基于PI-RADS研究MRI多参数成像对移行区前列腺癌的诊断价值  

A Study for Diagnostic Value of Multiparametric Magnetic Resonance Imaging in Transition Zone Prostate Cancer Based on Prostate Imaging Reporting and Data System

作　　者：张永胜[1,2] 龚向阳[1] 陈瑶[2] 郑斐群[2] 陈祖华[2] 张志田[2] 唐栋[2] 乐玲[2] 

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,310016 [2]浙江中医药大学附属第二医院放射科,310005

出　　处：《临床放射学杂志》2015年第6期930-934,共5页Journal of Clinical Radiology

基　　金：浙江省中医药科学研究基金计划项目(编号:2012ZB061)

摘　　要：目的基于PI-RADS评分研究MRI多参数成像对移行区前列腺癌(PCa)的诊断价值。方法回顾性分析经病理证实的移行区PCa 23例、前列腺增生(BPH)33例患者的T2WI、DWI及动态增强(DCE)资料,采用PIRADS评分对T2WI、T2WI+DCE、T2WI+DWI、T2WI+DWI+DCE四种组合图像进行分析,首先对两位医师统计的评分结果进行Cohen’s Kappa检验,再计算移行区PCa与BPH四种组合图像的平均评分并采用独立样本t检验比较。绘制ROC曲线并采用Z检验比较曲线下面积(Az),计算四种组合图像的敏感性、特异性及准确性。测量移行区PCa与BPH的ADC值并进行比较。结果在T2WI、T2WI+DCE、T2WI+DWI、T2WI+DWI+DCE四种组合图像中,两位医师的评分结果均具有较高的一致性(P﹤0.05),移行区PCa的平均评分依次为3.13±1.18、3.52±1.04、3.96±1.22、3.91±1.27,BPH的平均评分依次为2.18±0.88、2.33±1.05、2.42±1.28、2.27±1.21,移行区PCa的评分结果高于BPH(P﹤0.05);四种组合图像诊断移行区PCa的Az依次为0.713、0.767、0.798和0.812,各组合图像间差异均无统计学意义(P>0.05);四种组合图像的敏感性依次为60.87%、86.96%、91.30%、82.61%,特异度依次为63.64%、54.55%、42.42%、63.64%,准确性依次为62.5%、67.86%、62.50%、71.43%。移行区PCa与BPH的ADC值分别为(0.952±0.227)×10-3mm2/s、(1.299±0.243)×10-3mm2/s,两组间ADC值差异有统计学意义(P﹤0.05)。结论 MRI多参数成像有助于提高移行区PCa的检出及诊断准确性,其中以T2WI+DWI+DCE的诊断价值最高。PI-RADS评分是一种评价移行区PCa较好的半定量方法。Objective To investigate the diagnostic value of multiparametric magnetic resonance imaging in transition zone of prostate cancer（ PCa） based on prostate imaging reporting and data system（ PI-RADS）. Methods 23 cases of transition zone PCa and 33 cases of benign prostatic hyperplasia（ BPH） were confirmed by pathology with the result of T2 WI,DWI,and dynamic contrast enhancement（ DCE） were retrospectively analyzed. Four combined images which contained T2 WI,T2WI ＋ DCE,T2 WI ＋ DWI,T2 WI ＋ DWI ＋ DCE were analyzed based on PI-RADS score. The statistical scores for two physicians were compared by Cohen＇s kappa test,and then the average score of transition zone PCa and BPH were calculated and the independent samples t-test was used to compare the four combined images. ROC curve was drew and areas under the curve（ Az） were analyzed by Z test. The sensitivity,specificity and accuracy of four combined images were calculated. ADC values of transition zone PCa and BPH were measured and compared. Results In four combined images of T2 WI,T2WI ＋ DCE,T2 WI ＋ DWI,T2 WI ＋ DWI ＋ DCE,the scoring results for two physicians had high consistency（ P〈0. 05）,the average scores of transition zone PCa in order were 3. 13 ± 1. 18,3. 52 ± 1. 04,3. 96 ± 1. 22,3. 91 ±1. 27,the average scores of BPH in order were 2. 18 ± 0. 88,2. 33 ± 1. 05,2. 42 ± 1. 28,2. 27 ± 1. 21 and scores of transition zone PCa were higher than BPH（ P〈0. 05）. The Az values of four combined images to diagnose transition zone PCa were in an order of 0. 713,0. 767,0. 798 and 0. 812,and there were no significant differences among the groups（ P〈0. 05）. In four combined images,the sensitivity were 60. 87%,86. 96%,91. 30%,82. 61% in order,specificity were63. 64%,54. 55%,42. 42%,63. 64% in order,and accuracy were 62. 5%,67. 86%,62. 50%,71. 43% in order.ADC values of transition zone PCa and BPH were（ 0. 952 ± 0. 227） × 10- 3mm2/ s,（ 1. 299 ± 0. 243） × 10- 3mm2/ s respectively and there were significant dif

关 键 词：前列腺癌 前列腺增生 磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]