DCE-MRI与DWI定量分析在前列腺癌诊断和分级中的应用

Application of Quantitative Analysis of DCE-MRI and DWI in the Diagnosis and Grading of Prostate Cancer

目的探讨动态对比增强磁共振成像(DCE-MRI)与弥散加权成像(DWI)定量分析对前列腺癌的诊断和分级价值。方法纳入2017年1月至2019年12月就诊于郑州市第三人民医院和河南中医药大学第一附属医院的77例前列腺疾病患者,包括34例前列腺癌患者和43例前列腺增生患者,患者均接受DCE-MRI和DWI扫描。测量和计算病灶的血管渗透性定量参数,包括对比剂容积转运常数(K^(trans))、反流速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e))、血浆容积分数(V_(p)),以及表观弥散系数(ADC)。采用受试者工作特征(ROC)曲线分析定量参数的诊断价值,采用Spearman相关分析研究定量参数与Gleason评分的相关性。结果前列腺癌组K^(trans)、K_(ep)高于前列腺增生组(P<0.05),ADC值低于前列腺增生组(P<0.05)。K^(trans)、K_(ep)、ADC值对前列腺癌与前列腺增生的鉴别诊断价值较高,曲线下面积(AUC)=0.713、0.705、0.889。前列腺癌患者Gleason分级与K^(trans)呈负相关(r=-0.912,P<0.001)。结论DCE-MRI与DWI定量分析能够有效鉴别前列腺癌与前列腺增生,K^(trans)、K_(ep)、ADC值对前列腺癌具有较高的诊断效能,K^(trans)可用于前列腺癌的Gleason分级评估。

Objective To explore the quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)in the diagnosis and grading of prostate cancer.Methods A total of 77 patients with prostate disease who were admitted to the Third People’s Hospital of Zhengzhou or the First Affiliated Hospital of Henan University of CM from January 2017 to December 2019 were included,including 34 prostate cancer patients and 43 prostate hyperplasia patients.All patients underwent DCE-MRI and DWI scans.Quantitative parameters of vascular permeability of lesions,including volume transfer constant of the contrast agent(K^(trans)),reverse reflux rate constant(K_(ep)),volume fraction of extravas-cular extracellular space(V_(e)),volume fraction of plasma(V_(p)),and apparent dispersion coefficient(ADC)were measured and calculated.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of quantitative parameters,and Spearman correlation analysis was used to explore the correlation between quantitative parameters and Gleason score.Results The K^(trans)and K_(ep)in prostate cancer group were higher than those in prostate hyperplasia group(P<0.05),and the ADC value was lower than that in prostate hyperplasia group(P<0.05).K^(trans),K_(ep)and ADC were of high value in the differential diagnosis of prostate cancer and benign prostatic hyperplasia,area under the curve(AUC)=0.713,0.705,0.889.The Gleason grade of prostate cancer patients was negatively correlated with K^(trans)(r=-0.912,P<0.001).Conclusion The quantitative analysis of DCE-MRI and DWI could effectively distinguish prostate cancer from benign prostatic hyperplasia.K^(trans),K_(ep)and ADC values have high diagnostic efficiency for prostate cancer.K^(trans)could be used for Gleason grading assessment of prostate cancer.