MR对前列腺癌的定性诊断价值分析

Value of MR in differential diagnosis of prostate carcinoma

目的评价MR对前列腺癌的定性诊断价值。方法回顾性分析了1992年5月-2004年9月,所有在我院行前列腺MR检查的374例以定性诊断为目的并获得最终诊断结果患者的资料。因MR设备和扫描技术的不同,以2002年8月为界,分为两个时间段,比较前后两个阶段患者接受MR检查时的临床情况和MR定性诊断效能。结果①临床情况:前后两个时间段比较,患者的年龄差异不具有显著性(P>0.05)。就诊原因中,第二阶段有良性前列腺增生(BPH)症状和其他相关症状患者所占比例增加,但差异不具有显著性(P>0.05),前后两阶段血清平均前列腺特异性抗原(PSA)浓度值的差异也不具有显著性(P>0.05),但第二阶段因发现血清PSA浓度升高和前列腺结节行MR检查患者所占比例明显减少,差异具有显著性(P<0.05);②MR定性诊断效能:第二阶段与第一阶段比较,MR诊断准确性和阴性预测值升高,差异具有显著性(P<0.05);敏感性和特异性升高,阳性预测值下降,差异不具有显著性(P>0.05)。结论随着MR新技术的出现,MR诊断前列腺癌的准确性和阴性预测值升高,随着越来越多的早期前列腺癌和非前列腺癌患者接受MR检查,MR对前列腺癌定性诊断的阳性预测值略有降低。

Objective To assess the value of MR in differential diagnosis of the prostate cancer. Methods The clinical data and prostate MR imaging of 374 patients in past twelve years were analyzed retrospectively. Their referred purpose of MR examination was to differentiate the lesion in the prostate gland. With the dividing line of August 2002, they were divided into two groups （early period group and late period group） according to the different MR scanner and scan technique. Their clinical data and efficiency of MR in the differential diagnosis were compared. Results ① Clinical situation： there were 139 patients in the early period group and 235 in the late period group. Their ages and the proportion of patients with symptoms of benign prostate hyperplasia （BPH） ,suspect of metastasis or others was not statistically significant（P〉0. 05）. The average level of serum prostate specific antigen （PSA） （[-22.66±20.32] ng/ml of early period group vs [-19.49± 19.56] ng/ml of late period group） was not statistically significant （P〉0.05）, whereas the proportion of patients with elevated PSA and abnormal prostate evaluation on digital rectal examination or on ultrasound dropped, and the difference between the two groups was statistically significant （P〈0. 05）. ②The efficiency of differential diagnosis of MR： the qualification of sensitivity, specificity, accuracy, positive and negative predicating value were 64. 0%, 82.0%, 70.5%, 86.4% and 56.2% in the early period group and were 69. 6%, 88.0%, 80%, 81.6% and 79. 1% in the late period group, respectively. The difference of accuracy and negative predicating value between the two groups was statistically significant （P〈0.05）, whereas the difference of sensitivity, specificity and positive predicating value was not statistically significant （P〉0. 05）. Conclusion With the application of new techniques of MR, the qualification of accuracy and negative predicating value of MR in differential diagnosis is elevated. At the same time, as the number of patients with early prostate carcinoma or non-tumoral lesion in prostate gland increasing, the qualification of positive predicating value drops slightly.