3D酰胺质子转移成像与体素内不相干运动成像对前列腺癌的诊断价值研究

Comparison of 3D amide proton transfer imaging and intravoxel incoherent motion imaging in the diagnosis of prostate cancer

目的 探讨3D酰胺质子转移成像(amide proton transfer, APT)与体素内不相干运动(intravoxel incoherent motion, IVIM)成像对前列腺癌(prostate cancer, PCa)诊断以及评估PCa危险度的价值。材料与方法 回顾性分析2022年4月至2022年11月本院51例前列腺疾病患者病例资料,根据患者病理穿刺或者手术结果分为良性前列腺增生(benign prostatic hyperplasia, BPH)组27例和PCa组24例,依照Gleason评分(Gleason score, GS)结果把PCa组分为低危组(≤6分)6例和高危组(≥7分)18例。所有患者在术前行3.0 T MRI前列腺检查,扫描序列包括T2WI、APT、IVIM、扩散加权成像(diffusion-weighted imaging, DWI)等,在APT和IVIM参数图像上勾画感兴趣区,测量病灶的APT值、真实扩散系数(D)、伪扩散系数(D*)、灌注分数(f)以及表观扩散系数(apparent diffusion coefficient, ADC)。使用独立样本t检验比较BPH组和PCa组、PCa低危组与高危组间各参数差异,用受试者工作特征(receiver operating characteristic, ROC)曲线评估各参数的诊断效能。应用Spearman相关性分析法分析上述各参数与GS的相关性。结果 BPH组的D值和ADC值显著高于PCa组,APT值显著低于PCa组,差异均有统计学意义(P<0.05),D*值和f值在两组间差异无统计学意义(P>0.05)。PCa低危组的D值和ADC值显著高于PCa高危组,APT值显著低于PCa高危组,差异均有统计学意义(P<0.05)。ROC分析示ADC与D值鉴别诊断BPH与PCa的特异度高于APT值,而APT和D值鉴别诊断的敏感度高于ADC值。Spearman相关分析显示PCa病灶ADC值、D值与GS呈显著负相关(r=-0.691、-0.624,P<0.001);APT值与GS呈显著正相关(P=0.026,r=0.455),D*值和f值与GS无相关性(P>0.05)。结论 APT和IVIM成像对PCa鉴别诊断具有一定价值,APT值和IVIM的D值可为PCa的病理分级提供帮助,且D值的价值更高。

Objective:To investigate the value of 3D amide proton transfer(APT)imaging and intravoxel incoherent motion(IVIM)imaging in the diagnosis and risk assessment of prostate cancer(PCa).Materials and Methods:A total of 51 patients with prostate disease in our hospital from April 2022 to November 2022 were prospectively included and divided into 27 patients in the benign prostatic hyperplasia(BPH)group and 24 patients in the PCa group according to pathological puncture or surgical results.According to Gleason score(GS),PCa group was divided into low-risk group(≤6)with 6 cases and high-risk group(≥7)with 18 cases.All patients underwent 3.0 T MRI prostatic examination before surgery.The scans included APT,IVIM,diffusion-weighted imaging(DWI)and other sequences.The areas of interest were delineated on the APT and IVIM parameter images,and the APT value,true diffusion coefficient(D),pseudo diffusion coefficient(D*),perfusion fraction(f)and ADC value of the lesions were measured.Independent sample t test was used to compare the differences of various parameters between BPH group and PCa group,and between PCa high-risk group and low-risk group.Receiver operating characteristic(ROC)curve was used to assess the diagnostic efficiency of each parameter.Spearman correlation analysis was used to analyze the correlation between the parameters and GS.Results:The D value and ADC value of BPH group were observably higher than that of PCa group,while the APT value was observably lower than that of PCa group,with statistical significance(P<0.05).There was no statistical difference in D*and f values between the two groups.D value and ADC value in PCa low-risk group were significantly higher than those in PCa high-risk group,and APT value was significantly lower than those in PCa high-risk group,with statistical significance(P<0.05).ROC curve analysis showed that the diagnostic specificity of ADC and D values was higher than APT values,while the diagnostic sensitivity of APT and D values was higher than ADC values.Spearman correlation analysis displayed that the ADC value and D value of PCa lesions were significantly negatively correlated with GS(r=-0.691,-0.624;P<0.001);APT value was significantly positively correlated with GS(r=0.455,P=0.026),while D*value and f value were not correlated with GS(P>0.05).Conclusions:APT and IVIM imaging have certain value in the differential diagnosis of PCa,APT and IVIM D value can provide help for the pathological grading of PCa,and D value is higher.