磁共振扩散加权成像检查对前列腺癌新辅助内分泌治疗疗效的预测价值  

Evaluation and prediction of therapeutic response to neoadjuvant androgen deprivation therapy for prostate cancer by diffusion weighted imaging

作　　者：米悦[1] 吴静云[2] 沈棋[1] 虞巍[1] Mi Yue;Wu Jingyun;Shen Qi;Yu Wei(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China;Department of Radiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院泌尿外科、北京大学泌尿外科研究所、国家泌尿男性生殖系肿瘤研究中心,100034 [2]北京大学第一医院医学影像科,100034

出　　处：《中华泌尿外科杂志》2020年第2期120-125,共6页Chinese Journal of Urology

摘　　要：目的探讨磁共振扩散加权成像(DWI)检查对前列腺癌新辅助内分泌治疗疗效程度的预测价值。方法回顾性分析2016年1月至2019年9月北京大学第一医院收治的33例前列腺癌患者的病例资料。年龄平均67.7(49~81)岁。内分泌治疗前PSA平均36.8(7.5~126.5)ng/ml。33例均行前列腺MRI检查,其中30例于穿刺前平均18(2~33)d进行检查,3例于穿刺后平均35(20~44)d进行检查。扫描序列包括轴位和矢状位T1WI正反相位、冠状位T2WI压脂、轴位T1WI、轴位T2WI、轴位DWI及动态对比增强(DCE)序列。新辅助内分泌治疗前前列腺体积平均57.41(17.84~270.74)cm……3。由2名影像科医生根据前列腺影像报告和数据系统(PI-RADS)标准阅片,将PI-RADS 4~5分定义为前列腺癌灶。测量表观扩散系数(ADC)值。内分泌治疗前,患者正常外周带、移行带ADC值分别为(1.638±0.328)×10^-3mm^2/s、(1.335±0.249)×10^-3mm^2/s,癌灶ADC值为(0.828±0.291)×10^-3mm^2/s。所有患者均行经直肠超声引导下系统穿刺,病理诊断均为前列腺癌。Gleason评分:3+3分5例,3+4分4例,4+3分6例,3+5分1例,4+4分6例,4+5分8例,5+4分2例,5+5分1例。根据国际泌尿病理协会(ISUP)分级分组标准:1级(Gleason评分≤3+3=6分)5例,2级(Gleason评分3+4=7分)4例,3级(Gleason评分4+3=7分)6例,4级(Gleason评分4+4=8分、3+5=8分、5+3=8分)7例,5级(Gleason评分5+4=9分、4+5=9分、5+5=10分)11例。ISUP 1~3级为中低危组(15例),ISUP 4~5级为高危组(18例)。穿刺活检后行新辅助内分泌治疗,22例应用戈舍瑞林联合比卡鲁胺,9例应用曲普瑞林联合比卡鲁胺,2例应用亮丙瑞林联合比卡鲁胺。内分泌治疗时间平均7.2(5~13)个月。所有患者内分泌治疗后行根治性前列腺切除术。记录患者新辅助内分泌治疗后的ADC变化值和ADC变化率。比较ISUP中低危组和高危组的ADC变化值和ADC变化率,以及不同治疗反应程度患者的ADC变化值和ADC变化率。绘制受试者工作特征(ROC)�Objective To evaluate the effect of neoadjuvant androgen deprivation therapy(ADT)for prostate cancer on diffusion weighted imaging base on the pathological results after radical prostatectomy.Methods Medical records of 33 patients diagnosed with prostate cancer and treated with neoadjuvant androgen deprivation therapy and radical prostatectomy between January 2016 and September 2019 at Peking University First Hospital were retrospectively reviewed.Average age of patients was 67.7(49-81)years old.All of the patients underwent prostate MRI examination before and after neoadjuvant ADT.Results Mean prostate volume after neoadjuvant ADT is 28.5(6.25-113.76)cm^3,which decreased significantly by therapy(Z=-4.458,P<0.05).Apparent diffusion coefficient(ADC)values increased significantly in tumor(1.070±0.325)vs.(0.828±0.291)×10^-3mm^2/s(P<0.001)and decreased in benign prostatic tissue(P<0.05).Relative changes in ADC differed significantly between low-median level ISUP group and high level ISUP group(0.315±0.173)vs.(0.164±0.224)×10^-3mm^2/s(P<0.05),as well as obvious reaction group and focal reaction group(0.278±0.21)vs.(0.094±0.119)×10^-3mm^2/s(P<0.05).Conclusions There were significant,quantitative measurable changes of ADC value in prostate cancer after neoadjuvant ADT.DWI can be used to assess the efficacy of neoadjuvant ADT for prostate cancer as well as predicting pathological features.

关 键 词：前列腺肿瘤 前列腺癌 新辅助内分泌治疗 扩散加权成像 表观扩散系数 

分 类 号：R737[医药卫生—肿瘤] R44[医药卫生—临床医学]