高级扩散加权成像较单指数扩散加权成像在鉴别低级别移行带前列腺癌与前列腺增生伴炎症的优势  

Advantage of advanced diffusion weighted imaging over single index diffusion weighted imaging in distinguishing low-grade transitional zone prostate cancer from benign prostatic hyperplasia with inflammation

作　　者：任慧鹏[1] 万秦芸 吴博云 杨卷红 田宏哲[1] 任转勤 范晴[1] REN Huipeng;WAN Qinyun;WU Boyun;YANG Juanhong;TIAN Hongzhe;REN Zhuanqin;FAN Qing(Department of Medical Imaging,Baoji Central Hospital,Baoji,Shaanxi Province 721008,China;Department of Ultrasound Imaging,Baoji Central Hospital,Baoji,Shaanxi Province 721008,China;Department of Nuclear Medicine,Baoji Traditional Chinese Medicine Hospital,Baoji,Shaanxi Province 721000,China)

机构地区：[1]宝鸡市中心医院医学影像科,陕西宝鸡721008 [2]宝鸡市中心医院超声影像科,陕西宝鸡721008 [3]宝鸡市中医医院核医学科,陕西宝鸡721000

出　　处：《实用放射学杂志》2025年第3期442-446,共5页Journal of Practical Radiology

基　　金：陕西省科技厅科研课题(2023-YBSF-061)。

摘　　要：目的 探讨高级扩散加权成像(DWI)较单指数DWI在鉴别低级别移行带前列腺癌(TZ-PCa)与前列腺增生(BPH)伴炎症的优势.方法 选取经病理证实的32例低级别TZ-PCa患者(低级别TZ-PCa组)及38例BPH伴炎症患者(BPH伴炎症组),均接受 MR常规序列、单指数DWI、高级DWI[包括体素内不相干运动扩散加权成像(IVIM-DWI)、拉伸指数模型(SEM)、扩散峰度成像(DKI)]序列扫描,测量病变区诸序列相关参数[表观扩散系数(ADC)值、纯扩散系数(D)值、分布扩散系数(DDC)值及平均峰度(MK)值],采用独立样本t检验比较2组间参数值的差异,采用受试者工作特征(ROC)曲线计算诸参数值鉴别诊断低级别TZ-PCa与BPH伴炎症的曲线下面积(AUC),用Z检验比较高级DWI与单指数DWI的AUC差异.结果 低级别TZ-PCa组的ADC值、D值、DDC值小于BPH伴炎症组(P<0.05),低级别TZ-PCa组的 MK值大于BPH伴炎症组(P<0.05).D值、DDC值、MK值及联合参数(D+DDC+MK)均具有较高诊断效能(AUC均>0.9),且诊断效能明显优于ADC值(AUC 0.902、0.904、0.966、0.994 vs 0.725,P均<0.05),其中联合参数的AUC最大,虽然其诊断效能与D值、DDC值及 MK值无统计学差异(P>0.05),但其诊断的特异度明显提高.结论 高级DWI(IVIM-DWI、SEM、DKI)对低级别TZ-PCa与BPH伴炎症的鉴别诊断效能优于单指数DWI,且联合参数(D+DDC+MK)可进一步提高诊断的特异度.Objective To explore the advantage of advanced diffusion weighted imaging(DWI)over single index DWI in distinguishing low-grade transitional zone prostate cancer(TZ-PCa)from benign prostatic hyperplasia(BPH)with inflammation.Methods Thirty-two patients with low-grade TZ-PCa(low-grade TZ-PCa group)and 38 patients with BPH with inflammation(BPH with inflammation group)confirmed by pathology were selected.All patients underwent routine MR sequence,single index DWI,and advanced DWI[including introvoxel incoherent motion diffusion weighted imaging(IVIM-DWI),stretched-exponential model(SEM),diffusion kurtosis imaging(DKI)]sequences scans.The related parameters of the lesion area[including apparent diffusion coefficient(ADC),diffusion coefficient(D),distributed diffusion coefficient(DDC),and mean kurtosis(MK)values]were measured.Independent sample t-tests were used to compare differences in parameters values between the two groups.The receiver operating characteristic(ROC)curve was used to calculate the area under the curve(AUC)of varous parameters values in the differential diagnosis of low-grade TZ-PCa and BPH with inflammation.The difference in AUC between advanced DWI and single index DWI was compared using Z-test.Results The ADC,D,and DDC values of the low-grade TZ-PCa group were lower than those of the BPH with inflammation group(P<0.05).The MK value of the low-grade TZ-PCa group was higher than that of the BPH with inflammation group(P<0.05).The D,DDC,and MK values,and a combination of these parameters(D+DDC+MK)exhibited high diagnostic efficacy(all AUC>0.9).The diagnostic efficacy of these parameters was significantly higher than that of the ADC value (AUC 0.902,0.904,0.966,0.994 vs 0.725,all P<0.05).The combined parameterdemonstrated the highest AUC. Although the diagnostic efficacy of the combined parameter was not statistically different from the individual D,DDC,and MK values (P>0.05),the diagnostic specificity was significantly improved compared to the individual parameters.Conclusion Advanced DWI (IVIM-DWI

关 键 词：前列腺癌 前列腺增生 前列腺炎 磁共振成像 扩散加权成像 

分 类 号：R737.25[医药卫生—肿瘤] R69733[医药卫生—临床医学] R445.2