多参数磁共振成像对前列腺癌包膜外侵犯的诊断价值

Evaluation of Extracapsular Extension in Prostate Cancer Using Multiparametric MRI

目的探讨多参数磁共振成像(mpMRI)对前列腺癌包膜外侵犯(ECE)的诊断价值。方法搜集2015年6月至2017年9月本院经手术根除病理学证实、且行3.0T MRI检查的49例前列腺癌患者。所有患者均行T_1WI、T_2WI、扩散加权成像(DWI)和动态对比增强磁共振成像(DCE-MRI)检查,由2名放射科医师基于第2版前列腺影像报告和数据系统(PI-RADS V2)对所有图像进行分析并与病理结果对比。采用Kappa一致性检验评价mpMRI诊断前列腺癌ECE与病理结果的一致性。以病理结果为金标准,采用诊断实验方法分别计算T_2WI、DWI、DCE、T_2WI+DWI、T_2WI+DCE及T_2WI+DWI+DCE诊断前列腺癌ECE的敏感度、特异度、准确率。采用配对卡方检验比较不同参数及其组合诊断前列腺癌ECE的准确率。结果 T_2WI、DWI、DCE、T_2WI+DWI、T_2WI+DCE及T_2WI+DWI+DCE对前列腺癌ECE诊断的准确率分别为71.4%、67.3%、65.3%、83.7%、81.6%和91.8%。T_2WI+DWI+DCE诊断前列腺癌ECE的准确率均高于单独T_2WI、DWI、DCE-MRI,差异均有统计学意义(P<0.05)。mpMRI诊断前列腺癌ECE与病理诊断前列腺癌ECE的一致性好,Kappa=0.772。结论 3.0 T MR T_2WI+DWI+DCE可提高对前列腺癌ECE诊断的准确率,对前列腺癌ECE有较高的诊断价值,为前列腺癌术前临床分期提供了重要的诊断依据。

Objective To investigate the value of multiparametric magnetic resonance imaging(mpMRI) for extracapsular extension(ECE) in prostate cancer(PCa). Methods From June 2015 to September 2017,49 patients who underwent radical prostatectomy and preoperative mpMRI(T1WI,T2WI,DWI,DCE-MRI) for prostate cancer were enrolled retro-spectively. The MRI findings were analyzed by two radiologists based on the Prostate Imaging Reporting and Data System( PI-RADS V2) and compared with the pathologic findings in each patient. Kappa test was used to compare the diagnostic results of MRI with that at the histopathological analysis. The sensitivity,specificity,and accuracy of each sequence in the detection of extracapsular extension in prostate cancer were calculated with the histopathological results as the standard reference. The accuracy of evaluation of ECE in prostate cancer was compared among different parameters and their combinations using Paired chi-square test. Results For detecting ECE,The accuracies of different parameters and their combinations( T2 WI,DWI,DCE,T2 WI + DWI,T2 WI + DCE,T2 WI + DWI + DCE) were 71. 4%、67. 3%、65. 3%、83. 7%、81. 6%and 91. 8% respectively. The accuracy of T2 WI + DWI + DCE was the statistically better than that of T2 WI,DWI,DCE alone( P < 0. 05). The MRI findings were highly consistent with the histopathological findings( Kappa = 0. 772). Conclusion The combination of T2 WI,DWI and DCE-MRI can improve the accuracy of the detection of ECE in prostate cancer,which was of high diagnostic value for ECE in prostate cancer and provides an important diagnostic basis for preoperative clinical staging of prostate cancer.