表观扩散系数值在预测低中危前列腺癌Gleason分级中的价值

The value of magnetic resonance imaging apparent diffusion coefficient values in predicting Gleason grading of low to intermediate-risk prostate cancer

目的:探讨表观扩散系数(ADC)值对低中危前列腺癌(PCa)的诊断效能及其与Gleason评分(GS)之间的相关性。方法:收集2020年1月至2021年12月南京鼓楼医院前列腺受检者的临床影像数据进行回顾性分析。测量病灶的ADC值,分析ADC在低中危PCa诊断中的效能,以及ADC值与GS之间的相关性,比较平均表观扩散系数值(ADC_(mean))和最小表观扩散系数值(ADC_(min))的诊断效能。结果:纳入1051例患者,病灶总数为1202个,其中638个为PCa(53.08%),564个为良性病变(46.92%)。良性病变组的ADC_(min)及ADC_(mean)明显高于PCa组,差异具有统计学意义(P<0.01)。GS 4+3组的ADC_(min)及ADC_(mean)显著低于GS 3+4组、GS 3+3组和良性组,差异均有统计学意义(P<0.01)。诊断PCa的ADC_(min)和ADC_(mean)的AUC分别为0.911、0.972,诊断界值分别为0.703×10^(-3)mm^(2)·s^(-1)、0.896×10^(-3)mm^(2)·s^(-1)。ADC_(min)、ADC_(mean)与GS呈负性相关(ρ_(s)=-0.764,P<0.001;ρ_(s)=-0.845,P<0.001)。结论:ADC值与低中危PCa侵袭性呈负相关,对GS 3+4、GS 4+3病灶具有较高的鉴别诊断价值,敏感度、特异度高,且ADC_(mean)的诊断价值更高,可对PCa生物学特性进行有效的术前评估,辅助临床医师制订治疗方案,有效避免过度治疗。

Objective:To investigate the diagnostic performance of the apparent diffusion coefficient(ADC)for low to intermediate-risk prostate cancer(PCa),as well as its correlation with the prognostic Gleason score(GS).Methods:The images and data from prostate examination patients at Nanjing Drum Tower Hospital were collected for retrospective analysis spanning January 2020 to December 2021.During this analysis,the ADC values of lesions were measured to assess the efficacy of ADC in diagnosing low to intermediate-risk PCa.Additionally,the correlation between ADC values and GS was investigated,and the diagnostic efficacy between mean apparent diffusion coefficient values(ADC_(mean))and minimum apparent diffusion coefficient values(ADC_(min))was compared.Results:Among the 1051 patients,there were a total of 1202 lesions,with 638 cases identified as PCa(53.08%)and 564 cases as benign lesions(46.92%).The benign lesion group exhibited significantly higher ADC_(min) and ADC_(mean) values compared to the PCa group,and these differences were statistically significant(P<0.01).In terms of GS,the ADC_(min) and ADC_(mean) values of the GS 4+3 group were significantly lower than those of the GS 3+4 group,GS 3+3 group,and the benign group,with all differences being statistically significant(P<0.01).The AUC values for diagnosing PCa based on ADC_(min) and ADC_(mean) were 0.911 and 0.972,respectively.The corresponding diagnostic thresholds were 0.703×10^(-3) mm^(2)·s^(-1) for ADC_(min) and 0.896×10^(-3) mm^(2)·s^(-1) for ADC_(mean).The magnitudes of ADC_(min) and ADC_(mean) values exhibited a negative correlation with GS values(ρ_(s)=-0.764,P<0.001;ρ_(s)=-0.845,P<0.001).Conclusion:ADC values demonstrate an inverse relationship with the invasiveness of low to intermediate-risk PCa.They offer notable diagnostic value,particularly in distinguishing between GS 3+4 and GS 4+3 lesions,exhibiting both high sensitivity and specificity.Additionally,ADC_(mean) exhibits even greater diagnostic utility,facilitating effective preoperative assessment of PCa's biological attributes.This aids clinicians in formulating treatment strategies and mitigating the risk of excessive therapeutic interventions.