MRI多参数成像对前列腺癌诊断价值的研究  

Multiparametric magnetic resonance imaging in diagnosis of prostate cancer

作　　者：张永胜[1] 陈瑶[1] 陈祖华[1] 乐玲[1] 程凌霄[1] 张士更[2] 赵再秋[3] 

机构地区：[1]浙江中医药大学附属第二医院放射科,杭州310005 [2]浙江中医药大学附属第二医院泌尿外科,杭州310005 [3]浙江中医药大学附属第二医院病理科,杭州310005

出　　处：《浙江医学》2014年第14期1224-1227,I0001,共5页Zhejiang Medical Journal

基　　金：浙江省中医药科学研究基金计划(2012ZB061);浙江中医药大学校级科研基金(2012ZY12)

摘　　要：目的探讨MRI多参数成像对前列腺癌(PCa)的诊断价值。方法回顾性分析经病理证实PCa37例、前列腺增生42例和前列腺炎6例患者的T2Wf、弥散加权成像(DWl)及动态增强(DCE)资料。比较PCa与非癌患者的T_2WI、DWI、表观扩散系数(ADC)值和DCE表现。组合上述3种技术形成以下4种方案:方案1:T_2WI;方案2.T_2 WI+DWI;方案3:T_2WI+DCE;方案4:T_2WI+DWI+DCE。绘制ROC曲线,并采用Z检验比较曲线下面积(AUC),计算各方案的敏感度、特异度及准确度。结果 PCa在T_2WI上多呈斑片状、结节状低信号(25/37),DWI上大多呈斑片状或结节状明显高信号(33/37),动态增强均呈Ⅱ、Ⅲ型曲线(37/37);前列腺增生T_2WI上呈结节状高低混杂信号,DWI上大多呈等或稍高信号(33/42),动态增强大多呈Ⅰ、Ⅱ型曲线(39/42);前列腺炎T_2WI上多呈不规则稍低信号(4/6),DWI上多呈稍高信号(4/6),动态增强大多呈Ⅱ型曲线(4/6);PCa与非癌患者的ADC值分别约(0.99±0.21)×10^(-3)mm^2、(1175±0 25)×10^(-3)mm^2/s,两组问ADC值差异有统计学意义(P<0 05)。各方案AUC从小到大依次是:方案1:0.741、方案3:0.905、方案2:0 930、方案4:0.974。方案1与方案2N4间AUC值差异有统计学意义(P<0.05)。方案4的敏感度、特异度及准确度均最高,分别为94.59%、93.75%、94.12%。结论 MRI多参数成像显著提高前列腺癌的检出及诊断准确度,其中以T_2WI+DWI+DCE的诊断效能最高。Objective To assess the application of multiparametric magnetic resonance imaging in diagnosis of prostate cancer. Methods Thirty seven cases of prostate cancer, 42 cases of prostatic hyperplasia and 6 cases of prostatitis confirmed by pathology underwent magnetic resonance imaging （MRI） examination; the parameters of T2 weighted imaging （T2WI）, diffusion weighted imaging （DWI） and dynamic contrast-enhancement （DCE） were retrospectively analyzed. Four protocols were formed by combination of above three technologies： T2WI （protocol 1）, T2WI＋DWI （protocol 2）, T2WI＋DCE （protocol 3） and T2WI＋DWI＋DCE （protocol 4）. The areas under the receiver operating characteristic （ROC） curve of each protocol in diagnosis of prostate cancer were compared （AUC）, and the sensitivity, specificity and accuracy for each protocol were calculated. Results Prostate cancer often showed patchy, nodular low signal（25/37）on T2WI, patchy or nodular high signal（33/37 ）on DWI, type Ⅱ, Ⅲ curve （37/37） on DCE. Prostatic hyperplasia mainly showed mixed nodular signal on T2WI, equivalent or slightly high signal （33/42） on DWI, type Ⅰ , Ⅱ curve （39/42） on DCE. Prostatitis displayed triangular slightly low signal （4/6）on T2WI, higher signal（4/6）on DWI, type Ⅱ curve （3/6） on DCE. The apparent diffusion coefficient （ADC） value of prostate cancer and non-carcinoma were （0.99±0.21）×10^-3mm^2/s and （1.75±0.25）×10^-3mm^2/s, respectively （P〈0.05）. The areas under ROC curve of protocol 1, 2, 3 and 4 were 0.74, 0.930, 0.905 and 0.974, respectively. There was significant difference in AUC values between protocol 1 and protocol 2, 3, 4 were statistically significant difference （P〈0.05）. Taking cut-off value of protocol 1, 2, 3, the sensitivity, specificity and accuracy of protocol 4 in diagnosis of prostate cancer were the highest （94.59%, 93.75% and 94.12% respectively）. Conclusion Multiparametric magnetic resonance imaging can significantl

关 键 词：前列腺癌 前列腺增生 MRI多参数成像 

分 类 号：R737.25[医药卫生—肿瘤]