多b值DWI、ADC、DCE-MRI联合PSA相关指标对侵袭性前列腺癌、前列腺增生的鉴别诊断

Multi-b-value DWI, ADC, DCE-MRI combined with PSA-related indicators in the differential diagnosis of invasive prostate cancer and prostate hyperplasia

目的探讨多b值弥散加权成像(DWI)、表观扩散系数(ADC)、动态增强磁共振成像(DCE-MRI)联合血清前列腺特异性抗原(PSA)相关指标对侵袭性前列腺癌(PCa)、良性前列腺增生(BPH)的鉴别诊断价值。方法回顾性分析本院2018年12月至2020年1月收治的经病理证实为侵袭性PCa的60例患者及40例BPH患者。所有患者术前或治疗前均进行常规MRI、多b值DWI、DCE-MRI检查以及PSA相关指标检测。比较两类患者的多b值DWI、ADC、DCE-MRI、PSA相关指标以及联合诊断与病理结果之间的差异。结果PCa患者的多b值DWI均高于BPH患者,ADC均低于BPH患者(均P<0.05)。BPH、PCa在DCE-MRI中的ST-T曲线类型分布为Ⅰ型(11、3例),Ⅱ型(20、15例),Ⅲ型(9、42例),差异均有统计学意义(χ^(2)=26.73,均P<0.001)。以MRI+DWI+ADC+DCE-MRI+PSA联合诊断方式诊断PCa的准确度、灵敏度、特异度、阳性预测值、阴性预测值最高,与其他各项联合诊断方式比较,差异均有统计学意义(均P<0.05)。结论多b值DWI、ADC、DCE-MRI联合PSA相关指标对侵袭性PCa、BPH的鉴别诊断效果显著,有助于指导临床治疗方案的合理选择。

Objective To explore multi-b-value diffusion-weighted imaging(DWI),apparent diffusion coefficient(ADC),dynamic enhanced magnetic resonance imaging(DCE-MRI)combined with serum prostate-specific antigen(PSA)related indicators in the differential diagnosis of aggressive prostate cancer(PCa)and benign prostatic hyperplasia(BPH).Methods A retrospective analysis of 60 patients with pathologically proven aggressive prostate cancer and 40 patients with benign prostatic hyperplasia from December 2018 to January 2020 in our hospital were retrospectively analyzed.All patients underwent routine magnetic resonance imaging(MRI),multi-b-value DWI,DCE-MRI and PSA related indexes before operation or treatment.The multi-b-value DWI,ADC,DCE-MRI,PSA related indicators and the difference between the combined diagnosis and pathological results were compared.Results The multi-b-value DWI of PCa patients was higher than that of BPH patients,and the ADC was lower than that of BPH patients(all P<0.05).The ST-T curve distribution of BPH in DCE-MRI was typeⅠin 11 cases,typeⅡin 20 cases,and typeⅢin 9 cases.The ST-T curve distribution of PCa in DCE-MRI was typeⅠin 3 cases,typeⅡin 15 cases and typeⅢin 42 cases,and the difference between the two groups was statistically significant(χ^(2)=26.73,all P<0.001).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of PCa diagnosed by MRI+DWI+ADC+DCE-MRI+PSA combined diagnosis were the highest,and the differences were statistically significant(all P<0.05).Conclusions The multi-b-value DWI,ADC,DCE-MRI combined with PSA related indicators have a significant effect on the differential diagnosis of aggressive prostate cancer and prostatic hyperplasia,which is helpful to guide the rational choice of clinical treatment options.