酰胺质子转移成像联合T_(2)-mapping鉴别前列腺癌与前列腺增生的价值

The value of amide proton transfer imaging combined with T_(2)-mapping for differentiating prostate cancer from benign prostatic hyperplasia

目的:探索酰胺质子转移成像(APT)联合T_(2)-mapping对前列腺癌(PCa)和前列腺增生(BPH)的鉴别价值。方法:回顾性分析本院行3.0T MRI扫描、经病理证实的32例PCa和29例BPH患者资料。两位观察者分别测量两组病灶的APT值和T_(2)值。采用组内相关系数(ICC)检验两名观察者测量结果的一致性。采用独立样本t检验比较两组病灶各参数值的差异。采用受试者操作特征(ROC)曲线评估各有差异参数单独及联合对两组鉴别诊断的效能。采用Delong检验比较各参数及联合参数诊断效能的差异。采用Pearson相关检验对两参数进行相关性分析。结果:两名观察者测量各组数据的一致性良好(ICC>0.75)。PCa组的APT值[(2.36±0.56)%]大于BPH[(1.69±0.53)%]组,PCa组的T_(2)值[(76.29±8.64)ms]小于BPH[(91.36±10.07)ms]组,差异均有统计学意义(P<0.05)。APT值、T_(2)值及二者联合鉴别PCa和BPH的ROC曲线下面积分别为0.810、0.889、0.920。APT值与T_(2)值的诊断效能差异无统计学意义(P>0.05),两参数联合的诊断效能要优于APT值单独诊断效能(P<0.05)。APT值与T_(2)值呈负相关(r=-0.35,P<0.001)。结论:APT值、T_(2)值可有效鉴别PCa和BPH,APT值和T_(2)值之间存在显著负相关性,两者联合的鉴别效能明显提升,具有很好的临床应用前景。

Objective:To explore the value of amide proton transfer(APT)imaging and T_(2)-mapping for differentiating prostate cancer(PCa)from benign prostatic hyperplasia(BPH).Methods:32 patients with PCa and 29 patients with BPH who were pathologically confirmed were included in this study.They underwent preoperative pelvic 3.0T MR including APT,T_(2)-mapping.Inter-class correlation coefficients(ICC)were used to evaluate measurement reproducibility.APT and T_(2) values were compared between two groups using an unpaired t-test and diagnostic performances for differentiation between PCa and BPH were determined by receiver operating characteristic(ROC)curve and Delong test.Pearson correlation analysis was performed to evaluate the correlation of APT and T_(2) values.Results:There was good measurement consistency for two observers(ICC value>0.75).The APT value of the PCa group were significantly larger than that of BPH group[(2.36±0.56)%vs.(1.69±0.53)%,P<0.05].The T_(2) value of PCa group were significantly smaller than that of BPH group[(76.29±8.64)ms vs.(91.36±10.07)ms,P<0.05].The area under the ROC(AUC)curve of APT,T_(2) and combination of APT and T_(2) for distinguishing PCa from BPH were 0.810,0.889,and 0.920,respectively.There was no significant difference between the AUC for APT and T_(2)-mapping(P>0.05).The AUC of the combination of the two parameters was significantly larger than that of APT(P<0.05).The APT values showed negative correlation with T_(2) values(r=-0.35,P<0.001).Conclusion:A strong correlation existed between APT and T_(2) values.A combination of APT and T_(2)-mapping can significantly improve differentiation between PCa and BPH compared with APT or T_(2)-mapping alone.