表观扩散系数鉴别低及中高级别前列腺癌的应用价值

Application of apparent diffusion coefficient to identify low-and medium-high-grade prostate cancer

目的探讨表观扩散系数(ADC)鉴别低、中高级别前列腺癌的应用价值。方法收集2017年3月至2021年6月经连云港市第二人民医院病理证实的58例前列腺癌患者的磁共振成像(MRI)检查资料,平均年龄65岁。根据术后病理结果分为低级别组(Gleason评分≤6分,20例)和中高级别组(Gleason评分≥7分,38例)。所有患者均行完善的MRI平扫及扩散加权成像(DWI)检查,分别测量癌灶的最小ADC值(ADCmin)、平均ADC值(ADCmean)、标准化ADC值(ADCn),采用独立样本t检验比较两组间ADCmin、ADCmean、ADCn差异;绘制3种不同ADC值鉴别前列腺癌病理分级的受试者工作特征曲线(ROC),获取曲线下面积(AUC),评估各指标鉴别诊断低级别和中高级别前列腺癌的效能。采用Z检验比较各AUC之间差异。结果低级别组ADCmin、ADCmean、ADCn值分别为(0.734±0.063)×10^(-3)mm^(2)/s、(0.816±0.091)×10^(-3)mm^(2)/s、(0.631±0.037)×10^(-3)mm^(2)/s,均高于中高级别组(0.646±0.055)×10^(-3)mm^(2)/s、(0.698±0.059)×10^(-3)mm^(2)/s、(0.570±0.023)×10^(-3)mm^(2)/s,差异均有统计学意义(均P<0.05)。3种ADC值鉴别前列腺癌病理分级的AUC由高到低依次为ADCn 0.919、ADCmin 0.867、ADCmean 0.809。结论ADCmin、ADCmean、ADCn均可以用来鉴别低、中高级别前列腺癌,其中ADCn效能更为显著,可为临床选择治疗方案提供合理的影像依据。

Objective To investigate the application value of the apparent diffusion coefficient(ADC)in identifying low grade from medium-high-grade prostate cancer.Methods MRI examinations of patients with pathologically confirmed prostate cancer with an average age of 65 years old in The Second People's Hospital of Lianyungang from March 2017 to June 2021 were collected.According to the postoperative pathological findings,they were divided into a low-grade group(Gleason score≤6,20 cases)and a medium-high-grade group(Gleason score≥7,38 cases).All patients underwent complete MRI scan and diffusion weighted imaging(DWI)examination,and the minimum ADC(ADCmin),mean ADC(ADCmean),and normalized ADC(ADCn)values of the lesions were measured respectively,and the differences in ADCmin,ADCmean,and ADCn values between the two groups were compared by independent sample t test.The receiver operating characteristic curves(ROCs)of three different ADC values for identifying prostate cancer were plotted,and the area under the curve(AUC)was obtained to evaluate the effectiveness of each index in the differential diagnosis of low-grade and medium-high-grade prostate cancer.The Z test was used to compare the differences of AUCs.Results The ADCmin,ADCmean,and ADCn values of the low-grade group were(0.734±0.063)×10^(-3)mm^(2)/s,(0.816±0.091)×10^(-3)mm^(2)/s,and(0.631±0.037)×10^(-3)mm^(2)/s,respectively,which were higher than those in the medium-high-grade group[(0.646±0.055)×10^(-3)mm^(2)/s,(0.698±0.059)×10^(-3)mm^(2)/s,and(0.570±0.023)×10^(-3)mm^(2)/s],with statistically significant differences(all P<0.05).The AUC of three ADC values in differentiating pathological grade of prostate cancer was 0.919 of ADCn,0.867 of ADCmin,and 0.809 of ADCmean.Conclusions ADCmin,ADCmean,and ADCn all can be used to identify low grade from medium-high-grade prostate cancer,among which ADCn has the highest efficacy and can provide a reasonable imaging basis for clinical selection of treatment plans.