多参数MRI影像特征联合PSAD检测对前列腺移行区良恶性病变的诊断效果探究

Diagnostic effect of multi parameter MRI image features combined with PSAD detection in benign and malignant lesions of prostate transitional zone

目的探讨分析多参数MRI影像特征联合前列腺特异性抗原密度(PSAD)检测对前列腺移行区良恶性病变的诊断效果。方法选取2014年3月至2017年3月在内蒙古医科大学附属医院经穿刺病理证实的移行区PCa患者56例、移行区BPH患者103例作为研究对象。对患者进行多参数MRI检查,并采用PI-RADS评分系统进行诊断分析,检测患者血清前列腺特异性抗原(PSA)含量,经直肠超声测量前列腺癌体积以及移行区体积,计算PSAD值,比较分析多参数MRI以及PSAD对前列腺移行区良恶性病变的诊断价值。结果 PCa患者中T2WI图像凸透镜状、不规则性、信号不均匀、边界不清晰、无包膜检出率明显高于BPH患者,差异具有统计学意义(P<0.05);PCa患者DWI高信号/稍高信号检出率明显高于BPH患者,差异具有统计学意义(P<0.05),而PCa患者ADC值明显低于BPH患者,差异具有统计学意义(P<0.05);PCa患者DCE图像主要以II型曲线、III型曲线为主,而BPH患者DCE图像主要为II型曲线,差异具有统计学意义(P<0.05)。PCa组患者多参数MRI综合评分以及PSAD均显著高于BPH组,差异具有统计学意义(P<0.05)。多参数MRI与PSAD联合检测对移行区PCa患者的诊断灵敏度、特异度以及准确度均高于两者单独检测。多参数MRI对PCa诊断曲线下面积为0.787,PSAD对PCa患者诊断曲线下面积为0.707,两者联合对PCa患者诊断曲线下面积为0.929。结论多参数MRI与PSAD联合运用,可有效提高对前列腺良恶性病变患者的诊断鉴别效能,值得临床推广。

Objective To investigate the diagnostic value of multi parameter Magnetic Resonance Imaging ( MRI) image features combined with prostate-specific antigen density (PSAD) in benign and malignant lesions of the prostate transitional zone. Methods 56 patients with transitional region of PCa and 103 patients with transitional re-gion of BPH confirmed in The Affiliated Hospital of Inner Mongolia Medical University from March 2014 to March 2017 were selected. Multi parameter MRI examination was performed on all patients and PI-RADS score system was adopted for diagnosis and analysis. The serum prostate specific antigen (PSA) content was detected, and the volume of pros-tate cancer and transitional zone was measured by transrectal ultrasound andPSAD calculation was conducted. The di-agnostic value of multi parameter MRI and PSAD in prostate transitional zone of benign and malignant lesions was comparatively analyzed. Results In patients with PCa, the detection rate of T2WI image with lenticular and irregular shape, inhomogeneous signal, unclear boundary and no envelope was significantly higher than that in patients with BPH, with statistically significant differences ( P <0. 05). The detection rate of DWI with high signal or slightly high signal in patients with PCa was significantly higher than that in patients with BPH, with statistically significant differ-ence ( P < 0. 05 ). The ADC value of patients with PCawas significantly lower than that of patients withBPH, with sta-tistically significant difference(P <0. 05). The DCEimage of patients with PCa was mainly Ⅱ curve and Ⅲ curve, and that of patients with BPH was mainly Ⅱ curve ( P < 0. 05 ). The multi parameter MRI scores and PSAD value in pa-tients withPCa were significantly higher than those in patients with BPH, all with statistically significant differences (P <0. 05). The sensitivity, specificity and accuracy of combined detection of multi parameter MRI and PSAD in patients with PCawere higher than those of the two methods alone. The area under the PCa diagnostic curve of multi parameter MRI was 0.787, and that of PSAD was 0.707, while the area under thePCa diagnostic curve of the combination of multi parameter MRI and PSAD was 0.929. Conclusions The combination of multi parameter MRI and PSAD can effectively improve the efficacy of differential diagnosis of benign and malignant prostatic lesions, which is worthy of clinical promotion.