MR扩散加权成像单指数模型及体素内不相干运动模型参数直方图对移行区前列腺癌的诊断价值  

Histogram Analysis of Monoexponential DWI and Biexponential IVIM Model for the Differentiation of Prostate Cancer from BPH in the Transition Zone

作　　者：王希明[1] 包婕[1] 朱默[1] 平小夏[1] 胡春洪[1] 席启林[2] 董凤林[3] 孙军[3] 赵文露[4] 沈钧康[4] WANG Ximing;BAO Jie;ZHU Mo(Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006,P. R. China)

机构地区：[1]苏州大学附属第一医院影像中心,215006 [2]苏州大学附属第一医院泌尿外科,215006 [3]苏州大学附属第一医院超声科,215006 [4]苏州大学附属第二医院影像中心

出　　处：《临床放射学杂志》2018年第4期627-632,共6页Journal of Clinical Radiology

基　　金：苏州市临床重点病种诊疗技术专项基金(编号:LCZX201406);苏州市民生科技关键技术应用研究项目(编号:SS201748)

摘　　要：目的探讨DWI单指数模型（ADC）和体素内不相干运动（IVIM）双指数模型各参数直方图（Histogram）诊断移行区前列腺癌（PCa）的价值。方法回顾性搜集行前列腺常规MRI扫描和IVIM扫描并获得mp MRI/TRUS融合穿刺病理结果的49例患者资料;按三维感兴趣容积（VOI）法勾画移行区PCa和前列腺增生（BPH）病灶,计算ADC值和IVIM的D值、D＊值和f值,对所测得的参数行Histogram分析,得到各参数平均数、中位数、10%位数、90%位数、偏度和峰度。采用独立样本t检验（正态分布）和Mann-Whitney U检验（非正态分布）比较PCa组和BPH组Histogram参数,对于两组间差异具有统计学意义的参数值,应用ROC曲线分析各Histogram参数对移行区PCa和BPH的鉴别诊断效能。结果经病理证实移行区PCa 23例（28个病灶）和BPH 26例（33个病灶）;PCa组和BPH组的三维Histogram分析参数中,ADC值平均数、中位数、10%位数、90%位数偏度和峰度与D值的平均数、中位数和90%位数的差异具有统计学意义（P〈0.05）;ADC值平均数、中位数、10%位数、90%位数与D值平均数、中位数在鉴别移行区PCa和BPH的效能较高,ADC值平均数联合D值平均数曲线下面积（0.936）高于各单一参数的诊断效能,且差异具有统计学意义（P=0.049）。结论 DWI单指数模型和IVIM模型三维Histogram分析提供了病灶各参数的整体信息,对移行区PCa和BHP的鉴别诊断有一定的价值,以ADC值平均数联合D值平均数的诊断效能最优。Objective To evaluate histogram analysis of ADC and intravoxel incoherent motion（ IVIM） for detecting the prostate cancer（ PCa） in the transition zone（ TZ）. Methods A total of 49 patients underwent preoperative DW-MRI（ b of 0-1000 s/mm2） were prospectively collected and processed by monoexponential and biexponential IVIM model for quantitation of apparent diffusion coefficients（ ADCs）,perfusion fraction（ f）,diffusivity（ D） and pseudo-diffusivity（ D＊）.Histogram analysis was performed by outlining entire tumour regions of interest（ ROIs）. These parameters（ separately and combined in a logistic regression model） were used to differentiate lesions depending on histopathological analysis of magnetic resonance/transrectal ultrasound（ MR/TRUS） fusion guided biopsy. The diagnostic ability of differentiating the PCa from BHP in TZ was analysed by ROC regression. Results Twenty-two（ 28 focus） cases of PCa in PZ and 26（ 33 focus）cases of BPH were confirmed by pathology. Mean ADC,median ADC,10 th percentile ADC,90 th percentile ADC,kurtosis,skewness of ADC and mean D,median D and 90 th percentile D differed significantly between PCa and BPH in TZ. The highest classification accuracy was achieved by the mean ADC（ 0. 857） and mean D（ 0. 841）. Logistic regression models based on mean ADC and mean D led to an AUC of 0. 936. Conclusion Monoexponential DWI and biexponential IVIM could potentially improve the differentiation of prostate cancer in TZ,the combination of mean ADC and mean D performs better than the parameters alone in the diagnosis of PCa in TZ.

关 键 词：扩散加权成像 体素内不相干运动 前列腺癌 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]