磁共振波谱(mrs)和扩散加权成像(dwi)及其联合应用对前列腺癌的诊断价值

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1、《中国图书资料分类法》分类号：R445单位代码：10660学号：S090285贵阳医学院2012届临床医学硕士专业学位材料(临床论文部分)磁共振波谱（MRS）和扩散加权成像（DWI）及其联合应用对前列腺癌的诊断价值研究生：蔡登华导师：沈桂权年级：2009级专业：影像医学与核医学2012年5月1日贵阳医学院2012届硕士研究生论文目录摘要„„„„„„„„„„„„„„„„„„„„2略缩词表„„„„„„„„„„„„„„„„„„„4前言„„„„„„„„„„„„„„„„„„„„6材料与方法„„„„„„„„„„„„„„„„„„7结果„„„„„„„„„„„„„„„„„„„„

2、10讨论„„„„„„„„„„„„„„„„„„„„19结论„„„„„„„„„„„„„„„„„„„„23不足与展望„„„„„„„„„„„„„„„„„„24参考文献„„„„„„„„„„„„„„„„„„„24附图„„„„„„„„„„„„„„„„„„„„27致谢„„„„„„„„„„„„„„„„„„„„40英文摘要„„„„„„„„„„„„„„„„„„„41论文原创性声明„„„„„„„„„„„„„„„„42综述„„„„„„„„„„„„„„„„„„„„43附：临床能力考核有关材料：临床轮转考核表学术活动情况表临床能力考试及学位答辩情况-1-贵阳医学院2012届硕士研究生论文磁

3、共振波谱（MRS）和扩散加权成像（DWI）及其联合应用对前列腺癌的诊断价值专业：影像医学与核医学研究生：蔡登华导师：沈桂权教授中文摘要目的：分析前列腺癌的MRS代谢特征及在DWI上表观扩散系数的变化，与病理结果相对照，探讨MRS、DWI两种成像方法及其联合应用对前列腺癌进行定性诊断的价值。材料与方法：收集2011年3月—2012年1月期间经病理或临床证实的前列腺癌(PCa)28例及20例前列腺增生（BPH）患者资料；在MRS上观察病灶枸橼酸盐（Cit），胆碱（Cho）和肌酸（Cre）的波峰，测量其（Cho+Cre）/Cit（CC/C）比值；DWI上，观察病灶的

4、信号并进行ADC值测量，通过受试者操作特性曲线（ROC）评估(Cho+Cre)/Cit比值和ADC值对PCa的诊断效能，比较(Cho+Cre)/Cit比值和ADC值单独应用和二者联合应用对前列腺癌的诊断价值。结果：PCa的Cho峰值高于Cit和Cr峰值，BPH的Cit峰高于Cho和Cr峰值；PCa的(Cho+Cr)/Cit平均值为3.04±0.360，BPH的(Cho+Cr)/Cit平均值－3为0.515±0.072（p﹤0.05），PCa的平均ADC值为0.78±0.025×10，BPH的平－3均ADC值为1.59±0.045×10（p﹤0.05）。PCa与

5、BPH的波谱形态及（Cho+Cr)/Cit比值存在明显差异；据ROC曲线分析，根据（Cho+Cr)/Cit比值诊断PCa的最佳诊断域值为1.110，此诊断域值的敏感度(92.9%)和特异度(93.7%)。PCa与BPH的ADC值存在明显差异，根据ADC值诊断PCa的最佳诊断域值为1.182×10－3，此诊断域值敏感度(85.1%)和特异度(96.4%)。诊断效能：MRI＋MRS诊断PCa的敏感性96.42%，特异性90%，准确度93.75%；MRI＋DWI诊断PCa的敏感性92.85%，特异性85%，准确度89.58%；MRI＋MRS＋DWI联合应用诊断前列腺

6、癌的敏感性96.42%，特异性95%，准确度95.83%。结论：联合应用MRS和DWI的诊断效能优于单独应用MRS或DWI，MRI＋MRS＋DWI的敏感度、准确度和特异度最高，在常规MRI基础上，MRS结合DWI有助于前列腺癌的早期诊断与鉴别诊断。关键词：前列腺癌(PCa)，磁共振成像(MRI)，磁共振波谱(MRS)，磁共振扩散加权成像（DWI）-2-贵阳医学院2012届硕士研究生论文缩略词中英文对照表英文缩写英文全称中文全称MRImagneticresonanceimaging磁共振成像13DH-MRSThreedimensionalprotonmagnet

7、icresonancespectroscopy三维氢质子磁共振波谱CSIchemicalshiftimaging化学位移成像PRESSpoint-resolvedspatiallylocalizedspectroscopy点分辨空间定位波谱STEAMstimulatedechoacquisitionmode激励回波脉冲序列-3-贵阳医学院2012届硕士研究生论文SVSsinglevoxelspectroscopy单体素波谱MVSmultivoxelspeeortscopy多体素波谱FWHMfullwidthathalfmaximum最大半峰宽度Citcitra

8、te枸橼酸盐Chocholine-co