| 摘要: |
| 目的探讨动态对比增强磁共振成像（DCE-MRI）联合弥散加权成像（DWI）定量分析在前列腺癌（PCa）诊断中的应用价值。方法选取81例前列腺疾病患者，其中PCa44例、良性前列腺增生（BPH）37例，均行常规MRI、DWI和DCE-MRI检查，测量并比较两组患者病灶区域的血管渗透性参数（Ktrans、Kep、Ve、Vp）和表观扩散系数（ADC）值；应用ROC曲线分析以上参数诊断PCa的效能，应用logistic回归计算ADC值联合血管渗透性参数诊断PCa的效能。结果PCa组Ktrans、Kep、Ve、Vp和ADC值分别为（2.40±1.13）min-1、（1.90±0.72）min-1、0.82±0.24、0.31±0.25和（0.93±0.43）×10-3mm2/s，BPH组分别为（1.07±1.08）min-1、（1.04±0.48）min-1、0.64±0.37、0.43±0.36和（1.74±0.38）×10-3mm2/s；其中PCa组Ktrans、Kep、Ve均高于BPH组（均P＜0.05），BPH组ADC值高于PCa组（P＜0.05）。Ktrans、Kep、Ve和ADC值诊断PCa的灵敏度分别为84.1%、68.2%、79.5%和86.5%，特异度分别为75.7%、86.5%、70.3%和84.1%（均P＜0.05）；Vp无明显诊断价值（P＝0.211）。ADC值联合血管渗透性参数诊断PCa的效能分析，当2个参数联合时，Kep+ADC的诊断效能最好（AUC=0.939）；当3个参数联合时，诊断效能未见明显提高；当4个参数联合时，Ktrans+Kep+Ve+ADC的诊断效能有所提高（AUC=0.940），明显高于单个参数的诊断效能。结论DCE-MRI联合DWI定量分析在PCa诊断中具有较高的应用价值，Kep和ADC值可作为诊断PCa的主要参数，以提高PCa的诊断效能和前列腺良恶性病变的鉴别诊断。 |
| 关键词: 前列腺癌 动态对比增强磁共振成像 弥散加权成像 |
| DOI：10.12056/j.issn.1006-2785.2017.39.01.2016-1430 |
| 分类号: |
| 基金项目:浙江省医药卫生科技计划项目（2014KYB171）；浙江省中医药科技计划项目（2014ZB042） |
|
| Application of quantitative DCE-MRI combined with DWI in diagnosis of prostate cancer |
|
MA Xiangzheng, WANG Shiwei, XU Maosheng, YU Yingxing, LV Kun, PANG Peipei
|
|
the First Affiliated Hospital of Zhejiang Chinese Medical University
|
| Abstract: |
| Objective To evaluate the application of quantitative dynamic contrast-enhanced MRI (DCE-MRI) combined with diffusion weighted imaging (DWI) in diagnosis of prostate cancer (PCa). Methods Eighty one patients with prostate diseases, including 44 patients with PCa and 37 patients with benign prostatic hyperplasia (BPH), undergoing conventional MRI, DWI and DCE-MRI examinations were enrolled in the study. The apparent diffusion coefficient (ADC) values and the quantitative permeability parameters Ktrans、Kep、Ve、Vp of the lesions were calculated and compared between PCa patients and BPH patients. The diagnosis value of each parameter was evaluated by ROC curve, and the diagnosrtic efficiency of the ADC combined with the permeability parameters was analyzed by logistic analysis. Results The Ktrans、Kep、Ve、Vp and ADC values of the malignant lesions were (2.40±1.13)min-1, (1.90±0.72)min-1, 0.82±0.24, 0.31±0.25 and (0.93±0.43)×10-3mm2/s, while those of the benign lesions were (1.07±1.08)min-1, (1.04±0.48)min-1, 0.64±0.37, 0.43±0.36 and (1.74±0.38)×10-3mm2/s, respectively. The Ktrans, Kep and Ve of PCa patients were higher than those of BPH patients (P＜0.05), while the ADC of BPH patients was higher than that of PCa patients (P＜0.05). The sensitivity of the Ktrans, Kep, Ve and ADC values was 84.1%, 68.2%, 79.5%, 86.5% and the specificity
was 75.7% , 86.5% , 70.3%, 84.1%, respectively (P＜0.05). There was no significant difference in Vp (P＝0.211). ADC values combined with permeability parameters in the diagnosis of PCa, Kep plus ADC presented the best diagnostic efficacy when the two parameters combined (AUC ＝0.939).The diagnostic efficacy was not significantly improved when ADC combined with the
other two parameters. Ktrans+Kep+Ve+ADC had the higher diagnostic efficiency (AUC＝0.940), which was significantly higher than that of single parameter. Conclusion Quantitative DCE-MRI combined with DWI can increase the diagnostic value for PCa. The parameter Kep and ADC value can be used to improve the diagnostic efficacy, and differential diagnosis of PCa from benign hyperplasia. |
| Key words: Prostate cancer Dynamic contrast-enhanced MRI Diffusion weighted imaging |
