动态对比增强磁共振定量参数三维直方图与前列腺癌Gleason评分的相关性  

Correlation between three-dimensional histogram analysis of dynamic contrast-enhanced MRI and Gleason score in prostate cancer

作　　者：李志平 张永胜[1] 崔凤[1] 沈建良[2] 徐辉景 乐先杰[1] 舒畅 庞佩佩 陈明涛[5] 许茂盛[2] Li Zhiping;Zhang Yongsheng;Cui Feng;Shen Jianliang;Xu Huijing;Yue Xianjie;Shu Chang;Pang Peipei;Chen Mingtao;Xu Maosheng(Department of Radiology,Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007;Department of Radiology,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006;Department of Pathology,Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007;GE Institute of medical precision medicine,Hangzhou 310004;Department of Pathology,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006)

机构地区：[1]浙江中医药大学附属杭州市中医院放射科,杭州310007 [2]浙江中医药大学附属第一医院放射科,杭州310006 [3]浙江中医药大学附属杭州市中医院病理科,杭州310007 [4]GE医疗精准医学研究院,杭州310004 [5]浙江中医药大学附属第一医院病理科,杭州310006

出　　处：《中华老年医学杂志》2022年第3期296-301,共6页Chinese Journal of Geriatrics

基　　金：浙江省医药卫生科技项目(2018KY612、2020KY227)。

摘　　要：目的探讨双中心动态对比增强磁共振成像(DCE-MRI)定量参数三维直方图与前列腺癌Gleason评分(GS)的相关性及其在低、高级别前列腺癌中的诊断效能。方法回顾性分析2017年1月至2020年10月浙江中医药大学附属第一医院和浙江中医药大学附属杭州市中医院经病理证实的前列腺癌患者102例。按三维感兴趣体积法在DCE-MRI原始图形上逐层手动勾画,获得前列腺癌的定量参数,包括转运常数(K^(trans))、速率常数(K_(ep))和血管外细胞外间隙体积百分数(V_(e))和血浆内对比剂容积分数(V_(p)),然后进行三维直方图分析。分析各定量参数与GS的相关性及其诊断效能。结果低级别前列腺癌组(GS≤3+4)44例和高级别前列腺癌组(GS≥4+3)58例。两组间的年龄、病灶位置差异无统计学意义(均P>0.05),Gleason评分、前列腺特异抗原(PSA)水平、病灶直径差异有统计学意义(U=0.000、730.000、711.000,均P<0.05)。DCE-MRI的定量参数直方图中,K^(trans)、Kep(中位数、平均值、10%位数、25%位数、75%位数、90%位数)和K^(trans)(最大值)、Ve(平均值)与GS呈正相关(r=0.405~0.583,均P<0.05),Vp与GS呈负相关(r=-0.301~-0.341,均P<0.05),其中K^(trans)平均值正相关最高(r=0.583,P=0.000)。取r>0.4的定量参数通过ROC进行评估,其中K^(trans)75%位数的ROC下面积(AUC)最大,为0.832;当Ktranns75%位数的截点值≥0.680时,其约登指数为0.594,敏感度为0.776,特异度为0.818。结论DCE-MRI定量参数三维直方图与前列腺癌GS具有相关性,可以用于鉴别低、高级别前列腺癌。Objective To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital,and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca,including transport constant(K^(trans)),rate constant(K_(ep)),percent volume of the extravascular extracellular space(V_(e))and fraction of the Intraplasmic contrast volume(V_(p)),were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum,maximum,median,mean,area,10thpercentile,25thpercentile,75thpercentile and 90^(th)percentile.The correlations between quantitative parameters and GS,and diagnostic efficiencies were analyzed.Results 102 Pca patients were divided into low-grade prostate cancer group(GS≤3+4)(n=44)and high-grade Pca group(GS≥4+3)(n=58).There were no statistically significant differences in age and location of lesions between the two groups(P>0.05),but there were statistically significant differences in Gleason score,PSA level and lesion diameter between the two groups(U=0.000,730.000,711.000,all P<0.05).The median,mean,10thpercentile,25thpercentile,75thpercentile,90thpercentile derived from K^(trans),and Kep(median,mean,10%,25%,75%,90%)together with maximum of K^(trans)and mean for Ve were positively correlated with GS(r=0.405 to 0.583,P<0.05),in which mean of K^(trans)had the highest positive correlation(r=0.583,P=0.000).The histogram parameters derived from Vpwere negatively correlated with GS(r=-0.301 to

关 键 词：磁共振成像 前列腺肿瘤 直方图分析 

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]