前列腺癌的MRI诊断与临床对照研究

The study of comparison between MRI diagnosis and clinic on prostatic carcinoma

目的 :回顾性分析 94例临床拟诊前列腺疾患患者的MRI,探讨MRI对前列腺癌诊断的敏感度、特异度与诊断符合率 ;通过分析MRI对前列腺癌漏诊、误诊的原因 ,以期提高MRI对前列腺癌诊断的敏感度及诊断符合率。方法 :本研究中选取的 94例临床诊断前列腺疾病的患者均行MRI、DRE、B US检查及PSA化验检查。MRI常规采用快速自旋回波(FSE)T2 加权扫描 (T2 WI)及自旋回波 (SE)T1加权扫描 (T1WI) ,部分采用脂肪抑制序列 (STIR)或加扫矢状位、冠状位 ;磁共振检查结果与其它检查结果、临床诊断及平行试验进行对照。结果 :MRI对前列腺癌诊断的敏感度为 82 .6 9% ,特异度为90 .4 8% ,似然比为 8.6 82 7,诊断符合率为 86 .17% ,正确诊断指数为 0 .7317;平行试验对前列腺癌诊断敏感度为 98.0 8% ,特异度为 85 .71% ,似然比为 6 .86 5 4 ,诊断符合率为 92 .5 5 % ,正确诊断指数为 0 .8379;二者对前列腺癌诊断敏感度的差异有显著的统计学意义。结论 :不同的MRI脉冲序列对各种病变显示率不同 ;设置适当的脉冲序列、扫描方位及参数 ,并仔细观察影像学所见 ,可以明显减少病变的漏诊 ;MRI表现密切结合临床资料 ,有利于病灶的鉴别诊断 ,较大地提高前列腺疾病诊断符合率 ;平行试验可以明显提高对前列腺癌诊断的敏感度。

Objective:Date from magnetic resonance imaging (MRI) on 94 cases were diagnosed prostatic disease by clinic, evaluate the sensitivity 、specificity and accordant rate of MRI diagnosis on prostatic carcinoma; try to improve the diagnostic sensitivity and accordant rate of MRI diagnosis on prostatic carcinoma.Methods:All of the 94 patients were examined by MRI、digit rectum examination (DRE)、B-ultrasonography (B-US) and prostatic-specific antigen (PSA) examination. Using Fast Spin Echo-T 2 weighted imaging(FSE-T 2WI) and Spin Echo-T 1 weighted imaging (SE-T 1WI) pulse sequence in axial orientation as routine in MRI examination, some of them scan with fat-suppression (shot time of inversion recovery, STIR) pulse sequence or in sagittal、coronal orientation additional; The diagnostic results of MRI were compared with that of the other examinations、clinical final diagnosis and the test in parallel.Results:[WT5”BZ]Evaluating the MRI diagnosis on prostatic carcinoma: the sensitivity is 82.69%,the specificity is 90.48%,the likelihood ratio is 8.6827,the accordant rate of diagnosis is 86.17%,Youden's index is 0.7317; evaluating the diagnosis of the test in parallel on prostatic carcinoma: the sensitivity is 98.08%,the specificity is 85.71%,the likelihood ratio is 6.8654,the accordant rate of diagnosis is 92.55%,Youden's index is 0.8379; the sensitivity of diagnosis on prostatic carcinoma is evident different between MRI and the test in parallel by statistic analyse.[WT5”HZ]Conclusion:Different MRI pulse sequence caused different effect on displaying distinct pathologic variety; during scanning and diagnosing of MRI, set proper pulse sequence、 orientation 、parameters, and observe the MRI images carefully, could decrease the supposititious negative rate; combine MRI appearance with clinical information close, making for the diagnosis in differentiating the diversified prostatic diseases; the test in parallel could improve the diagnostic sensitivity on prostatic carcinoma.