超高b值扩散峰度成像对前列腺癌的诊断及肿瘤分级评估价值  

Evaluation of diffusion kurtosis imaging for detection and grading of prostate cancer

作　　者：李敏[1] 王明帅[2] 张继洋 张小东[2] 蒋涛[1] LI Min;WANG Ming-shuai;Zhang Ji-yang(Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《放射学实践》2021年第5期611-616,共6页Radiologic Practice

摘　　要：目的:探讨超高b值扩散峰度成像(DKI)对前列腺癌(PCa)的诊断及肿瘤分级评估价值。方法:回顾性分析经病理证实的63例PCa及39例前列腺增生(BPH)患者的术前DWI图像。计算癌灶及良性病灶的表观扩散系数(ADC_(3000))、DKI扩散系数(D_(7b))及峰度系数(K)。依据术后病理结果,将63例PCa患者分为低危组(Gleason评分=3+3、3+4)、中危组(Gleason评分=4+3、4+4)及高危组(Gleason评分≥9),比较低、中、高危组前列腺癌组织的D_(7b)、K及ADC_(3000)值,分析DKI预测PCa组织Gleason评分的能力。结果:外周带:39例癌灶的平均K值较39例良性病灶高,ADC_(3000)及D_(7b)值较良性病灶低,差异均有统计学意义(P值均<0.01)。DKI(D+K)及ADC_(3000)诊断外周带PCa的曲线下面积(AUC)分别为0.968及0.971。移行带:24例癌灶的平均K值较39例BPH高,ADC_(3000)及D_(7b)值较BPH低,差异均有统计学意义(P值均<0.01)。DKI(D+K)及ADC_(3000)诊断移行带PCa的AUC分别为0.963及0.955。低危组PCa的平均D、ADC_(3000)值与中、高危组差异均有统计学意义(P<0.001),低危组PCa的平均K值仅与高危组差异有统计学意义(P<0.001)。结论:b值最高为4000 s/mm^(2)时,DKI模型可用于PCa的鉴别诊断及肿瘤分级评估;相比ADC_(3000),DKI模型尚不能提供更多的临床诊断信息。Objective:To investigate the value of diffusion kurtosis imaging(DKI)for detection and grading of prostate cancer(PCa).Methods:The retrospective study included 102 patients with histopathological results(39 with benign prostate hyperplasia(BPH)and/or prostatitis,63 with prostate cancer).All patients underwent preoperative DWI with 7 b-value ranging from 0 to 4000s/mm^(2).ADC,D_(7b),K values were calculated.The PCa lesions were classified as low,indeterminate,and high risk groups according to Gleason scores.ADC,D and K values were compared between benign lesions and PCa.Quantitative DKI parameters were further compared among low,indeterminate,and high risk groups.Results:DKI parameters exhibited significant differences between benign lesions and PCa.The mean ADC_(3000) and D_(7b) values in PZ and TZ tumors were significantly lower than those in other benign peripheral region and BPH(P<0.01),and K significantly increased(P<0.01).Lower ADC,D_(7b) and higher K values were significantly associated with higher tumor Gleason grades(P<0.01).Combination of D and K yielded the largest area under curve(AUC)for PZ and TZ tumors differentiation,but there was no significant difference comparing to ADC alone(P>0.05).Conclusion:DKI may be valuable for characterization and grading of prostate carcinoma both in PZ and TZ.No additional benefits exists in comparison with conventional ADC measurements.

关 键 词：前列腺肿瘤 前列腺增生 扩散峰度成像 扩散加权成像 外周带 移行带 

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