3T体线圈三维氢质子磁共振波谱在前列腺癌鉴别诊断中的价值

Value of 3D 1H-MRS with Body Coil at 3T in the Differential Diagnosis of the Prostate Cancer

目的:探讨3T体线圈三维氢质子磁共振波谱(3D 1H-MRS)在前列腺癌鉴别诊断中的应用价值。方法:对40例临床可疑前列腺癌患者先行3T核磁共振(MRI)和磁共振波谱(MRS)检查,再行直肠B超引导下前列腺穿刺活检获得病理诊断。与病理结果对照,分析良性前列腺增生、前列腺癌、癌前病变MRS代谢特点,评估其对外周带前列腺癌的诊断效能。结果:所有患者均成功完成检查。间质、腺体增生为主内腺、内腺癌灶、外周带癌灶、正常外周带及前列腺上皮内瘤(胆碱+肌酸)/枸橼酸比值分别为:0.75±0.23、0.59±0.14、1.79±0.90、1.18±0.95、0.46±0.18、0.97±0.10。内腺癌灶与增生内腺、外周带癌灶与正常外周带差异有统计学意义(P<0.01)。外周带前列腺癌最佳诊断阈值为0.68,灵敏度88.6%,特异度88.7%。结论:3T体线圈3D 1H-MRS在前列腺癌鉴别诊断中具有较好的敏感性与特异性,对癌前病变的诊断有一定的参考价值。

Objective： To assess the value of three dimensional proton magnetic resonance spectroscopy （3D 1 H-MRS） with body coil at 3T in the differential diagnosis of prostate cancer. Methods ： Forty patients suspected of prostate cancer underwent MRI and MRS examinations, and then transrectal ultrasound guided prostate biopsy for pathological diagnosis. The MRI and MRS features of benign prostate hyperplasia, prostate cancer and prostatic intraepithelial neoplasia （PIN） were analyzed in comparison with the pathological reports, and the receiver operating characteristic curve was drawn for the diagnosis of cancer from peripheral zones. Results ： The examinations were accomplished for all the patients. The mean ratios of （Cho ＋ Cre）/Cit in the interstitial and glandular hyperplasia tissues, the cancer tissue of the central and peripheral glands, the healthy peripheral gland and PIN were 0.75 ± 0.23, 0.59±0.14, 1.79 ± 0. 90, 1.18 ± 0.95, 0. 46 ± 0.18, and 0.97 ± 0.10, respectively, with statistically significant differences between the cancer and normal prostate tissues （P 〈 0.01 ）. The optimum threshold for the diagnosis of prostate cancer in the peripheral zone was 0.68 with a sensitivity of 88.6% and a specificity of 88.7%. Conclusion ： The 3D 1 H-MRS with body coil at 3T has a high sensitivity and specificity in the differential diagnosis of prostate cancer, and can provide valuable information for the diagnosis of PIN.