前列腺癌患者DCE-MRI、DWI影像表现及与PSA的关系

Imaging Findings of DCE-MRI and DWI in Patients with Prostate Cancer and Their Relationship with PSA

目的 探究前列腺癌患者(PCa)磁共振动态增强扫描(DCE-MRI)、磁共振弥散加权成像(DWI)影像表现及与前到腺特异性抗原(PSA)的关系。方法 将2020年10月至2023年6月本院收治的78例疑似PCa患者,根据手术病理活检结果分为两组:45例为前列腺增生患者,33例为PCa患者,两组患者皆进行DCE-MRI和DWI序列检查。通过检查结果,对比两组患者动态的增强扫描参数以及两组患者总前列腺特异性抗原(tPSA)和游离前列腺特异性抗原(fPSA)水平。结果 DCE-MRI图像显示PCa患者的病灶在T_(2)WI上可见,增强扫描早期部分有强化。DWI图像显示稍高信号,并且ADC值较小。动态增强曲线呈现流出型。此外,在左侧移行带和两侧外周带上观察到大片T_(2)-FLAIR低信号,边界不清。DWI图像结果呈现出受限的弥散性,ADC结果显示信号减低;PCa组患者K^(trans)值、K_(ep)值和V_(e)值高于前列腺增生组,ADC值低于前列腺增生组(P<0.05);PCa组患者tPSA水平、 fPSA水平高于前列腺增生组,fPSA/tPSA比值低于前列腺增生组(P<0.05);K^(trans)值、K_(ep)值、V_(e)值与fPSA/tPSA比值呈负相关(r=-0.551、-0.566、-0.5 73,P<0.05),ADC值与fPSA/tPSA比值呈正相关(r=0.575,和0.05)。结论 前列腺增生与恶性肿瘤的磁共振影像学存在特征差异,影像学参数与肿瘤患者PSA密切相关,通过DCE-MRI与DWI检查可准确辅助诊断PCa。

Objective To explore the imaging findings of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) and diffusion-weighted imaging(DWI) and thir relationship with prostate-specific antigen(PSA) in patients with prostate cancer(PCa).Methods 78 patients with suspected PCa admitted to our hospital from October 2020 to June 2023 were examined by DCE-MRI and DWI,and were divided into two groups according to pathological biopsy results,including 45 cases with prostatic hyperplasia and 33 cases with PCa.The diagnostic results of DCE-MRI and DWI sequences were analyzed,and the dynamic enhanced scan parameters and the total prostate-specific antigen(tPSA) and free prostatespecific antigen(fPSA) levels were compared between the two groups.Results DCE-MRI images showed that the lesions of PCa patients were visible on T_2WI,and the ea rly pa rt of enhanced scan was enhanced.DWI images showed slightly higher signals and had a smaller ADC.Dynamic enhancement curve presented an outflow pattern.In addition,a large area of T_2-FLAIR low signal was observed in the left transition zone and both sides of the peripheral zone,and the boundary was unclear.DWI images show limited diffusion and low ADC signals.K^(trans),K_(ep) and V_(e) in PCa group were higher than those in prostatic hyperplasia group while ADC was lower than that in prostatic hyperplasia group(P<0.05).The tPSA and fPSA in PCa group we re higher while the fPSA/t PSA ratio was lower than that in prostatic hyperplasia group(P<0.05).K^(trans),K_(ep) and V_(e) were negatively correlated with fPSA/tPSA ratio(r=-0.551,-0.566,-0.573,P<0.05),and ADC was positively correlated with fPSA/tPSA ratio(r=0.575,P<0.05).Conclusion There are differences in magnetic resonance imaging characteristics between prostatic hyperplasia and malignant tumors.Imaging parameters are closely related to PSA in tumor patients.DCE-MRI and DWI can accurately assist the diagnosis of PCa.