前列腺上皮内瘤的三维磁共振波谱成像特点的初步研究

Characterristics of Three-Dimensional Magnetic Resonance Spectroscopy of Prostatic Intraepithelial Neoplasia

目的:探讨并评价三维磁共振波谱成像(3D MRSI)在前列腺内皮瘤(PIN)中的成像特点。方法:对38例前列腺特异性抗原(PSA)升高疑为前列腺癌的患者行MRI+3D MRSI检查,再经直肠彩色多普勒超声引导定位下对可疑位点穿刺行病理检查,另外收集20例同时期良性前列腺增生患者的MRI及MRS资料,回顾性分析前列腺病变部位、常规MRI特征、MRS检查结果,计算(胆碱+肌酸)/枸橼酸盐(CC/C)。采用重复测量方差分析比较良性前列腺增生(BPH)组、前列腺癌(PCa)组、低级别PIN(LG PIN)及高级别PIN(HG PIN)的CC/C差异。结果:20例BPH组患者CC/C值为0.62±0.21;7例LG PIN的CC/C为0.76±0.22,两组患者无明显统计学差异;11例HG PIN患者的T2WI患者外周带有明显或可疑低信号区,3D MRSI示枸橼酸盐峰值稍下降,胆碱峰变化不明显,CC/C值为1.72±0.49;20例PCa患者的T2WI的外周带明显低信号区,3DMRSI示枸橼酸盐峰值几乎均下降明显,胆碱峰升高,CC/C值3.49±1.64,LG PIN组与HG PIN及PCa组差异有统计学意义,与BPH组差异无统计学意义,HG PIN的CC/C值与其它各组的值差异有统计学意义(F=95,P<0.05);结论:LG PIN的3D MRSI表现类似于良性前列腺增生,而HG PIN的3D MRSI改变则更接近于前列腺癌。

Objective： To investigate and evaluate the features in three-dimensional magnetic resonance spectroscopy imaging（3D MRSI） in prostatic intraepithelial neoplasia（PIN）.Methods： A total of 38 patients with higher level of prostate specific antigen（PSA） suspected of prostate cancer（PCa） were examined by MRI＋3D MRSI,and then all proved by pathology of biopsy under TRUS.Another 20 patients with benign prostatic hyperplasia（BPH） in the same period were set as control group.The data of prostate lesions,conventional MRI characteristics,3D MRSI results were analyzed retrospectively,and the ratio of CC/C（CC/C=[choline＋creatine]/citrate） was calculated.The repeated analysis of variance measures was adopted to compare the difference among BPH group,PCa group,low grade PIN group（LG PIN） and high grade PIN group（HG PIN）.Results： The CC/C value was 0.62±0.21 and 0.76±0.22 respectively in BPH group and LG PIN group,and no significant difference was found between the two groups.While the CC/C value of HG PIN group was 1.72±0.49,which was significant different from that of Pca group（1.49±1.64） and other groups（all P0.05）.Conclusion： The 3D MRSI performance of LG PIN is similar to that of benign prostatic hyperplasia while that of HG PIN is even close to prostate cancer＇s.