磁共振动态增强联合常规T2WI、扩散加权成像在前列腺癌诊断中的价值

Value of MR dynamic enhancement combined with conventional T2WI and diffusion weighted imaging in the diagnosis of prostate cancer

目的探讨T2WI、扩散加权成像(DWI)和磁共振动态增强扫描(DCE-MRI)联合应用在前列腺癌(PCa)诊断中的价值。方法选取2015年3月至2018年8月平湖市第一人民医院收治的50例PCa患者作为PCa组,选取同期54例良性前列腺增生(BPH)患者作为BPH组,进行横断面研究。两组患者均行MR常规扫描、DWI及DCE-MRI扫描,对比两组表观弥散系数(ADC)、指数化表观扩散系数(EADC)、峰值时间(Tmax)、峰值强度(SIpeak)、信号强化率(SER)、最大增强斜率(MSI)及时间-信号强度(TIC)曲线类型,并综合分析癌灶和非癌灶间差异。统计T2WI、DWI、DCE-MRI检查结果,对比3种方法单独及联合诊断PCa的诊断效能。结果PCa组ADC值低于BPH组,EADC值高于BPH组(P<0.05);PCa组Tmax值低于BPH组,SER、MSI值高于BPH组(P<0.05);PCa组Ⅲ型TIC曲线占比(64.00%)高于BPH组(14.81%),Ⅱ型TIC曲线占比(24.00%)低于BPH组(66.67%,P<0.05);常规T2WI序列诊断出癌灶32例,另有10例BPH患者外周带检出低信号;DWI检查检出癌灶34例,另有10例BPH患者中央腺区检出稍高信号结节,ADC信号稍低,6例增生外周带高信号斑片影;经DCE-MRI检查50例PCa患者中42例病灶区呈早期明显强化,并快速或缓慢下降,2例表现为低峰值强化下降型,2例外周病灶表现为上升型,4例表现为不典型图形,4例病灶不明确;54例BPH患者中,10例T2WI检出低信号区;16例DWI检出稍高信号结节,其中8例ADC呈稍低信号;46例呈早期明显强化并逐渐上升,或呈平台强化;8例中央增生结节出现早期明显强化,并早期下降;T2WI、DWI、DCE-MRI联合诊断PCa的灵敏度(96.00%)、准确度(92.31%)高于3种方法单独诊断(P<0.05)。结论T2WI、DWI、DCE-MRI联合检查能获得更全面病灶信息,显著提高PCa诊断灵敏度及准确度,利于减少漏诊。

Objective To explore the value of combined application of T2WI,diffusion weighted imaging(DWI)and magnetic resonance dynamic enhanced scanning(DCE-MRI)in the diagnosis of prostate cancer(PCa).Methods A total of 50 PCa patients received in the First People's Hospital of Pinghu from March 2015 to August 2018 were selected as the PCa group,54 patients with benign prostatic hyperplasia(BPH)in the same period were selected as the BPH group for a cross-sectional study.Both groups of patients underwent conventional MR scans.The apparent diffusion coefficient(ADC),exponential apparent diffusion coefficient(EADC),peak time(Tmax),peak intensity(SIpeak),signal enhancement rate(SER),maximum enhancement slope(MSI)and time signal intensity(TIC)curve types were compared between the two groups,and the differences between the cancerous and non cancerous foci were analyzed comprehensively.The results of T2WI,DWI and DCE-MRI were statistically analyzed,and the diagnostic efficacy of the three methods alone and combined in the diagnosis of PCA were compared.Results The ADC value of PCa group was lower than that of BPH group,and the EADC value was higher than that of BPH group(P<0.05);the Tmax value of the PCa group was lower than that of the BPH group,and the SER and MSI values were higher than those of the BPH group(P<0.05);the proportion of typeⅢTIC curves in the PCa group(64.00%)was higher than that in the BPH group(14.81%),and the proportion of typeⅡTIC curves(24.00%)was lower than in the BPH group(66.67%,P<0.05);Conventional T2WI sequence diagnosed 32 cases of cancer,and 10 cases of BPH patients detected low signal in peripheral zone;DWI detected 34 cases of cancer,and 10 cases of BPH patients detected slightly high signal nodules in central gland area,ADC signal was slightly low,and 6 cases of hyperplastic peripheral zone high signal patchy shadow;DCE-MRI showed early obvious enhancement in 42 cases of 50 cases of PCA patients,and decreased rapidly or slowly,and 2 cases showed low peak in 54 cases of BPH,10 cases of T2WI detected low signal area;16 cases of DWI detected slightly high signal nodules,of which 8 cases of ADC showed slightly low signal;46 cases showed early obvious enhancement and gradually increased,or showed platform enhancement;8 cases of central proliferative nodules showed early obvious enhancement and early enhancement.The sensitivity(96.00%)and accuracy(92.31%)of T2WI,DWI and DCE-MRI in the diagnosis of PCA were higher than those of the three methods alone(P<0.05).Conclusions T2WI,DWI,DCE-MRI combined examination can obtain more comprehensive lesion information,significantly improve the sensitivity and accuracy of PCa diagnosis,and help to reduce missed diagnosis.