RS对中国人前列腺癌鉴别诊断标准的初步研究

Quantitative criteria of MR spectroscopy in the differential diagnosis of prostate cancer in China: preliminary study

目的 评价磁共振波谱分析 (MRS)对前列腺癌 (PCa)的鉴别诊断价值 ,初步确定中国人前列腺癌的MRS诊断标准。方法 经手术病理或穿刺活检证实的PCa 2 1例、良性前列腺增生 2 3例和正常老年志愿者 17例以六分区的方法进行MRS定量分析。在MRS代谢图上标记出手术病理或穿刺活检取材位置归入相应的分区 ,测量其 (胆碱 +肌酸 ) /枸椽酸盐 [(choline +creatine) /citrate ,CC/C]的比值。计算MRS对癌区外周带和非癌区外周带 (包括BPH患者的和PCa患者的 )定性诊断的准确性。结果 正常前列腺外周带、PCa患者癌区外周带及非癌区外周带的CC/C值分别为 :0 .42± 0 .19、2 .13± 0 .82和 0 .60± 0 .2 0。以正常人CC/C值的 -x +3SD为癌的诊断标准 ,将CC/C >0 .99者诊断为PCa区。本标准和国外文献标准 (CC/C >0 .86)鉴别PCa区与非PCa区的敏感性分别为 96.0 %和 97.3 % ( χ2 =0 .2 0 7,P =0 .64 9) ,特异性分别为94.7%和 86.3 % ( χ2 =4.5 63 ,P =0 .0 0 5 ) ,准确性分别为 95 .1%和 89.4% ( χ2 =5 .95 0 ,P =0 .0 15 )。结论 以CC/C >0 .

ObjectiveTo evaluate the value of MR spectroscopy in the differential diagnosis of prostate cancer and to incipiently determine the diagnostic criteria of prostate cancer in China using MRS. MethodsTwenty one cases of prostate cancer and 23 cases of BPH all proved by pathology of operation or systemic biopsy and 17 cases of normal volunteer were quantitatively assessed on a per sextant (region) by MRS. The locations of prostate cancer were marked by the surgeon and enrolled in a region. The corresponding ratios of (Cho+Cre)/Cit were calculated on the basis of the MRS metabolic map. The diagnostic accuracy of MRS for prostate cancer was calculated. ResultsThe average ratios of (Cho+Cre)/Cit in the peripheral zone of normal prostate, cancerous and noncancerous regions were 0.42±0.19, 2.13±0.82 and 0.60±0.20, respectively. Taking the high limit of normal variance ( Ax-G +3SD) as diagnostic threshold, that is, the areas with (Cho+Cre)/Cit>0.99 be considered as prostate cancer, the diagnostic sensitivity, specificity and accuracy was 96.0%, 94.7% and 95.1%, respectively. Taking the previously reported criteria as diagnostic threshold, that is, the areas with (Cho+Cre)/Cit>0.86 be considered as prostate cancer, the diagnostic sensitivity, specificity and accuracy was 97.3%, 86.3% and 89.4%, respectively. There was no statistically difference between the sensitivity (χ 2=0.207, P =0.649), but there were statistically differences between the specificity (χ 2=4.563, P =0.005) and accuracy (χ 2=5.950, P =0.015). ConclusionThe ratio of (Cho+Cre)/Cit >0.99 is a preferable threshold to differentiate prostate cancer and noncancerous tissue.