体素内不相干运动联合表观扩散系数对前列腺癌诊断价值的研究  

Study on the value of combining intravoxel incoherent motion with apparent diffusion coefficient in the diagnosis of prostate cancer

作　　者：陈炤庭 邹玉坚[1] 袁灼彬 王朝阳[1] 黄小兰 张坤林 陈祐君 梁桂锋 CHEN Zhaoting;ZOU Yujian;YUAN Zhuobin;WANG Chaoyang;HUANG Xiaolan;ZHANG Kunlin;CHEN Youjun;LIANG Guifeng(Department of Radiology,the Tenth Affiliated Hospital of Southern Medical University(Dongguan People's Hospital),Dongguan 523059,China;Department of Urology,the Tenth Affiliated Hospital of Southern Medical University(Dongguan People's Hospital),Dongguan 523059,China)

机构地区：[1]南方医科大学第十附属医院(东莞市人民医院)放射科,东莞523059 [2]南方医科大学第十附属医院(东莞市人民医院)泌尿外科,东莞523059

出　　处：《磁共振成像》2024年第7期118-123,142,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：东莞市社会科技发展项目(编号:20231800904442)。

摘　　要：目的 探讨体素内不相干运动(intravoxel incoherent motion, IVIM)定量参数联合表观扩散系数(apparent diffusion coefficient, ADC)对前列腺癌(prostatecancer,PCa)的诊断价值。材料与方法 收集本院行前列腺多参数磁共振成像(multiparametric MRI, mpMRI)检查患者74例,其中PCa 41例(外周带PCa 28例,移行带PCa 13例),良性前列腺增生(benign prostatic hyperplasia, BPH)33例。采用双指数模型拟合算法获得真实扩散系数(true diffusion coefficient, D)、伪扩散系数(pseudo-diffusion coefficient, D^(*))、灌注分数(perfusion fraction, f)、ADC值等定量参数。比较PCa与前列腺T2WI低信号、高信号增生结节的D值、D^(*)值、f值、ADC值差异。采用受试者工作特征(receiver operating characteristic, ROC)曲线及曲线下面积(area under the curve, AUC)评价IVIM定量参数联合ADC对PCa的诊断效能。分析IVIM各定量参数、ADC与Gleason评分的相关性。结果 PCa的ADC值、D值及f值低于T2WI低信号、高信号增生结节,差异有统计学意义(P<0.05)。D值在鉴别PCa与前列腺T2WI低信号增生结节中的AUC最大,特异度最高,差异具有统计学意义(P<0.05)。联合ADC值、D值、f值在鉴别PCa与T2WI低信号增生结节中的AUC、敏感度显著提高(分别为0.948、90.24%)。ADC值在鉴别PCa与T2WI高信号增生结节中的AUC、敏感度、特异度均非常高(分别为0.997、97.65%、100.00%)。ADC值、IVIM各定量参数与Gleason评分无显著相关性(P=0.068、0.455、0.822、0.297)。结论 IVIM定量参数联合ADC可显著提高对PCa与BPH的鉴别诊断效能。Objective:To explore the diagnostic value of combining quantitative parameters of intravoxel incoherent motion(IVIM)with apparent diffusion coefficient(ADC)for prostate cancer(PCa).Materials and Methods:Seventy-four cases underwent multiparametric magnetic resonance(mpMRI)prostate examination,including 41 cases of PCa(28 cases in the peripheral zone,13 cases in the transitional zone)and 33 cases of benign prostatic hyperplasia(BPH).Quantitative parameters including true diffusion coefficient(D),pseudo-diffusion coefficient(D^(*)),perfusion fraction(f),and ADC value were obtained by using a bi-exponential model fitting algorithm.The differences in D value,D^(*)value,f value and ADC value were compared between PCa and prostate hyperplastic nodule with hypointense and hyperintense in T2WI.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of combining IVIM quantitative parameters with ADC for PCa.The correlation of each quantitative parameter of IVIM and ADC with the Gleason score was analyzed.Results:The ADC,D,and f values of PCa were significantly lower than those of hyperplastic nodule with hypointense and hyperintense in T2WI,with statistically significant differences(P<0.05).D value had the largest area under the curve(AUC)and the highest specificity in distinguishing PCa from prostate hyperplastic nodule with hypointense in T2WI,with statistically significant differences(P<0.05).The combination of ADC,D and f values significantly increased the AUC and sensitivity between PCa and hyperplastic nodule with hypointense in T2WI(0.948,90.24%respectively).ADC value showed very high AUC,sensitivity and specificity for distinguishing PCa from prostate hyperplastic nodule with hyperintense in T2WI(0.997,97.65%,100.00%respectively).There was no significant correlation between ADC value,each quantitative parameter of IVIM and the Gleason score(P=0.068,0.455,0.822,0.297).Conclusions:The quantitative parameters of IVIM combined with ADC can obviously improve the differential diagnosti

关 键 词：前列腺癌 前列腺增生 磁共振成像 体素内不相干运动 表观扩散系数 鉴别诊断 

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]