功能MRI定量技术在前列腺癌中的应用研究进展  

Research progress of quantitative functional magnetic resonance imaging in prostate cancer

作　　者：朱蓉 王关顺 张娅 李瑞乾 杨银蕊 沈婧 顾尚尉 ZHU Rong;WANG Guanshun;ZHANG Ya;LI Ruiqian;YANG Yinrui;SHEN Jing;GU Shangwei(Department of Radiology,Yunnan Hospital of Peking University Cancer Hospital,Kunming,Yunnan 650100,China)

机构地区：[1]北京大学肿瘤医院云南医院(云南省肿瘤医院)放射科,云南昆明650100

出　　处：《中华全科医学》2024年第12期2104-2107,共4页Chinese Journal of General Practice

基　　金：云南省科技厅计划项目(202301AY07001-093)。

摘　　要：目前临床上主要通过前列腺特异性抗原(PSA)检测、MRI检查及超声引导下穿刺活检来诊断前列腺癌(PCa)。PSA是PCa的特异性肿瘤标志物,但前列腺增生、前列腺炎、膀胱镜检等PSA亦会升高,易出现假阳性结果。MRI是诊断的主要影像学检查技术,尤其是功能MRI在PCa的诊断中具有重要价值。目前基于扩散加权成像(DWI)、T_(2)WI、动态对比增强(DCE)形成的前列腺影像报告和数据系统(PI-RADS)已广泛应用于PCa的临床诊断中。但是对于各序列的评分仍然依赖影像科医生的主观性经验,尤其是PI-RADS 3分病灶不能确定其良恶性,也导致对该类病灶穿刺建议的不确定性。另外,不同危险分层PCa的预后、治疗方案的选择不同。PCa侵袭性通常通过Gleason评分(GS)反映。GS为最常见的肿瘤组织学Gleason分级数加上次常见的组织学Gleason分级数之和,Gleason分级根据细胞的分化程度分为1~5级,分级越高,细胞分化程度越差,预后越差。近年来,体素内不相干运动扩散加权成像、扩散峰度成像、动态增强磁共振成像、酰胺质子转移成像等多种功能MRI新技术不断发展,其定量参数可对前列腺病灶的细胞结构及细胞扩散、微循环灌注及血管生成、分子代谢变化等精准量化,有助于提高前列腺癌的诊断准确性,并具有预测肿瘤侵袭性的潜力,这将为PCa的正确诊断提供更多有价值的客观证据。本文综述以上功能MRI定量新技术在PCa诊断中的研究进展。Prostate specific antigen(PSA),MRI examination and ultrasound-guided puncture biopsy are mainly used to diagnose prostate cancer(PCa).PSA is a specific tumor marker for PCa,but PSA is also elevated in prostate hyperplasia,prostatitis,cystoscopy,etc.,which is prone to false-positive results.MRI is the main imaging technique for diagnosis,especially functional MRI plays an important value in the diagnosis of PCa.At present,the prostate imaging reporting and data system(PI-RADS)based on diffusion weighted imaging,diffusion weighted imaging(DWI),DCE and T_(2)WI has been widely used in the clinical diagnosis of PCa.However,the scoring of each sequence still relies on the subjective experience of the imaging physician,especially the PI-RADS score of 3 lesions cannot be determined as benign or malignant,which also leads to the uncertainty of the recommendation of puncture for such lesions.In addition,the prognosis and choice of treatment options for PCa differ among different risk strata.The aggressiveness of PCa is usually reflected by the Gleason score(GS).GS is the sum of the most common histological Gleason grade of the tumor plus the second most common histological Gleason grade.Gleason grading is divided into 1-5 grades according to the degree of differentiation of the cells,and the higher the grade,the worse the degree of cell differentiation and the worse the prognosis.In recent years,various new functional MRI techniques such as amide proton transfer imaging,intravoxel incoherent motion diffusion weighted imaging,diffusion kurtosis imaging,dynamic enhanced magnetic resonance imaging,etc.have been developed,and their quantitative parameters can accurately quantify the cytoarchitecture of prostate foci and cellular diffusion,microcirculation perfusion and angiogenesis,and molecular metabolism changes,which can help to increase the diagnostic accuracy of prostate cancer and have the potential to predict tumor.It also has the potential to predict tumor aggressiveness,which will provide more valuable objective evide

关 键 词：前列腺癌 扩散加权成像 动态增强磁共振成像 酰胺质子转移成像 体素内不相干运动 扩散峰度成像 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]