T_(1)、T_(2)值联合血清总前列腺特异性抗原对移行带前列腺癌的诊断价值

T_(1),T_(2) value combined with serum tPSA in diagnosis of prostate cancer in transition zone

目的:探讨T_(1)、T_(2)值联合血清总前列腺特异性抗原(tPSA)对移行带前列腺癌(PCa)的诊断价值。方法:招募tPSA≥4 ng/mL的病人,采集常规MRI和合成MRI图像,纳入MRI显示为前列腺移行带病灶的病人133例。由两名放射科医生独立评估PI-RADS评分,独立勾画感兴趣区测量病变区域的T_(1)、T_(2)值,后根据穿刺病理结果将病人分为PCa组和非PCa组。采用受试者工作特征(ROC)曲线分析T_(1)值、T_(2)值、PI-RADS评分、t PSA诊断移行带PCa的效能,进一步建立回归树分析T_(1)、T_(2)值联合tPSA以及PI-RADS评分联合t PSA诊断移行带PCa的敏感性和特异性,并采用二项精确检验比较两组联合诊断的效能。结果:PCa组64例,非PCa组69例。T_(1)值、T_(2)值、t PSA、PI-RADS评分诊断移行带PCa的曲线下面积(AUC)分别为0.889(95%CI:0.831~0.946)、0.950(95%CI:0.915~0.986)、0.748(95%CI:0.664~0.833)和0.731(95%CI:0.654~0.809),T_(1)、T_(2)值对应的AUC显著大于tPSA(Z=2.51,P=0.01;Z=4.08,P<0.000 1)和PI-RADS评分(Z=3.55,P<0.001;Z=5.56,P<0.000 01)的AUC。回归树分析显示T_(1)、T_(2)值联合tPSA诊断PCa的最低误差节点为T_(2)值<80.5 ms或T_(2)值为80.5~<85.5 ms且tPSA>16.16 ng/mL,诊断的敏感性和特异性分别为96.9%和94.2%。结论:T_(1)、T_(2)值联合血清t PSA能有效提高移行带PCa诊断的敏感性和特异性,T_(2)值和tPSA对最后诊断起决定作用。

Objective:To evaluate T_(1),T_(2)value combined with serum total prostate specific antigen(tPSA) in the diagnosis of prostate cancer in transition zone.Methods:Patients with tPSA>4 ng/mL underwent conventional and synthetic MAGiC sequence imaging at GE Magnet.The patients with the lesion in transition zone were enrolled.PI-RADS score was evaluated and T_(1),T_(2)value of lesion were measured in post-processing workstation by region of interest.The prostate lesions in prostate transition zone were confirmed by biopsy pathology.There were 64 cases in prostate cancer group and 69 cases in non-prostate cancer group,finally.Receiver operating characteristic(ROC) curve was used to analyze the accuracy of T_(1)value,T_(2)value,PI-RADS score,and t PSA in the diagnosis of prostate cancer in transition zone.Further,a regression tree was established to analyze the sensitivity and specificity of T_(1),T_(2)value combined with tPSA in the diagnosis of prostate cancer in transitional zone,and the sensitivity and specificity of diagnosis were compared between various combinations.Results:The areas under the curve of T_(1)value,T_(2)value,tPSA and PI-RADS score for the diagnosis of transitional band prostate cancer were 0.889(95%CI:0.831~0.946),0.950(95%CI:0.915~0.986),0.748(95%CI:0.664~0.833) and 0.731(95%CI:0.654~0.809),the AUCs of T_(1),T_(2)value are significantly higher than those of tPSA(Z=2.51,P=0.01;Z=4.08,P16.16 ng/mL),the diagnostic sensitivity and specificity were 96.9% and 94.2%,respectively.Conclusion:Combined T_(1),T_(2)value and serum tPSA can effectively improve the sensitivity and specificity of prostate cancer in transitional zone.Only T_(2)value and tPSA have effects on the diagnosis in the combination.