前列腺中央腺体癌的MRS和DWI定量诊断研究

Study on MRS and DWI Quantitative Diagnosis of Prostatic Central Gland Cancer

目的探讨(胆碱+肌酸)/枸橼酸盐(CC/C)值和表观扩散系数(ADC)值及联合应用两者对中央腺体癌的诊断效能。方法回顾性分析经病理证实的前列腺中央腺体癌27例,良性中央腺体病变62例,比较两者的平均CC/C值和ADC值(采用3种测量方法分别获得最小ADC值、平均ADC1和平均ADC2);通过判别分析计算平均CC/C值和ADC值诊断中央腺体癌时各自所占的权重;采用受试者工作特征曲线分析计算平均CC/C值、3种ADC值及联合CC/C值和ADC值对中央腺体癌的诊断效能。结果 (1)前列腺中央腺体癌组和良性中央腺体病变的平均CC/C值、最小ADC值、平均ADC1和平均ADC2比较差异均有统计学意义(t=3.582、-9.416、-9.716、-9.889,P<0.05);(2)3种ADC值诊断中央腺体癌的权重均高于平均CC/C值;(3)3种ADC值、分别联合平均CC/C值和3种ADC值诊断中央腺体癌的曲线下面积(AUC)显著高于平均CC/C值,差异均有统计学意义(P<0.05);3种ADC值、分别联合平均CC/C值和3种ADC值诊断中央腺体癌的AUC差异均无统计学意义(P>0.05);3种ADC值诊断中央腺体癌的AUC差异无统计学意义(P>0.05)。结论 DWI对中央腺体癌的诊断效能优于MRS;不同方法所测得的ADC值对中央腺体癌的诊断效能无差异;联合DWI和MRS对中央腺体良恶性病变的鉴别优于MRS。

Objective To evaluate the diagnostic efficacy of CC/C value, ADC value and the combination use of the two values in identifying the prostatic central gland cancer. Methods The clinical data and MRI materials of 27 cases with prostatic central gland cancer （malignant group ） and 56 cases with benign prostatic central gland lesion （benign group） were retrospectively analyzed. By using three measurement methods, the minimal ADC value, the average ADC1 value and the average ADC2 value were obtained. The average CC/C value and the ADC value were thus determined. The weights of the CC/C value and the ADC value in diagnosing prostatic central gland cancer were separately estimated. The diagnostic efficacy of the average CC/C value, the three kinds of ADC values and the combination use of the two parameters were evaluated by ROC analysis. Results （ 1 ） Statistically significant differences in the average CC/C value, the mini- mal ADC value, the average ADC1 and the average ADC2 existed between the malignant group and the benign group （ t = 3. 582, t = -9. 416, t = -9. 716 and t = -9. 889 respectively, P 〈0.05）. （2） The weights of the three ADC values in diagnosing prostatic central gland cancer were higher than that of the average CC/C value. （3） In diagnosing prostatic cen- tral gland cancer, the area under curve （AUC） of the three ADC values and the combination use of the average CC/C value with the three ADC values was higher than that of the average CC/C value alone, the difference was statistically significant （ P 〈 0.05 ） ; while in diagnosing prostatic central gland cancer the difference in AUC between the three ADC values and the combination use of the average CC/C value was not significant （ P 〉 0.05 ） ; in diagnosing prostatic central gland cancer the difference in AUC among the three ADC values was not significant （ P 〉 0.05 ）. Conclusion In diagnosing prostatic central gland cancer, DWI is superior to MRS; no significant difference in diagnosing prostatic central gland cancer exists between the different ADC values obtained by different methods. For the diagnosis of prostatic central gland cancer, combi- nation use of DWI and MRS is superior to MRS alone.