MR IVIM-DWI参数预测外周带和移行带前列腺癌危险度的应用价值  

The value of MR IVIM-DWI parameters in predicting the risk ofperipheral and transitional zone prostate cancer

作　　者：车志文 仲津漫 尚阿利 魏泽华 杨全新[1] CHE Zhiwen;ZHONG Jinman;SHANG Ali;WEI Zehua;YANG Quanxin(Department of Radiology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Radiology,The Affiliated Hospital of Northwest University/Xi’an No.3 Hospital,Xi’an 710018,China)

机构地区：[1]西安交通大学第二附属医院医学影像科,陕西西安710004 [2]西北大学附属医院/西安市第三医院放射科,陕西西安710018

出　　处：《西安交通大学学报(医学版)》2025年第2期274-279,共6页Journal of Xi’an Jiaotong University(Medical Sciences)

基　　金：陕西省重点研发计划资助(No.2024SF-YBXM-417);西安交通大学第二附属医院科研基金资助[No.YJ(QN)202313]。

摘　　要：目的探讨体素内不相干运动扩散加权成像(diffusion-weighted intravoxel incoherent motion imaging,IVIM-DWI)量化参数在预测不同解剖分区起源前列腺癌(PCa)临床病理特征的价值。方法收集2022年7月至2023年10月在本院经穿刺活检或根治术后病理证实为PCa患者47例(移行区PCa 20例,外周区PCa 27例,所有患者术前均行bpMRI+IVIM-DWI检查),根据国际泌尿系统病理学学会(International Society of Urological Pathology,ISUP)的PCa危险度分级,将患者分为高危组(ISUP≥3级)和低危组(ISUP≤2级)。比较移行区组和外周区组PCa危险度差异,进一步评估高低危组之间年龄、血清总前列腺特异性抗原(total prostate specific antigen,tPSA)、扩散系数(diffusion coefficient,D)、伪扩散系数(pseudo diffusion coefficient,D^(*))、灌注分数(perfusion fraction,F)及表观扩散系数(apparent diffusion coefficient,ADC)的差异;以PCa危险度为因变量,利用二元Logistic回归分析PCa高低危险度发生的相关因素。绘制受试者工作特征(ROC)曲线评估tPSA、D平均值(D_(mean))、解剖分区及tPSA+D_(mean)+解剖分区联合模型诊断PCa危险度的效能。结果外周区PCa组的危险度高于移行区PCa组(P=0.015)。二元Logistic回归分析显示,PCa高危组的tPSA水平高于低危组(OR=1.026,95%CI:1.004~1.049,P=0.014)、D_(mean)值低于低危组(OR=0.993,95%CI:0.987~0.999,P=0.034),高危组PCa更多分布在外周区(OR=5.250,95%CI:1.468~18.772,P=0.023)。联合模型(AUC=0.887,95%CI:0.787~0.987)的诊断效能高于tPSA、D_(mean)、解剖分区单独进行诊断的效能(P=0.001、0.043、0.003)。结论外周区PCa的危险度高于移行区PCa;tPSA、解剖分区联合D值预测PCa危险度效能最高,有望为PCa临床诊疗的精准化、个性化方案提供支持。Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in predicting the clinical and pathological features of prostate cancer(PCa).Methods We recruited 47 patients who underwent bpMRI combined with IVIM-DWI in our hospital from July 2022 to October 2023 and pathologically confirmed with PCa.Among these cases,20 were transitional zone PCa(TZ-PCa),and 27 were peripheral zone PCa(PZ-PCa).According to the International Society of Urological Pathology(ISUP)risk grades,the patients were divided into high-risk group(ISUP≥3)and low-risk group(ISUP≤2).Differences in the risk levels between TZ-PCa group and PZ-PCa group were compared.Factors including age,total prostate-specific antigen(tPSA),diffusion coefficient(D)value,pseudo diffusion coefficient(D^(*))value,perfusion fraction(F)value,and apparent diffusion coefficient(ADC)as independent variables were compared between the two groups.Binary logistic regression analysis was further used to identify the factors associated with high or low risk of PCa.Receiver operation characteristic(ROC)curves were plotted to evaluate the diagnostic efficacy of PSA,D value,anatomical zones,and the combined model of PSA+D value+anatomical zones in predicting the risk level of PCa.Results The risk level was higher in PZ-PCa group than in TZ-PCa group(P=0.015).Binary logistic regression analysis showed that the tPSA level in the high-risk group of PCa was higher than that in the low-risk group(OR=1.026,95%CI:1.004-1.049,P=0.014),but the D mean value was lower than that in the low-risk group(OR=0.993,95%CI:0.987-0.999,P=0.034).PCa in the high-risk group was more distributed in the peripheral zone(OR=5.250,95%CI:1.468-18.772,P=0.023).The diagnostic efficacy of the combined model(AUC=0.887,95%CI:0.787-0.987)was higher than that of tPSA,D mean,or anatomical partitioning alone(P=0.001,0.043,and 0.003,respectively).Conclusion PZ-PCa has a higher risk level than TZ-PCa.Combining bpMRI localization of anatomical zones with PSA and D value provid

关 键 词：双参数磁共振成像 体素内不相干运动扩散加权成像(IVIM-DWI) 前列腺癌 外周带 移行带 

分 类 号：R445[医药卫生—影像医学与核医学]