高级扩散加权成像比单指数DWI在鉴别移行带前列腺癌与前列腺增生的优势  

The advantage of advanced diffusion-weighted imaging compared with single index DWI in differentiating transitional zone prostate cancer and benign prostatic hyperplasia

作　　者：任慧鹏[1] 范晴[1] 王晓虎[1] 任转琴 REN Huipeng;FAN Qing;WANG Xiaohu;REN Zhuanqin(Imaging Department of Baoji Central Hospital,Shaanxi Province,Baoji 721008,China)

机构地区：[1]陕西省宝鸡市中心医院影像科,宝鸡721008

出　　处：《磁共振成像》2020年第7期552-556,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：宝鸡市卫计局科研课题(编号:2017-06)。

摘　　要：目的探讨高级扩散加权成像(advanced diffusion-weighted imaging)在移行带前列腺癌(transition zone prostate cancer,TZ-PCa)与良性前列腺增生(benign prostatic hyperplasia,BPH)鉴别诊断中较单指数扩散加权成像(diffusion-weighted imaging,DWI)的优势。材料与方法收集经病理证实的48例TZ-PCa患者及56例BPH患者,所有患者均接受了常规序列、单指数DWI、高级扩散加权成像序列扫描,高级扩散加权成像包括体素内不相干运动DWI(introvoxel incoherent movement DWI,IVIM-DWI)、拉伸指数DWI模型(stretched exponential DWI model,SEM)、扩散峰度成像(diffusion kurtosis imaging,DKI),测量单指数DWI的表观扩散系数(apparent diffusion coefficient,ADC)、IVIM-DWI的慢速扩散系数(ADCslow)、SEM的扩散分布系数(distributed diffusion coefficient,DDC)及DKI的平均峰度(mean kurtosis,MK)等参数值,采用独立样本t检验比较两组间诸参数值的差异。用受试者工作特征(receiver operating characteristic curve,ROC)曲线评价诸参数鉴别诊断TZ-PCa和BPH的效能,用Z检验比较各参数值间的曲线下面积(area under the cure,AUC)。结果TZ-Ca与BPH间的ADC、ADCslow、DDC及MK值均具有统计学差异(P值均<0.001)。MK、DDC、ADCslow、ADCslow+DDC+MK及ADC值的诊断效能均较高(AUC均>0.9),MK、DDC及ADCslow+DDC+MK的诊断效能优于ADC值(P值均<0.05),MK+DDC+ADCslow的诊断效能最大(AUC=1),联合参数较单参数有更好的敏感度和特异度。结论高级扩散加权成像鉴别诊断移行带前列腺癌和前列腺增生的效能优于单指数DWI,ADCslow+DDC+MK联合能进一步提高诊断的敏感度和特异度。Objective:To investigate the advantage of advanced diffusion-weighted imaging in the differential diagnosis of transitional zone prostate cancer(TZ-PCa)and benign prostatic hyperplasia(BPH)compared with single index diffusion-weighted imaging(DWI).Materials and Methods:Forty-eight patients with TZ-PCa and 56 patients with BPH confirmed by pathology were collected.All patients were scanned with conventional sequence,single index DWI and advanced diffusion weighted imaging sequence.advanced diffusion weighted imaging included introvoxel incoherent movement DWI(IVIM-DWI),stretched exponential DWI model(SEM)and diffusion kurtosis imaging(DKI).Measure the diffusion coefficients(ADC,ADCslow,DDC)from single index DWI,IVIM-DWI and SEM and average kurtosis(MK)from DKI,independent sample t-test was used to compare the differences of these parameters between the two groups.The ROC curve was used to evaluate the effectiveness of the parameters in the differential diagnosis of TZ-PCa and BPH,and the AUC between the parameters was compared by Z-test.Results:there were significant differences in ADC,ADCslow,DDC and MK between TZ-Ca and BPH(P<0.001).The diagnostic efficiency of MK,DDC,ADCslow,ADCslow+DDC+MK and ADC value were all higher(AUC>0.9),the diagnostic efficiency of MK,DDC and ADCslow+DDC+MK was better than ADC value(P<0.05),the diagnostic efficiency of ADCslow+DDC+MK was the highest(AUC=1),and the combined parameters had better sensitivity and specificity than single parameters.Conclusions:advanced diffusion-weighted imaging is superior to the single index DWI in the differential diagnosis of TZ-PCa and BPH.ADCslow+DDC+MK can further improve the sensitivity and specificity of the diagnosis.

关 键 词：前列腺肿瘤 前列腺增生 磁共振成像 扩散加权成像 诊断 鉴别 

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]