前列腺癌表观扩散系数值与Gleason评分的关系  

The relationship between ADC value and Gleason score in prostate cancer

作　　者：刘颖刚 徐云龙 王博 LIU Yinggang;XU Yunlong;WANG Bo(CT/MR Room,the Second Affiliated Hospital of Chifeng College,Chifeng 024000,China)

机构地区：[1]赤峰学院第二附属医院CT/核磁室,内蒙古赤峰024000

出　　处：《实用放射学杂志》2019年第9期1468-1471,1475,共5页Journal of Practical Radiology

摘　　要：目的定量研究前列腺内腺癌最低ADC值与Gleason评分的相关性。方法37例经病理证实的前列腺内腺癌患者术前行MRI检查。通过ROC曲线确定AUC,对AUC>0.85的组别确定敏感度(阳性率)、特异度(阴性率)、最大约登指数、最佳临界值和x±s。以最低ADC值95%置信区间、最佳临界值结合整体内腺癌最佳临界值确定相关级别ADC值参考范围。结果各组别ADC值均符合正态分布。37例内腺癌各有1例极端值(Z分数3.31)、离群值(Z分数2.84)和离群值(Z分数2.98),均予以剔除。36例内腺癌ADC值与Gleason评分负相关。各级别内腺癌ADC值方差齐;t检验低中级别P>0.05(P=0.122),其余级别均P<0.01。内腺癌AUC 0.991,敏感度即阳性率97.22%,特异度即阴性率98.9%,最大约登指数0.961,最佳临界值0.71×10^-3mm^2/s;低中级别内腺癌和高级别内腺癌AUC均为0.876,最大约登指数均为0.607,最佳临界值均为0.567×10^-3mm^2/s,敏感度分别为84.21%和76.47%,特异度分别为76.47%和84.21%,x±s分别为(0.626±0.071)×10^-3mm^2/s和(0.516±0.066)×10^-3mm^2/s。低中级别内腺癌95%置信区间为(0.487~0.75)×10^-3mm^2/s,高级别内腺癌95%置信区间为(0.386~0.646)×10^-3mm^2/s,低中级别和高级别重叠总数21例,重叠比例4:3。最佳临界值结合95%置信区间的低中级别和高级别内腺癌ADC值参考值范围:(0.567<最低ADC值≤0.71)×10^-3mm^2/s,低中级别,准确率78.95%(15/19);(0.386≤最低ADC值≤0.567)×10^-3mm^2/s,高级别,准确率81.25%(13/16)。结论前列腺内腺癌ADC值与Gleason评分显著负相关。在内腺癌高诊断价值的基础上初步确定了80%左右诊断准确率的低中级别和高级别内腺癌ADC值参考范围,具有较高的应用价值。Objective To investigate quantificationally the correlation between lowest ADC value and Gleason score in inner gland cancer of the prostate.Methods 37 patients with pathologically confirmed inner gland cancer of prostate underwent preoperative MRI examinatioa ROC curve for AUC and the sensitivity!positive rate),specificity (negative rate),maximum Youden index,optimal critical value,the mean± standard deviation were determined for larger than 0.85 AUC group. Determining the reference range of correlation grade ADC value by using 95% confidence interval and optimal critical value of the lowest ADC value,optimal critical value of overall inner gland cancer.Results The ADC values of all groups conformed to the normal distribution.The 1 extreme value (Z score 3.31),1 outlier (Z score 2.84) and 1 outlier (Z score 2.98) of the 37 cases of inner gland cancer were eliminated.The ADC value and the Gleason score in 36 cases of inner gland cancer was negative correlation. Various grades ADC value of inner gland cancer was homogeneoust. T test showed low-medium grade P>0.05 (P = 0.122) and the rest grade was P<0.01.The AUC was 0.991 .sensitivity (positive rate) 97.22%,specificity (negative rate) 98.9%.maximum Youden index 0.961 .optimal critical value 0.71×10^-3mm^2/s for the inner gland cancer,and the AUC was 0.876, maximum Youden index 0.607, optimal critical value 0.567×10^-3mm^2/s,the sensitivity 84.21% and 76.47% respectively, specificity 76.47% and 84.21% respectively,mean±standard deviation (0.626 ± 0.071)×10^-3mm^2/s and (0.516 ± 0.066 )×10^-3mm^2/srespectively for both low-medium grade and high grade inner gland cancer.The 95% confidence interval of low-medium grade inner gland cancer was(0.487-0.75)×10^-3mm^2/s and high grade was (0.386-0.646)×10^-3mm^2/s.The overlap number of low-medium and high grade was 21 cases, with an overlap ratio of 4 : 3.Combined optimal critical value with 95% confidence interval and the ADC value reference range of low-medium grade and high grade inner gland cancer for:(0.567<l

关 键 词：GLEASON评分 表观扩散系数 内腺癌 前列腺 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]