高b值DWI联合DCE-MRI对前列腺癌的诊断价值

Diagnostic value of DWI with ultrahigh b-value combined with DCE-MRI in prostate cancer

目的探讨高b值DWI联合DCE-MRI对前列腺癌的诊断价值。方法选择本院收治的疑似前列腺癌患者90例,入院前均行前列腺MRI检查,扫描方案包括高b值DWI和DCE序列模式,所采集影像资料分别对应本序列下的非癌性灶区和癌灶区作为勾画感兴趣区,分别测定ADC值及K_(trans)、K_(ep)值并进行比较。所有患者均行穿刺或手术病理检查,以此作为最终诊断结果,比较分析高b值DWI序列(83例)、DCE序列(77例)、DWI联合DCE序列(70例)对前列腺癌的诊断效能。结果 b值为2000 s/mm2测得前列腺癌与前列腺增生中央区ADC均值分别为1.02±0.67、2.01±0.57(P<0.05),移行区分别为1.14±0.72、2.07±0.64(P<0.05),外周区分别为1.56±0.36、2.88±0.44(P<0.001);癌灶和非癌灶区K_(trans)、K_(ep)测定结果差异均有显著性(K_(trans):χ~2=151.62,P<0.001;K_(ep):χ~2=146.19,P<0.001);两种方案联合诊断的准确率、敏感性、特异性(π=94.29%、Se=97.83%、Sp=87.50%)均优于高b值DWI(π=81.93%、Se=86.79%、Sp=73.33%)与DCE序列(π=87.01%、Se=91.84%、Sp=78.57%)单项诊断。结论与单一的高b值DWI或DCE-MRI相比,联合成像对前列腺癌具有更高的诊断效能。

Objective To explore the value of high b-value DWI combined with DCE-MRI in prostate cancer. Method A retrospective analysis was carried with 90 patients suspected with prostate cancer. MRI detection was done before confirmed pathology, including high b-value DWI and DCE sequences. The cancer and non-cancer area were marked as interested region, and the value of ADC and Ktrans,Kep were compared to analyze the diagnostic efficiency of different protocols in prostate cancer. Result The average ADC value of anatomical division at a level of b=2000 s/mm2 in prostate cancer and benign prostatic hyperplasia were： central zone（1.02±0.67, 2.01±0.57, P〉0.05）, transitional zone：（1.14±0.72, 2.07±0.64, P〈0.05）, peripheral zone：（1.56±0.36, 2.88±0.44, P〈0.001）; The Ktrans,Kep value was statistically significant（Ktrans： χ2=151.62, P〈0.001）; Kep： χ2 =146.19, P〈0.001） in cancer and non-cancer tissues; In addition, the accuracy, sensitivity and specificity of combined method were 94.29%, 97.83% and 87.50%, which were higher than just DWI-MRI at a high level of b-value（π=81.93%, Se= 86.79%, Sp=73.33%） or DCE-MRI（π=87.01%, Se=91.84%, Sp=78.57%）. Conclusion The ultrahigh b-value DWI-MRI combined DCE-MRI is more reliable for the diagnosis of prostate cancer.