time, different equipment and repeated measurements of the prostate IVIM quantitative parameters in the prostate IVIM-DWI examination of 3.0T MR equipment. The correlation between the D values (ICC greater than 0.75) was the best, and the consistency of the parameters was better, and the consistency of the D value was better than the D* and F values. It shows that the consistency of the quantitative parameters of the prostate IVIM parameters measured by different equipment and repeated measurements at different time in the prostate IVIM-DWI examination of 3.0T MR equipment is better. The quantitative parameter of IVIM can be used as an evaluation index for the study of prostate multi center.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R445.2;R737.25;R697.3

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