DCE-MRI定量参数鉴别诊断外周带早期前列腺癌与前列腺炎价值探讨

Value of DCE-MRI Quantitative Parameters in the Differential Diagnosis of Early Prostate Peripheral Zone Cancer and Prostatitis

目的探讨核磁共振动态增强扫描(DCE-MRI)定量参数鉴别诊断外周带早期前列腺癌与前列腺炎的价值。方法将2017年2月至2019年10月本院的经临床病理诊断确诊为外周带早期前列腺癌患者78例,设为癌症组;将确诊为前列腺炎患者75例,设为炎症组。对所有患者均行常规磁共振(MRI)、DCE-MRI检查。观察比较两组经DCE-MRI检查测出的转运常数(K^(trans)),对K^(trans)鉴别诊断外周带早期前列腺癌与前列腺炎的价值进行ROC曲线分析,得出K^(trans)临界值;比较此K^(trans)临界值与常规MRI诊断外周带早期前列腺癌的敏感度、特异性、准确度、阳性预测值、阴性预测值、kappa值。结果癌症组、炎症组K^(trans)分别为(0.13±0.06)、(0.08±0.03)min^(-1),差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,DCE-MRI定量参数K^(trans)诊断外周带早期前列腺癌的AUC为0.732,临界值为0.116min^(-1),差异具有统计学意义(P<0.05),此K^(trans)临界值与常规MRI诊断外周带早期前列腺癌的敏感度分别为96.2%、71.8%,特异性分别为97.3%、69.3%,准确值分别为96.7%、70.6%,阳性预测值分别为97.4%、70.9%,阴性预测值分别为96.1%、70.3%,kappa值分别为0.935、0.411,差异均具有统计学意义(P<0.05)。结论DCE-MRI定量参数对外周带早期前列腺癌与前列腺炎具有较大的鉴别诊断价值,值得临床进一步推广应用。

Objective To explore the value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of early prostate peripheral zone cancer and prostatitis.Methods From February 2017 to October 2019,78 patients confirmed with early prostate peripheral zone cancer by clinical pathology in the hospital were enrolled as a cancer group,while 75 patients confirmed with prostatitis were enrolled as an inflammation group.All underwent routine MRI and DCE-MRI.The transfer constant(K^(trans))measured by DCE-MRI was observed and compared between the two groups.The differential diagnosis value of K^(trans)for early prostate peripheral zone cancer and prostatitis was analyzed by ROC curves to obtain the cut-off value of K^(trans).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,and kappa value of the cut-off value and routine MRI for early prostate peripheral zone cancer diagnosis were compared.Results There was a significant difference in K^(trans)between the cancer group and inflammation group[(0.13±0.06)min^(-1) vs.(0.08±0.03)min^(-1)](P<0.05).The results of ROC curve analysis showed that the AUC and cut-off value of K^(trans)for diagnosis of early prostate peripheral zone cancer were 0.732 and 0.116 min^(-1)(P<0.05).There were significant differences in the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of the cut-off value and routine MRI for diagnosis of early prostate peripheral zone cancer[(96.2%,71.8%),(97.3%,69.3%),(96.7%,70.6%),(97.4%,70.9%),(96.1%,70.3%),(0.935,0.411)](P<0.05).Conclusion The quantitative parameters of DCE-MRI are of great differential diagnosis value in early prostate peripheral zone cancer and prostatitis.