中央腺前列腺癌表观扩散系数与Gleason评分的相关性

Correlative Study of ADC Value and Gleason Score in Central Gland Prostate Carcinoma

目的研究中央腺前列腺癌灶和膀胱内尿液表观扩散系数比值(rADC)与Gleason评分的关系,评价ADC值在中央腺前列腺癌Gleason分级中的诊断价值。资料与方法使用1.5 T MR扫描仪对69例经根治术或穿刺活检病理证实的前列腺癌患者进行扩散加权成像(DWI)检查,b值取0和800 s/mm2,分别测量中央腺癌灶和膀胱内尿液相对ADC值,计算中央腺前列腺癌的rADC;根据病理结果将中央腺前列腺癌分为Gleason 3+3,3+4,4+3,≥4+4四组,将各组中央腺前列腺癌rADC与Gleason评分进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验中央腺前列腺癌rADC与Gleason评分的相关性。将中央腺前列腺癌Gleason评分≤7与Gleason评分≥8两组之间分别进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值点。结果中央腺前列腺癌Gleason评分3+3组与其余各组间rADC差异均有统计学意义(P<0.05),3+4,4+3、≥4+4各组间rADC差异无统计学意义(P>0.05)。中央腺前列腺癌rADC与Gleason评分呈负相关(相关系数r=-0.58,P<0.01;),Gleason评分越高,rADC越小。以rADC值0.225作为阈值,鉴别低中危组与高危组中央腺前列腺癌的敏感度和特异度分别为71.4%和85%。结论中央腺前列腺癌ADC值与Gleason评分有一定相关性,有助于中央腺前列腺癌临床危险度的分级判定。

Objective To study the ratio of ADC value（rADC）of prostate carcinoma and urine in bladder in relation to the Gleason histological grading,and to investigate the predictive value of ADC value in grading of prostate carcinoma.Materials and Methods69 patients with the central gland prostate carcinoma proved by ultrasound guided systemic biopsy or radical prostatectomy underwent MR scan with b value of 0 and 800 s/ mm2.The ADC value and ratio of the central gland prostate carcinoma and urine in bladder were measured.The central gland prostate cancer were classified into Gleason 3＋3,3＋4,4＋3,≥4＋4,four group,according to the result of pathology.The rADC of the central gland and the four groups Gleason score were analyzed by one way ANOVA,every two groups was compared.Person correlative analysis test of the rADC of the central gland prostate cancer and Gleason score was used.ROC curve between Gleason≤7 and Gleason≥8 of the central gland prostate cancer was used.ResultsThere was a significant difference between Gleason 3＋3 and the other groups,but the rest of the differences were not statistically significant.A significant negative correlation was found between rADC and the Gleason scores in central gland（coefficient of correlation r=-0.58,P0.01）,the higher the Gleason score was,the smaller the ratio was.The sensitivity of differentiating the medium and high grade cancer was 71.4 %,and the specificity was 85 %,with the cutoff point 0.225 in central gland.ConclusionThere is a significant negative correlation between the ratio of ADC of the central gland prostate carcinoma and Gleason scores,ADC value is helpful for prediction of the central gland prostate carcinoma grade.