基于前列腺全器官大组织切片评价弥散加权成像技术对病灶范围检测的准确性

Accuracy of diffusion weighted imaging in the detection of focus range based on prostate whole organ large tissue section

目的通过前列腺全器官大组织切片评价弥散加权成像(DWI)技术在检测前列腺癌病灶范围的准确性及其影响因素。方法回顾性分析2018年3月至2019年8月行前列腺癌根治术并于术后行前列腺全器官大组织切片制备的40例患者的临床资料。以前列腺影像报告和数据系统(PI-RADS,version 2.0)为标准对患者MRI进行评分,标记可疑区域,并以术后前列腺全器官大组织切片为金标准,评价DWI对病灶范围检测的准确性及影响因素。结果共有31例患者的主要肿瘤病灶被MRI检测到且被前列腺全器官大组织切片证实,MRI检测主要肿瘤的敏感性为77.5%(31/40)。31例患者的主要肿瘤在DWI上测得的肿瘤最大径(MTD)平均值为(18.79±9.63)mm,在前列腺全器官大组织切片下测得对应的MTD并校正后的平均值为(21.79±9.86)mm,两组间差异有统计学意义(P<0.05)。DWI对病灶范围的低估程度平均值为(15.12±9.82)%。有序多分类Logistic回归分析的结果提示Gleason评分是DWI检测病灶时产生低估的影响因素。结论DWI在检测前列腺癌主要肿瘤时通常会对病灶的实际范围产生一定程度的低估,且在检测高Gleason评分病灶时会产生更大的低估。

Objective To evaluate the accuracy and influencing factors of diffusion weighted imaging(DWI)in detecting the focus range of prostate cancer as confirmed by prostate whole organ large tissue section prepared from the specimens after radical prostatectomy.Methods The clinical data of 40 patients who underwent radical prostatectomy and prostate whole organ large tissue section during Mar.2018 and Aug.2019 were retrospectively analyzed.PI-RADS(version 2.0)was used as the standard to evaluate the MRI,the suspicious areas were marked,and the whole organ large tissue section was set as the gold standard.Results A total of 31 patients had major tumors detected on MRI and confirmed to be clinically significant prostate cancer(csPca)by prostate whole organ large tissue section.The sensitivity of MRI in detecting major tumors was 77.5%(31/40).The mean maximum tumor diameter(MTD)measured on DWI and whole organ large tissue section was(18.79±9.63)mm and(21.79±9.86)mm,respectively,with significant difference(P<0.05).The mean underestimation of DWI was(15.12±9.82)%.Logistic regression analysis showed that Gleason score was the influencing factor of underestimation in DWI detection of lesions.Conclusion In detecting prostate cancer,DWI usually underestimates the actual focus range,and higher Gleason score is associated with greater underestimation.