^1H-MRS对前列腺外周带良恶性病变的鉴别诊断价值  

Value of^1H-MRS for differential diagnosis of benign and malignant lesions in peripheral prostate zone

作　　者：张盼 李辉 付丽媛 钟群 肖慧 许尚文 陈自谦 ZHANG Pan;LI Hui;FU Li-yuan;ZHONG Qun;XIAO Hui;XU Shang-wen;CHEN Zi-qian(Radiology Department,the 900th Hospital of Joint Logistics Support Force,Fuzhou 350025,China;The Affilicated Dongfang Hospital of Xiamen University,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第900医院放射诊断科,福州350025 [2]厦门大学附属东方医院,福州350025

出　　处：《医疗卫生装备》2020年第8期1-5,共5页Chinese Medical Equipment Journal

基　　金：国家重点研发计划数字诊疗装备研发重点专项子课题(2016YFC0103103)。

摘　　要：目的:探讨氢质子磁共振波谱(^1H-magnetic resonance spectroscopy,^1H-MRS)技术在前列腺外周带良恶性病变鉴别诊断中的价值,评价^1H-MRS测得的代谢物变化与外周带前列腺癌(prostate cancer,PCa)血管生成的相关性。方法:选取某院65例前列腺特异抗原(prostate specific antigen,PSA)≥2.5 ng/ml并行常规MRI、^1H-MRS检查和病理活检的患者,其中外周带PCa 28例(PCa组),良性前列腺增生症(benign prostate hyperplasia,BPH)25例(BPH组)。另选取20名PSA正常且无泌尿系统症状的志愿者作为正常对照组。正常对照组只进行常规MRI、^1H-MRS检查,不进行病理活检。所有受试者进行^1H-MRS检查后将数据传送到后处理工作站,测量得到胆碱化合物(Cho)、肌酸(Cr)和枸橼酸盐(Ci)峰的峰值,并计算正常外周带区(normal periphery zone,NPZ)、BPH、外周带非肿瘤区(non-tumor area of periphery zone,NTAPZ)和PCa的Cho+Cr与Ci的峰值比[(Cho+Cr)/Ci]。对PCa组和BPH组患者进行活检穿刺和免疫组织化学检查,观察微血管密度(microvessel density,MVD)和血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达,并分析PCa的(Cho+Cr)/Ci值与MVD及VEGF表达的相关性。采用SPSS 22.0软件进行统计学分析,对PCa组和BPH组数据绘制ROC曲线并计算AUC值。结果:^1H-MRS表现:正常外周带区示Ci峰为主峰,Cho峰低平;BPH区示高耸的Ci峰,Cho峰略微增加;PCa区示Ci峰降低,Cho峰升高。PCa、BPH、NTAPZ和NPZ平均(Cho+Cr)/Ci值从高到低为2.37±1.42、0.49±0.34、0.45±0.28、0.23±0.21,4组间差异有统计学意义(P=0.016),PCa组与BPH组差异显著(P=0.003)。(Cho+Cr)/Ci截断值为1.005时,^1H-MRS诊断外周带PCa的敏感性、特异性和AUC值分别为93%、81%和0.93。PCa组的MVD和VEGF表达显著高于BPH组(P<0.05),(Cho+Cr)/Ci与MVD(P=0.018)和VEGF(P=0.026)显著相关。结论:^1H-MRS对PCa和前列腺良性病变的鉴别诊断具有较高的价值,(Cho+Cr))/Ci值在反映PCa血管生成情况方面具有�Objective To investigate the value of^1H-MRS for the differential diagnosis of benign and malignant lesions in the peripheral prostate zone,and to evaluate the correlation between metabolites changes measured by^1H-MRS and angiogenesis in the prostate cancer(PCa)in the peripheral zone.Methods Totally 65 patients with elevated prostate specific antigen(PSA)(≥2.5 ng/mL)undergoing routine MRI,^1H-MRS and pathological biopsy were selected,including 28 ones with PCa in the peripheral zone(PCa group)and 25 ones with benign prostate hyperplasia(BPH group);another 20 volunteers with normal PSA and no urological symptoms were enrolled into a normal control group.Only routine MRI and^1H-MRS examinations were performed in the normal control group.All the subjects went through^1H-MRS examination and the data were transferred to a post-processing workstation.The peak values of choline compound(Cho),creatine(Cr)and citrate(Ci)were measured,and the(Cho+Cr)/Ci ratio was calculated at the normal periphery zone(NPZ),BPH and non-tumor area of the periphery zone(NTAPZ).Biopsy and immunohistochemistry examinations were performed on the patients in the PCa and BPH groups to observe the expressions of microvessel density(MVD)and vascular endothelial growth factor(VEGF),and to analyze the correlation between(Cho+Cr)/Ci ratio and the expressions of MVD and VEGF.Statistical analysis was carried out using SPSS 22.0 software to plot ROC curves and calculate AUC values for the PCa and BPH group data.Results^1H-MRS showed that Ci peak was the main peak in normal peripheral zone and Cho peak was low and flat;high Cit peak and slightly increased Cho peak were shown in BPH area;decreased Ci peak and increased Cho peak could be observed in PCa area.The mean(Cho+Cr)/Ci ratios of PCa,BPH,NTAPZ and NPZ were 2.37±1.42,0.49±0.34,0.45±0.28 and 0.23±0.21 respectively,which had significant differences with each other(P=0.016);there was statistical difference between PCa group and BPH group(P=0.003),and the sensitivity,specificity and AUC values of^

关 键 词：MRI ^1H-MRS 前列腺外周带 前列腺癌 前列腺良性增生 微血管密度 血管内皮生长因子 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]