盆腔多参数磁共振诊断模型在早期前列腺癌诊断中的应用研究

Application of pelvis multi-parameter MRI diagnostic model for the diagnosis of prostate cancer in early stage

目的 探讨盆腔多参数磁共振诊断模型在早期前列腺癌诊断中的有效性及临床价值.方法 收集2013年10月至2014年11月就诊的前列腺特异性抗原（PSA） ＜20 μg/L且行经直肠前列腺系统穿刺活检的260例患者的临床资料.年龄（68.4±9.1）岁,血清总前列腺特异性抗原（tPSA）为（7.98±4.66）μg/L,其中PSA ≥4 μg/L者211例.首先通过包括由T2加权像（T2 weighted imaging,T2WI）、弥散加权像（diffusion weighted imaging,DWI）以及整合上述两种扫描序列特征的盆腔磁共振诊断模型对研究对象罹患前列腺癌的可能性进行判断,再经前列腺系统穿刺活检加以验证.结果 本组260例中,107例通过经直肠穿刺活检确诊为前列腺癌,阳性率为41.2％,随T2WI、DWI及T2WI联合DWI诊断评分的递增,穿刺活检阳性率显著升高,依次为6.7％ ～65.6％、14.4％～60.7％、13.5％ ～ 55.9％,差异均有统计学意义（P＜0.05）.T2WI、DWI和T2WI联合DWI的诊断结果和病理结果对照后绘制受试者工作特征曲线,曲线下面积依次为0.651±0.034、0.744±0.031和0.728±0.031.以T2WI诊断1分作为参照,2～5分发生前列腺癌的风险依次为2.933、3.882、5.005、7.944倍.以DWI诊断1分作为参照,2～5分发生前列腺癌的风险依次为2.233、8.136、8.614、18.313倍.以T2WI联合DWI诊断1分作为参照,2～5分发生前列腺癌的风险依次为1.333、6.228、8.305、9.996倍.结论 盆腔多参数磁共振诊断模型能显著提高磁共振检查对早期前列腺癌的诊断效能,减少漏诊和过度诊断的发生率.

Objective To explore the effectiveness and clinical value of pelvic multi-parameter MRI diagnostic model in the diagnosis of prostate cancer in early stage.Methods the clinical data of 260 patients whose PSA 〈 20μ g/L were Collected from October 2013 to November 2014 in Beijing hospital.All the patients were first evaluated by MRI diagnostic model which consists of the imaging presentation from T2 weighted imaging （T2WI）, Diffusion weighted imaging （DWI） ,and the both together in order to acquire the likelihood of prostate cancer, and followed by systemic prostate biopsy in order to verify the diagnosis above.Results Among 260 patients, a total of 107 cases of patients were diagnosed prostate cancer via trans-rectal fine needle biopsy,the positive rate was 41.15%.the scores of T2W1,DWI and T2WI ＋ DWI significantly correlated with the rate of positive biopsy,from 6.7% to 65.6% , 14.4% to 60.7% and 13.5% to 55.9% respectively,P 〈 0.05.Receiver Operating Characteristic （ROC） curves were made based on the T2WI, DWI and T2WI ＋ DWI diagnostic model,whose Area Under Curve（AUC）s were 0.651 ± 0.034,0.744 ± 0.031 and 0.728 ± 0.031 respectively.To take the 1 score in the T2WI model as the baseline,from 2 score to 5 score, the risk of prostate cancer incidence was 2.933,3.882,5.005and 7.944 times respectively.To take the 1 score in the DWI model as the as the baseline,from 2 score to 5 score,the risk of prostate cancer incidence was 2.233,8.136,8.614 and 18.313 times respectively.In the T2WI ＋ DWI group,the risk of incidence was 1.333,6.228,8.305 and 9.996 times respectively based on the 1 score of the model itself.Conclusion This model has the capacity for enhancing the accuracy of diagnosis the prostate cancer in the early stage, which could reduce the incidence of misdiagnosis and over diagnosis at same time.