多参数MRI联合临床相关指标对PSA灰区前列腺癌的诊断及危险分层  

Diagnosis and Risk Stratification of Prostate Cancer in the Psa Grey Zone by Multiparametric MRI Combined with Clinically Relevant Indicators

作　　者：汪兵 谭必勇 WANG Bing;TAN Bi-yong(Department of radiology,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,Hubei Province,China)

机构地区：[1]恩施土家族苗族自治州中心医院放射科,湖北恩施445000

出　　处：《中国CT和MRI杂志》2025年第2期156-158,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨多参数磁共振成像(mpMRI)联合临床相关指标对前列腺特异性抗原(PSA)灰区前列腺癌(PCa)的诊断及危险分层价值。方法回顾性分析2020年4月至2023年3月收治的204例PSA灰区(4~10 ng/mL)的可疑PCa患者的临床病理资料,穿刺前均接受mpMRI[T2WI、弥散加权成像(DWI)、磁共振动态对比增强(DCE-MRI)]扫描,对mpMRI参数进行前列腺影像报告和数据系统(PI-RADS)V2.1评分。以病理诊断结果为金标准将患者分为临床显著性PCa(CsPCa)组和非CsPCa组,比较两组的mpMRI PI-RADS V2.1评分及临床相关指标,采用多因素Logistic回归分析法分析CsPCa的独立相关因素,并构建风险预测模型,采用受试者工作特征(ROC)曲线分析进行CsPCa诊断效能评价。结果本研究共纳入204例PSA灰区可疑PCa患者,年龄49~87岁,平均(66.48±6.05)岁。穿刺活检病理证实CsPCa 34例,非CsPCa 170例。CsPCa组与非CsPCa组mpMRI PI-RADS V2.1评分分布比较,差异有统计学意义(P<0.05)。CsPCa组患者年龄、PSA密度(PSAD)、外周带(PZ)位置检出率、直肠指检阳性率高于非CsPCa组,前列腺体积、游离PSA(fPSA)、游离/总PSA(f/t PSA)低于非CsPCa组(P<0.05)。多因素Logistic回归分析结果显示,PSAD及PI-RADS V2.1评分升高均是CsPCa的独立危险因素,f/tPSA升高是独立保护因素(P<0.05),据此构建PSA灰区CsPCa危险模型:P=-0.221-0.334×f/t PSA+0.124×PSAD+0.729×PI-RADS V2.1评分(χ^(2)=18.442,P<0.001)。ROC分析显示,f/t PSA、PSAD、PI-RADS V2.1评分单独用于诊断CsPCa的AUC(95%CI)为0.878(0.825~0.920)、0.683(0.614~0.746)、0.814(0.753~0.865),危险模型诊断CsPCa的AUC为0.934(0.891~0.964),高于三项单独诊断(P<0.05)。结论mpMRI联合临床相关指标f/t PSA、PSAD对PSA灰区PCa有较高的诊断价值,基于mpMRI构建的模型可提高对PSA灰区PCa危险分层预测的准确性。Objective To investigate the diagnostic and risk stratification value of multiparametric magnetic resonance imaging(mpMRI)combined with clinical related indexes for prostate-specific antigen(PSA)grey zone prostate cancer(PCa).Methods Clinicopathological data of 204 patients with suspected PCa in the grey zone of PSA(4-10 ng/mL)admitted from April 2020 to March 2023 were retrospectively analysed.All underwent mpMRI[T2WI,diffusion-weighted imaging(DWI),magnetic resonance dynamic contrast-enhanced(DCE-MRI)]scanning before puncture.Prostate Imaging Reporting and Data System(PI-RADS)V2.1 scoring was performed on mpMRI parameters.Patients were divided into clinically significant PCa(CsPCa)and non-CsPCa groups using the pathological diagnosis as the gold standard.The mpMRI PI-RADS V2.1 scores and clinical correlates were compared between the two groups.Independent correlates of CsPCa were analysed using multifactorial logistic regression analysis,and a risk prediction model was constructed.The diagnostic efficacy of CsPCa was evaluated by using subject work characteristics(ROC)curve analysis.Results A total of 204 patients with suspected PCa in the grey zone of PSA,aged 49-87 years,with a mean of(66.48±6.05)years,were included in this study.Pathological confirmation of CsPCa by puncture biopsy was found in 34 cases and non-CsPCa in 170 cases.The distribution of mpMRI PI-RADS V2.1 scores was compared between the CsPCa group and the non-CsPCa group,and the difference was statistically significant(P<0.05).The age,PSA density(PSAD),peripheral zone(PZ)location detection rate,and positive rectal fingerprinting rate of patients in the CsPCa group were higher than those in the non-CsPCa group,and the prostate volume,free PSA(fPSA),and free/total PSA(f/t PSA)were lower than those in the non-CsPCa group(P<0.05).The results of multifactorial logistic regression analysis showed that both elevated PSAD and PI-RADS V2.1 scores were independent risk factors for CsPCa,and elevated f/t PSA was an independent protective factor(P<0.05)Ac

关 键 词：前列腺癌 多参数磁共振成像 前列腺特异性抗原 诊断 危险分层 

分 类 号：R737.25[医药卫生—肿瘤]