超高b值扩散加权成像及体素内不相干运动成像用于前列腺癌诊断

Ultra-high b value diffusion-weighted imaging and intravoxel incoherent motion imaging in diagnosis of prostatic neoplasms

目的观察超高b值扩散加权成像(DWI)及体素内不相干运动(IVIM)成像鉴别诊断前列腺癌(PCa)与前列腺增生(BPH)及预测PCa病理分级的价值。方法收集55例接受前列腺IVIM-DWI(b=0、50、100、150、200、400、600、800、1000、1500、2000 s/mm^2)并经病理确诊为PCa(PCa组)或BPH(BPH组)患者,根据病理分级结果将PCa组分为低分亚组与高分亚组,比较组间及亚组间ADC值、D值、D^*值及f值差异,对差异有意义的参数绘制鉴别诊断PCa与BPH及预测PCa病理分级的ROC曲线,评估其诊断效能;分析PCa组各参数与Gleason评分的相关性。结果共纳入44例,PCa组24例,BPH组20例,组间ADC值、D值差异均有统计学意义(t=-14.24、-10.87,P均<0.01),而ADC值(0.99)及D值(0.98)鉴别诊断PCa与BPH的AUC差异无统计学意义(Z=1.18,P=0.24)。PCa组内低、高分亚组的ADC值及D值差异均有统计学意义(t=2.28、3.86,P均<0.05),ADC值(0.76)及D值(0.88)预测PCa病理分级的AUC差异亦均有统计学意义(Z=2.23,P=0.02);PCa组ADC值(r=-0.44)及D值(r=-0.56)与Gleason评分均呈负相关(P均<0.05)。结论超高b值DWI与IVIM成像对PCa有一定应用价值。ADC值与D值鉴别诊断PCa与BPH的效能相当,而D值预测PCa病理级别的效能高于ADC值。

Objective To investigate the value of ultra-high b value diffusion-weighted imaging(DWI)and intravoxel irrelevant motion(IVIM)imaging in differential diagnosis of prostate cancer(PCa)and benign prostate hyperplasia(BPH)and predicting pathological grade of PCa.Methods Totally 55 patients who underwent prostate IVIM-DWI(b=0,50,100,150,200,400,600,800,1000,1500,2000 s/mm^2)and were pathologically confirmed as PCa(PCa group)or BPH(BPH group)were collected.Patients in PCa group were divided into low score subgroup or high score subgroup according to the pathological grading.The differences of ADC value,D value,D^*value and f value were compared between PCa and BPH groups as well as low score subgroup and high score subgroup.ROC curve for differential diagnosis of PCa and BPH and predicting PCa pathological grading were drawn to evaluate the diagnostic efficacy of the indexes significantly different between PCa and BPH or low and high score subgroups of PCa,and the correlation between parameters and Gleason scores in PCa group were analyzed.Results A total of 44 patients were enrolled,including 24 cases in PCa group and 20 in BPH group.ADC value and D value were statistically different(t=-14.24,-10.87,both P<0.01),while AUC of ADC value(0.99)and D value(0.98)for differentiating PCa and BPH were not between 2 groups(Z=1.18,P=0.24).In PCa group,ADC value and D value were statistically different(t=2.28,3.86,both P<0.05),and AUC of ADC value(0.76)and D value(0.88)for predicting pathological grading of PCa were also statistically different between 2 subgroups(Z=2.23,P=0.02).ADC value(r=-0.44)and D value(r=-0.56)were both negatively correlated with Gleason score(both P<0.05)in PCa gruop.Conclusion Ultra-high b value DWI and IVIM imaging had certain application value in PCa.For differential diagnosis of PCa and BPH,the efficiency of ADC value was comparable to that of D value,while for predicting pathological grading of PCa,the efficiency of D value was better than that of ADC value.