MRI多指标联合在前列腺癌中的鉴别诊断价值研究  

Research on the Differential Diagnostic Value of MRI Multi Index Combination in Prostate Cancer

作　　者：李守斌 侯唯姝[1] 张书海 汪军[1] LI Shoubin;HOU Weishu;ZHANG Shuhai;WANG Jun(Department of Radiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,P.R.China)

机构地区：[1]安徽医科大学第一附属医院放射科,安徽合肥230022

出　　处：《影像科学与光化学》2024年第6期654-659,共6页Imaging Science and Photochemistry

基　　金：安徽省转化医学研究院科研基金资助项目(2022zhyx-B14)。

摘　　要：目的:探讨表观扩散系数(ADC)联合氨基质子转移成像(APT)技术对前列腺癌(PCa)和前列腺增生(BPH)的鉴别诊断价值,预期通过多指标联合分析提高诊断准确率。方法:回顾性分析2023年6-12月本院62例前列腺患者的MRI资料,经病理证实BPH:30例,PCa:32例。所纳患者采用Philips Ingenia 3.0T CX磁共振扫描仪进行检查,在常规T1WI、T2WI序列的基础上加做高b值(b=2000 s/mm^(2))DWI和APT序列,将DWI和APT图像上传到Philips专用工作站IntelliSpace,测量得到ADC值、APT值,rAPT通过公式rAPT=ROI内的APT值/对侧的APT值计算获得。PCa组和BPH组基线资料以及APT、rAPT、ADC比较采用独立样本t检验。Logistic回归构建多参数联合诊断模型,绘制ROC曲线以AUC评估3个指标的单独以及联合诊断效能。结果:ADC(t=2.169,P=0.034)、APT(t=-8.156,P<0.001)、rAPT(t=-8.917,P<0.001)3个指标在PCa组和BPH组之间存在明显的统计学差异。APT的最佳诊断阈值为2.25%,敏感度为91%,特异度为83%,AUC为0.921(95%CI:0.849~0.993,P<0.05)。rAPT的最佳诊断阈值为1.175,敏感度为88%,特异度为93%,AUC为0.876(95%CI:0.772~0.980,P<0.05)。ADC的最佳诊断阈值为0.803×10^(-3) mm^(2)/s,敏感度为94%,特异度为97%。AUC为0.928(95%CI:0.841~1.000,P<0.05)。联合诊断的AUC为0.969(95%CI:0.920~1.000,P<0.001)。结论:APT、rAPT、ADC联合诊断效能优于单独诊断效能,临床MRI多指标联合分析可提高诊断准确率。Objective:To explore the value of apparent diffusion coefficient(ADC)combined with amide proton transfer imaging(APT)in the differential diagnosis of prostate cancer(PCa)and prostatic hyperplasia(BPH),and to improve the diagnostic accuracy through the combined analysis of multiple indicators.Methods:The MRI data of 62 prostate patients in our hospital from June to December 2023 were retrospectively analyzed.Pathological findings showed that 30 cases of BPH and 32 cases of PCa.The patients were examined by Philips Ingenia 3.0T CX magnetic resonance scanner,and high b-value(b=2000 s/mm^(2))DWI and APT sequences were added on the basis of conventional T1WI and T2WI sequences.The DWI and APT images were uploaded to IntelliSpace,a Philips dedicated workstation,and ADC values and APT values were measured.The rAPT was calculated by the APT value in the formula rAPT=APT in ROI/the APT value on the opposite side.The baseline data of PCa group and BPH group as well as APT,rAPT and ADC were compared by independent sample t test.Logistic regression was used to construct a multi-parameter combined diagnosis model,and ROC curve was drawn to evaluate the single and combined diagnosis efficiency of the three indicators with AUC.Results:ADC(t=2.169,P=0.034),APT(t=-8.156,P<0.001)and rAPT(t=-8.917,P<0.001)were significantly different between PCa group and BPH group.The optimal diagnostic thresholds for APT were 2.25%,sensitivity 91%,specificity 83%,and AUC 0.921(95%CI:0.849-0.993,P<0.05).The optimal diagnostic threshold of rAPT was 1.175,sensitivity was 88%,specificity was 93%,and AUC was 0.876(95%CI:0.772-0.980,P<0.05).The optimal diagnostic threshold of ADC is 0.803×10^(-3) mm^(2)/s,with 94%sensitivity and 97%specificity.The AUC was 0.928(95%CI:0.841-1.000,P<0.05).The AUC for combined diagnosis was 0.969(95%CI:0.920-1.000,P<0.001).Conclusion:APT,rAPT,ADC combined diagnostic efficiency is better than single diagnostic efficiency,clinical MRI multi-index combined analysis can improve the diagnostic accuracy.

关 键 词：前列腺增生 表观扩散系数 前列腺癌 氨基质子转移成像 

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]