磁共振动态增强扫描与DWI序列ADC图像评估前列腺癌病理分级的价值  

Value of dynamic contrast-enhanced magnetic resonance scanning and DWI sequence ADC image in the diagno⁃sis of pathological grading of prostate cancer

作　　者：潘玲玲 潘细根 占习双 王位 PAN Lingling;PAN Xigen;ZHAN Xishuang(Department of Radi-ology,Wenling Hospital of Traditional Chinese Medicine,Wenling 317500,China.)

机构地区：[1]温岭市中医院放射科,浙江温岭317500 [2]温岭市中医院泌尿外科,浙江温岭317500 [3]温岭市中医院神经内科,浙江温岭317500

出　　处：《全科医学临床与教育》2023年第4期332-335,共4页Clinical Education of General Practice

基　　金：温岭市科技项目(2015C311048)。

摘　　要：目的探究磁共振动态增强扫描(DCE-MRI)与磁共振弥散加权成像(DWI)表观弥散系数(ADC)图像对前列腺癌病理分级的评估价值。方法回顾性分析188例前列腺癌患者临床资料,所有患者均行DCE-MRI与DWI检查,以病理活检结果为金标准,根据Gleason分级系统将患者分为Ⅰ级组(52例)、Ⅱ级组(84例)、Ⅲ级组(52例)。分析DCE-MRI与DWI序列ADC图像诊断结果,比较不同Gleason分级患者动态增强扫描参数容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)及DWI图像ADC值,分析各参数与Gleason分级相关性,绘制受试者曲线(ROC)评估磁共振参数对病理分级的评估价值。结果DCE-MRI与DWI联合对前列腺癌检出率为85.11%(160/188)。Ktrans值、Kep值随病理分级升高而增大,ADC值随病理分级升高而减小(F分别=9.52、14.57、32.31,P均<0.05);不同病理分级Ve值比较,差异无统计学意义(F=0.57,P>0.05)。Ktrans值、Kep值与Gleason评分呈正相关(r分别=0.25、0.23,P均<0.05),ADC值与Gleason评分呈负相关(r=-0.38,P<0.05)。Ktrans值、Kep值、ADC值及三者联合诊断Ⅲ级前列腺癌的曲线下面积分别为0.68、0.66、0.76、0.83,三者联合诊断Ⅲ级前列腺癌的价值最高(Z分别=3.51、4.04、2.66,P均<0.05)。结论前列腺癌患者DCE-MRI检查参数Ktrans值、Kep值与病理分级Gleason评分呈正相关,DWI成像ADC值与Gleason评分呈负相关,三个参数值联合诊断高分化前列腺癌的价值较高,可作为评估前列腺癌患者肿瘤病理分级的参考指标。Objective To explore the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)apparent diffusion coefficient(ADC)image in the pathological grading of pros⁃tate cancer.Methods The clinical data of 188 patients with prostate cancer were retrospectively analyzed.All patients underwent DCE-MRI and DWI.Taking pathological biopsy results as the gold standard,the patients were divided into gradeⅠgroup(n=52),gradeⅡgroup(n=84)and gradeⅢgroup(n=52).The diagnostic results of DCE-MRI and DWI sequence ADC image were compared,and the dynamic contrast-enhanced scanning parameters such as volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular space volume fraction(Ve)and ADC value of DWI image were compared among patients with different Gleason grades.The correlation between each parameter and Gleason grading was analyzed,and receiver operator characteristic(ROC)curve was drawn to evaluate the value of mag⁃netic resonance parameters on pathological grading.Results The combined detection rate of DCE-MRI and DWI for prostate cancer was 85.11%(160/188).The Ktrans and Kep values were increased with the severity of pathological grading,while the ADC value was decreased with the severity of the pathological grading(F=9.52,14.57,32.31,P<0.05).There was no statistical difference in the Ve value and different pathological grading(F=0.57,P>0.05).Ktrans and Kep values were positively correlated with Gleason score(r=0.25,0.23,P<0.05),and ADC value was negatively correlated with Gleason score(r=-0.38,P<0.05).The areas under the curves of Ktrans value,Kep value,ADC value and the combination of the three indexs in diagnosing gradeⅢprostate cancer were 0.68,0.66,0.76 and 0.83 respectively,the combination of the three indexs had the highest value for diagnostic grade prostate cancer(Z=3.51,4.04,2.66,P<0.05).Conclusion DCE-MRI exami⁃nation parameters such as Ktrans value and Kep value of patients with prostate cancer are positively correlated with patho⁃l

关 键 词：前列腺癌 磁共振动态增强扫描 磁共振弥散加权成像 表观弥散系数 病理分级 

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]