标准化ADC、PSAD对PSA灰区PI-RADS 3分病灶的应用价值  

Application Value of Normalized Apparent Diffusion Coefficient and Prostate-specific Antigen Density for Prostate Imaging Reporting and Data System Category 3 Lesions in the Prostate-specific Antigen Gray Zone

作　　者：张苏波 赵艳 刘静芳 杨伏猛[1,2] 霍雷鸣 ZHANG Subo;ZHAO Yan;LIU Jingfang;YANG Fumeng;HUO Leiming(Department of Medical Imaging,Lianyungang Hospital Affiliated of Jiangsu University,Lianyungang 222000,China;Department of Medical Imaging,Lianyungang Second People's Hospital affiliated to Kangda College of Nanjing Medical University,Lianyungang 222000,China;Department of Respiratory Medicine,Lianyungang Second People's Hospital,Lianyungang 222000,China)

机构地区：[1]江苏大学附属连云港医院影像科,江苏连云港222000 [2]南京医科大学康达学院附属连云港第二人民医院影像科,江苏连云港222000 [3]连云港市第二人民医院呼吸科,江苏连云港222000

出　　处：《CT理论与应用研究（中英文）》2024年第1期63-70,共8页Computerized Tomography Theory and Applications

基　　金：江苏大学临床医学科技发展基金(JLY2021089);连云港市2023年度卫生健康面上科技项目(202325);江苏省卫生健康委2020年度医学科研项目(M2020079)。

摘　　要：目的:探讨当血清PSA处于4~10 ng/mL时,标准化表观扩散系数ADCn、前列腺特异性抗原密度PSAD在2.1版前列腺影像报告和数据系统(PI-RADS v2.1)评分3分病灶中的应用价值。方法:选取2018年1月至2022年6月经病理证实的58例PI-RADS v2.1评分为3分患者,PSA值均为4~10 ng/mL。根据病理结果分为PCa组(20例)和非PCa组(38例)。收集患者的临床资料,包括年龄、前列腺特异性抗原PSA、前列腺体积PV,通过公式计算PSAD(PSAD=PSA/V);同时于ADC图像上测量病变区及外周带正常组织的表观扩散系数值ADC,并计算标准化表观扩散系数值,即ADCn(ADC病灶/ADC外周带)。比较ADCn、PSAD在两组间差异是否具有统计学意义,采用受试者工作特性曲线(ROC)比较二者对PI-RADS v2.1评分3分病灶中PCa的诊断效能。结果:年龄、PSA在两组间差异无统计学意义;PCa组的ADCn小于非PCa组(0.52 vs.0.69),PCa组的PSAD大于非PCa组(0.28 vs.0.18)。ADCn、PSAD诊断PCa的ROC曲线下面积AUC、敏感度、特异度分别为0.849、85.2%、81.6%,0.813、85.0%、78.4%,ADCn表现的效能较高。当二者联合应用取最佳诊断阈值0.373时,诊断PCa的AUC为0.962,敏感度90.0%、特异度89.5%。结论:ADCn、PSAD能够辅助PSA灰区时PI-RADS v2.1评分3分病灶中PCa的检出,二者联合应用可明显提高诊断敏感性和特异性。Objective:To investigate the application value of normalized apparent diffusion coefficient(ADC)values and prostate-specific antigen density(PSAD)in category 3 Prostate Imaging Reporting and Data System(PI-RADS)version 2.1 lesions when the serum prostate-specific antigen(PSA)level is in the grey zone of 4~10 ng/mL.Methods:From January 2018 to June 2022,58 patients with PI-RADS v2.1 scores of 3 and PSA values of 4~10 ng/mL were selected.According to the pathological results,the patients were divided into the PCa(20 cases)and non-PCa(38 cases)groups.The clinical data of the patients were collected,including age,PSA,prostate volume(PV),and PSAD(PSA/V)calculated by formula.Meanwhile,the ADC values of the lesion area and the normal tissue in the peripheral zone were measured on the ADC image,and the standardized apparent diffusion coefficient value was calculated,namely ADCn(ADC lesion/ADC peripheral zone).Statistical software was used to determine the statistical significance of the differences of ADCn and PSAD between the two groups.Receiver operating characteristic(ROC)curves were used to compare the diagnostic efficacy of the two for PCa in lesions with PI-RADS v2.1 score of 3.Results:Age and PSA did not differ significantly between the two groups.Compared to the non-PCa group,the PCa group showed lower ADCn(0.52 vs.0.69)and higher PSAD(0.28 vs.0.18).The area under the ROC curve(AUC),sensitivity,and specificity of ADCn and PSAD in the diagnosis of PCa were 0.849,85.2%,and 81.6%and 0.813,85.0%,and 78.4%,respectively.For an optimal diagnostic threshold of 0.373,the AUC,sensitivity,and specificity of PCa were 0.962,90.0%,and 89.5%,respectively.Conclusions:ADCn and PSAD can assist in PCa detection in lesions category 3 PI-RADS v2.1 lesions in the PSA gray area.The combination of ADCn and PSAD can significantly improve the diagnostic sensitivity and specificity.

关 键 词：扩散系数 前列腺癌 前列腺特异性抗原密度 PSA灰区 

分 类 号：R814[医药卫生—影像医学与核医学]