T2 WI、DWI和动态增强MRI联合应用对前列腺中央腺体癌诊断的价值

Preliminary study of combining T2-weighted imaging, diffusion weighted imaging and dynamic contrast enhanced-magnetic resonance imaging for diagnosing prostatic central gland cancer

目的：以病理结果为金标准，探讨T2 WI、DWI和DCE-MRI三种技术单独及联合应用对前列腺中央腺体癌（ CGPCa）的诊断价值。方法回顾性分析宁夏医科大学总医院2009年1月至2012年12月经病理证实的42例CGPCa 和42例良性前列腺增生症（ BPH ）患者的T2 WI、DWI和DCE-MRI资料，通过诊断试验方法计算每种技术单独及联合应用诊断CGPCa的敏感性、特异性，根据kappa值判断MRI诊断结果和病理结果的一致性，采用ROC曲线下面积（AZ）比较不同方法的诊断效能。结果 T2 WI 诊断 CGPCa 的敏感性、特异性、AZ 和 kappa 值分别为66.7％、76.2％、0.714和0.429；DWI为78.6％、81.0％、0.798和0.595；DCE-MRI为83.3％、61.9％、0.726和0.452。 DWI诊断CGPCa的AZ优于T2WI，差异有统计学意义（P＜0.05），与DCE-MRI相比差异无统计学意义（P＞0.05）。 T2 WI、DWI 和 DCE-MRI 三者联合诊断 CGPCa 的敏感性、特异性、AZ 和 kappa 值分别为90.5％、88.1％、0.893和0.786，诊断效能（ AZ ）均优于每种技术的单独应用，差异均有统计学意义（均P＜0.05）。结论 DWI独立诊断CGPCa效能优于T2 WI；将T2 WI、DWI和DCE-MRI三者联合应用能显著提高诊断效能，且诊断结果与病理分析一致性较好。

Objective To explore the value of combining T2-weighted imaging （ T2 WI ） , diffusion weighted imaging （ DWI ） and dynamic contrast enhanced-magnetic resonance imaging （ DCE-MRI ） for qualitatively diagnosing central gland prostate cancer （CGPCa） as a gold standard with pathologic findings.Methods A total of 42 cases with CGPCa and 42 cases with benign prostate hyperplasia （ BPH） proved by pathology were followed up with T2 WI, DWI and DCE-MRI examinations retrospectively.The diagnosis sensitivity and specificity by T2 WI, DWI, DCE-MRI alone and combination were calculated respectively.And the consistency of MRI diagnosis and pathological results was judged by Kappa value and the diagnostic value of each method evaluated by Az of receiver operating characteristic curve.Results While using T2 WI alone, the diagnostic sensitivity, specificity, Az and Kappa value was 66.7%, 76.2%, 0.714 and 0.429;DWI 78.6%, 81.0%, 0.798 and 0.595;DCE-MRI 83.3%, 61.9%, 0.726 and 0.452, Az between DWI and T2 WI was statistically significant （ P〈0.05 ） while DCE-MRI insignificant （ P〉0.05 ）.When combining T2WI ＋DWI ＋DCE-MRI, the diagnostic sensitivity, specificity, Az and Kappa value was 90.5%, 88.1%, 0.893 and 0.786, Az between T2 WI＋DWI＋DCE-MRI and T2 WI, DWI and DCE-MRI was statistically significant respectively （ all P〈0.05 ）.Conclusion DWI is better than T2 WI for diagnosing CGPCa.Combining T2 WI＋DWI＋DCE-MRI can obviously improve the diagnostic accuracy of CGPCa.And it has excellent consistency with pathological analysis.