多参数MRI影像特征诊断前列腺移行区良恶性病变的影响因素分析

Multi-parametric magnetic resonance imaging in diagnosis of transition zone benign and malignant prostatic lesions

目的探讨多参数MRI(T_2WI、DWI、动态增强)影像特征诊断前列腺移行区良恶性病变的影响因素。方法回顾性分析经病理证实的移行区前列腺癌(PCa)48例、前列腺增生(BPH)83例患者的临床资料,纳入T_2WI病灶形态、信号均匀度、边界、包膜、患侧移行区体积、患侧移行区与外周带的分界、前列腺包膜、DWI信号强度、ADC值及动态增强的曲线类型等10种影像特征,分析影响前列腺移行区良恶性病变的因素。结果 48例移行区PCa纳入81个癌灶,83例BPH筛选出142个结节;移行区PCa的ADC值为(0.938±0.223)×10^(-3)mm^2/s,明显低于移行区BPH的(1.195±0.194)×10^(-3)mm^2/s,差异有统计学意义(P<0.05)。单因素分析显示,患侧移行区体积与移行区PCa诊断未见相关(P>0.05),其余9种影像特征均与移行区PCa诊断明显相关(均P<0.05)。将差异有统计学意义的9种影像特征纳入多因素logistic回归分析,共筛选出T_2WI病灶形态、信号均匀度、边界、患侧移行区与外周带分界、DWI的信号强度及ADC值与移行区PCa诊断均呈明显相关性(均P<0.05),其中ADC值与移行区PCa诊断呈负相关,其余影像特征与移行区PCa诊断均呈正相关。结论多参数MRI上,T2WI病灶形态、信号均匀度、边界、患侧移行区与外周带分界、DWI信号及ADC值是影响移行区PCa诊断的危险因素。

Objective To investigate the application of multi-parametric magnetic resonance imaging（Mp-MRI） in diagnosis of transition zone benign and malignant prostatic lesions. Methods The imaging data of 48 patients with transition zone prostate cancer（PCa）and 83 patients with benign prostatic hyperplasia（BPH） confirmed by pathology who underwent Mp-MRI were retrospectively analyzed. The correlation of 10 imaging parameters with diagnosis of transition zone benign and malignant lesions was analyzes, the parameters including the shape of lesions, signal intensity, signal uniformity, margin of lesion, boundary of transition zone and peripheral zone, prostatic capsule on T_2WI, the type of time-signal intensity on dynamic contrast enhanced（DCE）, signal intensity and ADC value on DWI. Results There were81 lesions in 43 cases of transition zone PCa and 142 nodules in 83 cases of BPH. ADC values of transition zone PCa and BPH were（0.938±0.223） ×10^-3mm^2/s,（1.195 ±0.194） ×10^-3）mm2/s, respectively（P〈0.05）. The univariate analysis showed that among 10 parameters, 9 were significantly associated with diagnosis of transition zone PCa（P〈0.05）, except the volume of transition zone（P〈0.05）. Multivariate logistic regression showed that the shape of lesions, intensity uniformity, margin of lesion, boundary of transition zone and peripheral zone, signal intensity were positively correlated, and ADC value on DWI was negatively correlated with diagnosis of transition zone PCa（P〈0.05）.Conclusion The shape of lesions, intensity uniformity, margin of lesion, boundary of transition zone and peripheral zone on T_2WI, signal intensity and ADC value on DWI are associated with the diagnosis of transition zone PCa on Mp-MRI.