前列腺癌与前列腺增生的影像学诊断研究

Imaging diagnosis of prostatic hyperplasia and prostate cancer

目的探讨提高前列腺癌和前列腺增生患者的MRI诊断正确率的方法。方法回顾性分析2013年7月至2016年3月由于前列腺特异性抗原(PSA)升高明显在我院行前列腺MRI扫描后经活检证实为前列腺增生或前列腺癌的患者87例,2名医师分别通过新版前列腺报告和数据系统(PI-RADS V2)评分、常规T2WI+DWI/ADC+DCE-MRI+MRS综合判定和PI-RADS V2+MRS 3种方法进行诊断,对照病理结果,比较2名医师诊断的一致性,比较3种方式的敏感性、准确性、特异性,并将PI-RADS V2评分与病理Gleason评分做相关性分析。结果 2位医师诊断一致性分析:PI-RADS V2评分K值为0.951;通过常规T2WI+DWI/ADC+DCE-MRI+MRS传统方式评分K值为0.838;PI-RADS V2+MRSI评分K值为0.937;相关性结果分析,结果 r=0.871,P=0.001 4;PI-RADS V2评分诊断的敏感性、特异性及准确性分别为77.3%、74.4%、75.9%;常规T2WI+DWI/ADC+DCE-MRI+MRS诊断的敏感性、特异性及准确性分别为88.6%、76.7%、82.8%;PI-RADS V2+MRSI评分诊断的敏感性、特异性及准确性分别为86.4%、81.4%、83.9%。结论相对于传统诊断方式,新版前列腺报告和数据系统与MRSI结合能提高前列腺癌和前列腺增生的诊断正确率,病灶描述更加客观,移行区的低信号良性增生结节应通过多种影像参数综合进行判断。

Objective To explore the methods of improving diagnosis correctness between the patients with prostate cancer and benign prostatic hyperplasia. Methods Totally 87 patients with benign prostatic hyperplasia or prostate cancer which confirmed by MRI and prostate biopsy for the PSA significantly increased in our hospital from July 2013 to March 2016 were collected. By using the three methods of the PI- RADS V2 score ,the T2WI ＋ DWI/ADC ＋ DCE-MRI ＋ MRS and PI-RADS V2 score ＋ MRS to diagnose,and comparing with the pathology results, the diagnostic consistency of the two physicians were analyzed. The sensitivity, accuracy and specificity of three ways were compared, and the correlation between PI-RADS V2 score and Gleason score were calculated. Results The diagnostic consistency of the two physi- cians ： PI-RADS V2 score, K = 0.951 ;T2WI ＋ DWI/ADC ＋ DCE-MRI ＋ MRS score, K = 0. 838 ; PI-RADS V2 ＋ MRSI score, K = 0. 937. The correlation between PI-RADS V2 score and Gleason score,r = 0.871 ,P = 0. 001 4 ;diagnostic sensitivity, specificity and accuracy of PI-RADS V2 score were 77.3% ,74.4% ,75.9% ; diagnostic sensitivity, specificity and accuracy of T2WI ＋ DWI/ADC ＋ DCE-MRI ＋ MRS were 88. 6% , 76.7% , 82.8% ; diagnostic sensitivity, specificity and accuracy of PI-RADS V2 ＋ MRSI score were 86.4% ,81.4% , 83.9% , respectively. Conclusion Compared with the traditional diagnostic methods,the combination of new prostate report and data system and MRSI can improve the diagnostic accuracy of prostate cancer and benign prostatic hyperplasia. The PI-RADS V2 score is more objective and accurate in the description of the lesion ,but the low signal of benign hyperplastic nodules in transitional zone should be dialogued carefully through a variety of image parameters.