3.0T磁共振扩散张量成像在老年前列腺癌诊断中的应用

3.0T Diffusion Tensor Imaging (DTI) in the Diagnosis of Prostate Cancer in the Elderly

目的探讨3.0 T磁共振扩散张量成像(DTI)在老年前列腺癌(PCa)诊断中的应用价值。方法选择2017年1月至2019年6月经病理学检查证实的PCa患者42例和良性前列腺增生(BPH)患者50例为研究对象(年龄均≥60岁),均行前列腺常规MRI、DWI、DTI扫描,测量相应病变部位表观扩散系数(ADC)和各向异性分数(FA),并绘制DTI参数图及纤维示踪图,采用受试者工作特征曲线(ROC)的曲线下面积(AUC)值比较ADC、FA及两者联合对老年PCa的诊断效能,并确定诊断阈值。结果老年PCa、BPH病变区域ADC值、FA值比较,差异均有统计学意义(t值分别为12.663和8.793,P均<0.05);ADC阈值为1.03×10-3mm2/s,敏感度、特异度、约登指数、AUC分别为95.24%、93.88%、0.89、0.983;FA阈值为0.21,敏感度、特异度、约登指数、AUC分别为80.95%、87.76%、0.68、0.910;两者联合的敏感度、特异度、约登指数、AUC分别97.6%、95.9%、0.93、0.991。AUC的两两比较,ADC值与FA值、ADC值与两者联合、FA值与两者联合的Z值分别为2.336、1.169、2.807,P值分别为0.019、0.243、0.005。结论老年PCa和BPH的DTI表现存在明显差异,其评价参数ADC、FA及纤维示踪图可提供定量诊断信息,ADC值较FA值对老年PCa的诊断效能高,差异具有统计学意义。两者联合的诊断效能与ADC值相比无统计学差异,与FA值相比差异有统计学意义。

Objective To evaluate the value of 3.0 t diffusion tensor imaging(DTI)in the diagnosis of prostate cancer in the elderly.Methods A total of 42 patients with prostate cancer(PCa)and 50 patients with benign prostatic hyperplasia(BPH)admitted to our hospital from January 2017 to June 2019 were selected as study subjects(all aged≥60 years).Both routine MRI,DWI,and DTI scans of the prostate were performed to measure the apparent diffusion coefficient(ADC)and anisotropy score(FA)of the corresponding lesions,and draw DTI parameter maps and fiber tracers.The area under ROC curve(AUC)value was used to compare the diagnostic efficacy of ADC,FA and the combination of the two for senile prostate cancer,and to determine the diagnostic threshold.Results The comparison of ADC values and FA values in the lesion areas of prostate cancer and benign prostatic hyperplasia in the elderly showed statistically significant differences between the two groups(T values were 12.663 and 8.793,respectively,P values were all<0.05).The ADC threshold was1.03×10-3 mm2/s,and the sensitivity,specificity,youden index and AUC were 95.24%,93.88%,0.89 and 0.983,respectively.FA threshold was 0.21,sensitivity,specificity,youden index and AUC were 80.95%,87.76%,0.68 and0.910,respectively.The sensitivity,specificity,youden index and AUC were 97.6%,95.9%,0.93 and 0.991,respectively.In paired comparison of AUC,ADC value was combined with FA value,ADC value was combined with both,and FA value was combined with both.Z value was 2.336,1.169,2.807,and P value was 0.019,0.243,0.005,respectively.Conclusion There are significant differences in DTI realization between prostate cancer and benign prostatic hyperplasia in the elderly,and the evaluation parameters ADC、FA And fiber tracers can provide quantitative diagnostic information for prostate cancer and benign prostatic hyperplasia in the elderly.The ADC value is more effective than FA value in the diagnosis of prostate cancer in the elderly,and the difference is statistically significant.There was no statistically significant difference in the combined diagnostic efficacy between the two groups compared with the ADC value,and the difference was statistically significant when compared with the FA value.