ADC值及eADC值在双参数MRI诊断临床显著性前列腺癌中的应用价值

Application value of ADC value and eADC value in bi-parametric MRI in detecting clinical significant prostate cancer

目的:探究表观弥散系数(apparent diffusion coefficient,ADC)及指数化ADC(exponential ADC,eADC)在双参数磁共振成像(bi-parametric magnetic resonance imaging,bpMRI)诊断临床显著性前列腺癌中的应用价值。方法:回顾并分析2014年1月—2021年12月在首都医科大学电力教学医院就诊的101例临床怀疑为前列腺癌患者的临床、影像学及病理学资料。依据穿刺活检结果分为组1(临床显著性前列腺癌组)和组2(非临床显著性前列腺癌+非前列腺癌),由2名阅片者依据前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System,PI-RADS)指南评分标准分别按照bpMRI诊断方案和多参数MRI(multi-parametric MRI,mpMRI)诊断方案进行评分(记为bpMRI评分和mpMRI评分),并且测量病灶最大层面的ADC值和eADC值,将bpMRI评分和mpMRI评分分别与ADC值及eADC值联合构建logistic回归模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值、eADC值、bpMRI诊断方案、mpMRI诊断方案以及两者分别联合ADC值及eADC值对临床显著性前列腺癌的诊断价值,运用Z检验对比各方案的曲线下面积(area under curve,AUC)有无差异。结果:109例可疑病灶中,组1病灶共计50例,组2病灶共计59例。ADC值、eADC值、bpMRI评分及mpMRI评分是诊断临床显著性前列腺癌的有效指标(P<0.001),ADC值及eADC值的AUC值分别为0.888和0.931,差异无统计学意义(Z=1.512,P=0.1306)。BpMRI评分分别联合ADC值及eADC值的AUC值分别为0.973、0.978,高于单独运用bpMRI评分的AUC值(AUC=0.954),差异有统计学意义(Z=2.391,P=0.0168;Z=2.125,P=0.0336)。mpMRI评分分别联合ADC值及eADC值的AUC值分别为0.985、0.985,高于单独运用mpMRI评分的AUC值(AUC=0.974),但差异无统计学意义(Z=1.295,P=0.1953;Z=1.354,P=0.1757)。结论:ADC值和eADC值都是诊断临床显著性前列腺癌有价值的MRI定量指标,两者联合bpMRI评分可以显著地提高bpMRI的诊断效能与临床应用价值。

Objective:To explore the application value of apparent diffusion coefficient(ADC)and exponential ADC(eADC)in bi-parametric magnetic resonance imaging(bpMRI)in detecting clinical significant prostate cancer.Methods:The clinical,imaging and pathological data of 101 patients with clinically suspected prostate cancer who were treated in Medical University Electric Power Teaching Hospital from January 2014 to December 2021 were retrospectively analyzed.According to the pathological results,the patients were divided into group 1(clinical significant prostate cancer group)and group 2(non-clinical significant prostate cancer+non-prostate cancer).Two radiographers used Prostate Imaging Reporting and Data System(PI-RADS)to scored the prostate MRI images of all patients according to the two schemes of mpMRI and bpMRI,and measured the ADC value and eADC value of the lesions.Logistic regression model was constructed by combining bpMRI score or mpMRI score with ADC value or eADC value respectively,and receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of the ADC value,eADC value,bpMRI scheme,mpMRI scheme and the logistic regression model of bpMRI scheme or mpMRI scheme combined with ADC value or eADC value.The area under curve(AUC)of each scheme was compared by Z test.Results:Among 109 suspected lesions,50 lesions were divided into group 1 and 59 were divided into group 2.ADC values,eADC values,BpMRI score and mpMRI score were effective indicators in diagnosis of clinical significant prostate cancer(P<0.001).The AUC values of ADC value and eADC value were 0.888 and 0.931 respectively,but there was no statistically significant difference between ADC value and eADC value(Z=1.512,P=0.1306).The AUC values of bpMRI score combined with ADC value or eADC value were 0.973 and 0.978 respectively,were higher than the AUC value of bpMRI score(AUC=0.954),and the difference was statistically significant(Z=2.391,P=0.0168;Z=2.125,P=0.0336).The AUC values of mpMRI score combined with ADC value or eADC value were 0.985 and 0.985 respectively,were higher than the AUC value of mpMRI score(AUC=0.974),But the difference was no statistically significant(Z=1.295,P=0.1953;Z=1.354,P=0.1757).Conclusion:Both ADC value and eADC value are valuable quantitative MRI indicators in diagnosis of clinical significant prostate cancer,and combing the two values with bpMRI score can effectively improve the diagnostic efficiency and clinical application value of bpMRI schemes.