MR扩散加权成像在前列腺病变中的诊断价值

Diffusion-weighted imaging in diagnosis of prostatic diseases

目的:探讨DWI在前列腺病变诊断中的价值。方法:分别对30例前列腺癌(PCa)、30例良性前列腺增生(BPH)患者和30名健康志愿者进行前列腺DWI扫描,分析三者的DWI图、ADC图的信号表现,以及癌灶、增生结节灶、正常前列腺的ADC值,以及前两者病灶ADC值与其周围正常外周带ADC值的相对比值变化规律。所有BPH和PCa病例均经手术或穿刺活检病理证实。结果:①PCa、BPH患者和健康志愿者(各30例)DWI表现:PCa表现为高信号影为主;增生结节呈稍高信号为主,强度低于外周带,并且信号不均匀;健康志愿者外周带呈稍高信号为主,中央带呈等信号为主,外周带信号高于中央带,二者分界清晰;②PCa癌灶平均ADC值(0.878±0.056)×10-3mm2/s;BPH增生结节灶平均ADC值(1.379±0.201)×10-3mm2/s;健康者前列腺中央带平均ADC值(1.287±0.041)×10-3mm2/s;健康者前列腺外周带平均ADC值(1.636±0.064)×10-3mm2/s;③PCa癌灶、BPH增生结节灶(各30例)的平均ADC值与其周围正常外周带ADC值的相对比值平均分别为0.54±0.05,0.85±0.06。结论:正常前列腺外周带、BPH、正常前列腺中央带、PCa在DWI图像上信号有较大差别,PCa癌灶信号最高。正常前列腺外周带、BPH、正常前列腺中央带、PCa癌灶的ADC值依次下降。BPH、PCa癌灶ADC值与其周围正常外周带组织ADC值的相对比值有明显差别。ADC值≤0.97×10-3mm2/s,特别是同时ADC相对比值≤0.62,是PCa DWI诊断的可靠依据,有临床诊断意义。

Objective：To investigate the DWI appearance and the ADC diagnostic value of the normal prostate gland, benign prostatic hyperplasia （BPH） and prostatic carcinoma （Pca） .Methods：30 Pea, 30 BPH, and 30 healthy vohmteers were scanned with DWI. Their DWI and ADC characteristics were analyzed respectively and the diagnostic values of DWI and ADC were summarized. ALl the BPH and PCa received a histological diagnosis. Results： DWI appearance： Pea showed very high signal imensity, the signal intensity of BPH nodule was more non-homogeneous and lower than the peripheral zone. The central zone and peripheral zone of normal prostate were shown clearly, the signal intensity of peripheral zone was higher than central zone. The mean ADCs for the PCa focus, BPH nodules, and normal central gland, peripheral zone were （0.878±0.156）× 10^-3 mm^2s^-1, （1.379±0.201） × 10^-3 mm^2s^-1, （1.287±0.041） × 10^-3 mm^2s^-1, （1.636 ±0.064） × 10^-3 mm^2s^-1, respectively.Conclusion：The DWI appearance and ADCs for the PCa, BPH, and normal central gland, peripheral zone demonstrate a significant difference, which can be used in the diagnosis of the diseases of prostate. The ADC value≤0.97 × 10^-3 mm^2s^-1 and the ADC ratio≤0.62 probably would be used as a reliable diagnostic criteria.