3.0T多参数MRI对前列腺良恶性病变的诊断价值

Differential Diagnosis of Benign and Malignant Prostate Diseases Using 3.0T Multi-parametric MRI

目的前列腺良恶性病变在弥散加权成像(DWI)、磁共振波谱成像(MRS)及动态磁共振增强(DCE-MR)表现中存在部分重叠,多参数MR的联合应用具有重要诊断价值。本研究拟探讨多参数成像对前列腺良恶性病变的诊断价值及参数优选。资料与方法收集2012年12月-2014年9月于甘肃省人民医院就诊的前列腺特异性抗原(PSA)异常,且符合研究标准的59例患者。后根据手术或穿刺病理结果分别纳入前列腺癌组(29例)和非癌组(30例)。以3.0T MR行前列腺DWI、~1H-MRS及DCE-MRI扫描。测量表观扩散系数(ADC)、1H-MRS的CC/C、DCE-MRI参数容量转移常数(K^(trans))、速率常数(K_ep)、血管外细胞外容积分数(Ve)及初始曲线下面积(i AUC)值,并进行统计学分析。结果各参数ROC曲线分析显示,对前列腺癌的诊断效能由高到低依次为ADC(AUC=0.97)、K^(trans)(AUC=0.95)、i AUC(AUC=0.93)、CC/C(AUC=0.90)、K_(ep)(AUC=0.88)和V_e(AUC=0.79)。经Fisher判别分析,ADC、K^(trans)及CC/C被引入判别方程,经回顾性误判分析,其诊断敏感度为89.6%、特异度为100%。结论 DWI、1H-MRS及DCE-MR中以ADC诊断效能最高,K^(trans)次之。ADC、K^(trans)及CC/C多参数联合应用时诊断效能显著提高,以特异度尤为明显。

Purpose There are overlaps between benign and malignant prostate lesions on diffusion weighted imaging（DWI）, magnetic resonance spectroscopy（MRS） and dynamic contrast-enhanced magnetic resonance（DCE-MR）, thus combination of multi MR parameters is important for the correct diagnosis. The aim of this study is to evaluate the multi-parametric MRI techniques in the diagnosis of prostate diseases. Materials and Methods Fifty-nine patients with an abnormal prostate-specific antigen from December 2012 to September 2014 were enrolled in the study. All the patients were divided into cancer group（29 cases） and non-cancer group（30 cases） according to the pathology after surgery or biopsy. MRI including DWI, ^1H-MRS and DCE-MR was performed at 3.0T MR scanner. Apparent diffusion coefficient（ADC）,（choline＋Cre）/citrate（CC/C） from 1H-MRS, K^（trans）, K_（ep）, Ve and i AUC from DCE-MR was measured. Results The receiver operating characteristic curve showed that the diagnostic efficacy order from high to low was ADC（AUC=0.97）, K^（trans）（AUC=0.95）, i AUC（AUC=0.93）, CC/C（AUC=0.90）, K_（ep）（AUC=0.88） and V_e（AUC=0.79）, respectively. Fisher discriminant analysis with ADC, K^（trans） and CC/C introduced into the discriminant equations revealed sensitivity of 89.6% and specificity of 100%. Conclusion Among all of the parameters, ADC has the highest diagnostic efficiency and K^（trans） followed. The diagnostic efficiency would be improved significantly when combined multi MR parameters including ADC, K^（trans） and CC/C, especially for the specificity.