MRS对可疑前列腺癌鉴别诊断价值的研究

Application value of MRS in the differential diagnosis of prostate cancer

目的探讨3.0T三维磁共振波谱成像(MRS)影像学检查对可疑前列腺癌患者鉴别诊断的价值。方法收集2013年1月至2014年4月在本院就诊怀疑前列腺癌并行MRI及MRS检查患者的临床资料,根据病理结果分为前列腺癌(Pca)组、前列腺增生(BHP)组。观察两组患者MRS参数胆碱(Choline,Cho)+肌酸(Creatine,Cre)/枸橼酸盐(Citrate,Cit)值(CC/C),并与病理Gleason评分(G)对照;评估MRS对Pca诊断效能,分析CC/C值与病理分级的关系。结果 32例Pca的CC/C平均值为2.52±1.42,而52例BHP的为0.70±0.77(P<0.01),MRS对前列腺癌诊断效率:灵敏度87.5%、特异度86.3%、阳性预测值80%、阴性预测值91.6%;G≤7患者CC/C平均值为1.81±1.09,G>7患者为3.38±0.98(P<0.01)。结论 MRS的应用有助于对可疑前列腺癌患者进行鉴别诊断,且其参数对前列腺癌病理分级有参考意义。

Objective To evaluate the application value of MRS in differential diagnosis of primary benign and malignant prostate lesions. Methods A total of 83 suspected cases of prostate cancer diagnosed by PSA, DRE or ultrasound underwent MRS examination, then the choline ＋ creatine / citrate （CC/C） was calculated. Following MRS the patients were submitted to 13-core biopsy or TURP. After matching the histopathologic findings with MRS, the parameters of MRS between the benign prostatic hyperplasia （BPH） and prostatic cancer （Pca） were compared. Results The prostate cancer sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 86. 3%~, 80%, and 91.6%. The CC/C value of cancer was 2.52±1.42, which was higher than that of BPH （0.70±0.77）. For Pca patients with Gleason score〉7, the CC/C was 3.38±0.9, while for patients with Gleason score ≤7, the CC/C was 1.81±1.09. Conclusion MRS can differentially diag- nose suspected prostate lesions. The CC/C value has close relationship with the Gleason score.