扩散峰度成像定量参数直方图分析在诊断前列腺癌及判定其恶性程度中的价值  

The value of histogram quantitative analysis based on diffusion kurtosis imaging in detecting prostate cancer and assessing tumor aggressiveness

作　　者：汪香玉 覃涛[2] 涂宁[1] 王科[1] 王攀英 吴光耀[1] Wang Xiangyu, Qin Tao ,Tu Ning ,Wang Ke , Wang Partying ,Wu Guangyao(Department of Medical Imaging, Zhongnan Hospital of Wuhan University, Wuhan 430071, Chin)

机构地区：[1]武汉大学中南医院医学影像科,430071 [2]三峡大学仁和医院影像科

出　　处：《中华放射学杂志》2018年第4期277-282,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金重点仪器专项（81227902）;国家重点研发专项（2016YFC1304702）

摘　　要：目的探讨扩散峰度成像（DKI）定量参数直方图分析在诊断前列腺癌和判定其恶性程度中的应用价值。方法回顾性分析2014年11月至2016年11月武汉大学中南医院，经前列腺穿刺活检诊断，有明确Gleason评分结果，且接受过前列腺MRI检查的120例患者。前列腺癌67例（90个癌灶），其中Gleason评分≤6分23例（37个癌灶），Gleason评分3＋4=7分7例（7个癌灶），Gleason评分4＋3=7分3例（3个癌灶），Gleason评分≥8分34例（43个癌灶）；低级别癌灶37个（Gleason评分≤6），高级别癌灶53个（Gleason评分≥7）。前列腺增生53例。患者均行前列腺常规MRI和多b值DKI检查，获得经非高斯模型校正后表观扩散系数（Dapp）、表观峰度系数（Kapp）值和ADC值，并行直方图分析。采用两独立样本t检验比较前列腺增生和前列腺癌病灶间、高低级别前列腺癌病灶间ADC、Dapp和Kapp值的差异。采用ROC分析DKI参数诊断前列腺癌及区分高低级别前列腺癌的效能。采用Pearson相关分析评估ADC、Dapp和Kapp值直方图参数与Gleason评分的相关性。结果前列腺增生与前列腺癌病灶间，除Kapp值偏度值差异无统计学意义外，其他参数差异均有统计学意义（P均〈0.05）。高、低级别前列腺癌灶间，除Kapp偏度值差异无统计学意义外，其余参数差异均有统计学意义（P均〈0.05）。ADC、Dapp与Kapp值的中位数、平均数和标准差鉴别诊断前列腺增生和前列腺癌，以及区分高、低级别的前列腺癌均有较好的效能，ROC下面积为0.558~0.985。ADC值的中位数、平均数（r值分别为－0.701、－0.676），Dapp值的中位数、平均数（r值分别为－0.712、－0.701），Kapp值的中位数、标准差及峰度（r值分别为0.458、0.516和－0.528）与Gleason评分有中度或较强的相关性（P均〈0.05）。结论DKI参数结合直方图分析有助于鉴别诊断前列腺癌以及评价前列腺癌恶Objective To explore the application value of histogram quantitative analysis based on diffusion kurtosis imaging （DKI） in detecting prostate cancer （PCa） and assessing tumor aggressiveness.MethodsOne hundred and twenty patients were retrospectively enrolled in Zhongnan Hospital of Wuhan University from November 2014 to November 2016, with diagnosis confirmed by prostate biopsy, definitive Gleason score（GS） results and prostate MRI examinations. There were 90 tumor foci in 67 prostate cancer patients, including 23 cases with GS≤6 （37 tumor foci）, 7 GS 3＋4=7（7 tumor foci）, 3 GS 4＋3=7（3 tumor foci）. Thirty four cases who were with GS≥8（43 tumor foci） were divided into low-grade PCa （37 GS ≤6） and high-grade PCa （53 GS≥7）. Fifty three patients were diagnosed with benign prostatic hyperplasia （BPH）. All patients underwent conventional prostate MRI examination and multi b value DKI examination. The apparent diffusion coefficient （Dapp） corrected by non-Gaussian model, apparent kurtosis coefficient （Kapp） and ADC value were obtained for histogram analysis. Student＇s t test was executed to compare the differences of ADCs, Dapp and Kapp values between prostate cancer（PCa） and BPH, low-grade PCa and high-grade PCa. ROC curves were used to evaluate the diagnostic value of ADCs, Dapp and Kapp values in differentiating PCa from BPH and differentiating high-grade PCa from low-grade PCa. Pearson correlation was used to assess the correlations between the histogram quantitative parameters of ADCs, Dapp and Kapp values and Gleason score.ResultsExcept skew of Kapp, the other histogram quantitative parameters of Kapp between PCa and BPH were statistically significant （all P〈0.05）. Except the skew of Kapp, the other histogram quantitative parameters of Kapp between low-grade PCa and high-grade PCa were statistically significant （all P〈0.05）. The median, mean and standard deviation of ADC, Dapp and Kapp have good diagnostic value in detecting PCa from BPH

关 键 词：前列腺肿瘤 磁共振成像 扩散峰度成像 直方图分析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]