ESWAN联合DWI诊断前列腺增生和前列腺癌的一致性研究

Consistency Study of ESWAN Combined with DWI in the Diagnosis of Prostate Hyperplasia and Prostate Cancer

目的 探讨多回波采集重度T_(2)^(*)WI三维梯度回波(ESWAN)序列联合磁共振弥散加权成像(DWI)在前列腺增生和前列腺癌中的诊断价值。方法 选取研究对象为湖南省人民医院2017年1月~2020年1月收治的19例前列腺癌患者,将其设为前列腺癌组,另外选取同期收治的11例前列腺增生患者行对照分析,设为前列腺增生组,所有患者入院2~3d后选择飞利浦Ingenia3.0T MRI超导磁共振机行ESWAN和DWI扫描,另外通过一致性分析ESWAN、DWI及ESWAN联合DWI诊断前到腺增生和前列腺癌的价值。结果 前列腺19例癌患者中,存在癌灶26个:主要包括高信号结节2个,等信号结节2个,T_(2)W1低信号结节18个,高低混杂信号结节4个;其中外周带病灶位置为16个、中央带病灶位置为10个,癌灶突出包膜、侵及精囊腺和骨转移分别为15例、7例、4例。此外,还有前列腺增生11例患者结节均处于中央带,T_(2)W1低信号结节、T1W1信号略低结节、等信号结节和低信号结节分别为4、4、2和1个。前列腺癌组ADC值显著低于前列腺增生组,P<0.05。30例前列腺增生和前列腺癌患者中ESWAN检查(+)24例,灵敏度66.67%,特异度91.67%,准确率76.67%,Kappa=0.544。30例前列腺增生和前列腺癌患者中DWI检查(+)25例,灵敏度67.57%,特异度96.30%,准确率76.67%, Kappa=0.544。30例前列腺增生和前列腺癌患者中联合检查(+)28例,灵敏度84.85%,特异度96.3 0%,准确率90.00%,Kappa=0.801。DWI结合ESWAN诊断前列腺癌、前列腺增生的灵敏度和准确性均明显高于单一诊断,P<0.05。结论 ESWAN、DWI均可应用在前列腺癌、前列腺增生诊断之中,且ESWAN联合DWI诊断前列腺癌、前列腺增生的灵敏度和准确性更高,值得临床重视。

Objective To explore the diagnostic value of multi-echo acquisition severe T_(2)^(*)WI three-dimensional gradient echo(ESWAN)sequence combined with magnetic resonance diffusion weighted imaging(DWI)in benign prostatic hyperplasia and prostate cancer.Methods The selected study subjects were 19 prostate cancer patients admitted to Hunan Provincial People's Hospital from January 2017 to January 2020,and set them as the prostate cancer group.In addition,11 patients with benign prostatic hyperplasia admitted during the same period were selected for comparative analysis and set as prostate In the hyperplasia group,all patients selected Philips Ingenia 3.0T MRI superconducting magnetic resonance machine for ESWAN and DWI scans 2 to 3 days after admission.In addition,the value of ESWAN,DWI and ESWAN combined with DWI in the diagnosis of prostate hyperplasia and prostate cancer was analyzed by consistency.Results Among the 19 patients with prostate cancer,there were 26 cancer foci,including 2 high-signal nodules,2 isosignal nodules,18 low-signal nodules T_(2)W1,and 4 high-low mixed signal nodules.Among them,16 lesions were located in the peripheral zone and 10 in the central zone,and 15,7 and 4 cases of carcinoma focused protrusion of capsule,invasion of seminal vesicle and bone metastasis,respectively.In addition,nodules of 11 patients with prostatic hyperplasia were all located in the central zone,with 4,4,2 and 1 nodules of low signal T_(2)W1,slightly low signal T1W1,isosignal and low signal,respectively.ADC value in prostate cancer group was significantly lower than that in prostatic hyperplasia group,P<0.05.The sensitivity of ESWAN test(+)was 66.67%,specificity 91.67%,accuracy 76.67%(Kappa=0.544)in 24 of 30 patients with prostatic hyperplasia and prostate cancer.25 cases of 30 patients with prostatic hyperplasia and prostate cancer were examined by DWI(+),the sensitivity was 67.57%,the specificity was 91.30%,the accuracy was 76.67%(Kappa=0.544).The sensitivity,specificity and accuracy were 84.85%,96.30%,and 90.00%(Kappa=0.801).The sensitivity and accuracy of DWI combined with ESWAN in the diagnosis of prostate cancer and prostate hyperplasia were significantly higher than that of single diagnosis,P<0.05.Conclusion Both ESWAN and DWI can be used in the diagnosis of prostate cancer and prostate hyperplasia,and ESWAN combined with DWI has higher sensitivity and accuracy in the diagnosis of prostate cancer and prostate hyperplasia,which is worthy of clinical attention.