ADCmean联合PSAD对PI-RADS≥3分临床显著性前列腺癌的预测价值  

Predictive value of ADCmean combined with PSAD in clinically significant prostate cancer with PI-RADS score ≥ 3

作　　者：贝明洁 许竞方 祝新[1] BEI Mingjie;XU Jingfang;ZHU Xin(Department of Radiology,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属江苏省中医院放射科,南京210029

出　　处：《磁共振成像》2025年第4期81-86,107,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省中医院院内基金项目(编号:Y2021ZR30)。

摘　　要：目的 探讨表观扩散系数平均值(mean apparent diffusion coefficient,ADCmean)联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)≥3分临床显著性前列腺癌(clinical significant prostate cancer,csPCa)的预测价值。材料与方法 回顾性分析2022年2月至2024年8月期间我院行前列腺MRI检查PI-RADS评分≥3分且有病理组织学检查患者的临床资料和影像资料。选择最高PI-RADS评分且最大病灶的最大层面勾画感兴趣区(region of interest,ROI),测量病灶的ADCmean和表观扩散系数最小值(min apparent diffusion coefficient,ADCmin)。单因素和多因素logistic回归分析筛选出预测csPCa的最佳临床和影像指标,采用受试者工作特征(receiver operating characteristics,ROC)曲线比较最佳临床和影像预测模型及两者联合模型的诊断效能,计算曲线下面积(area under the curve,AUC)、敏感度和特异度,并行DeLong检验。结果 本研究共纳入csPCa患者75例(48.39%),非csPCa患者80例(51.61%)。csPCa组的年龄、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free prostate specific antigen,fPSA)、PSAD大于非csPCa组,csPCa组的前列腺体积(prostate volume,PV)、fPSA和tPSA比值(f/t)、ADCmin、ADCmean均小于非csPCa组,差异具有统计学意义(均P<0.05)。逐步logistic回归筛选和ROC曲线分析,获得预测csPCa的最佳临床指标为PSAD和影像指标ADCmean,AUC分别为0.846、0.898,PSAD诊断阈值为0.307 ng/mL2,敏感度为66.67%,特异度为91.25%,ADCmean诊断阈值为773.5 mm2/s,敏感度为86.67%,特异度为85.00%,两者联合模型的AUC高达0.925。DeLong检验比较联合模型与单一模型的AUC差异有统计学意义(P<0.05),联合模型预测csPCa的敏感性和特异度分别为86.67%和88.75%。结论 ADCmean对PI-RADS≥3分csPCa的预测效能优于ADCmin,与PSAD的联合模型能进一步提高�Objective:To investigate the predictive value of mean apparent diffusion coefficient(ADCmean) combined with prostate specific antigen density(PSAD) for clinically significant prostate cancer(csPCa) with a prostate imaging reporting and data system version(PI-RADS) score ≥ 3.Materials and Methods:Clinical data and imaging data of patients with PI-RADS score ≥ 3 on prostate MRI performed at our hospital between February 2022 and August 2024 and with pathologic histology were retrospectively analyzed.The highest PI-RADS score and the largest dimension of the largest lesion were selected for ROI outlining,and the ADCmean and apparent diffusion coefficient min(ADCmin) of the lesion were measured.Univariate and multivariate logistic regression analyses were performed to identify the best clinical and imaging predictors of csPCa.Receiver operating characteristics(ROC) curves and the DeLong test were used to compare the diagnostic efficacy of the best clinical and imaging predictive models and their combined models by calculating the area under the curve(AUC),sensitivity and specificity.Results:A total of 75(48.39%) csPCa patients and 80(51.61%)non-csPCa patients were included in this study.age,total prostate specific antigen(tPSA),free prostate specific antigen(fPSA),and PSAD were greater in the csPCa group than in the non-csPCa group,and prostate volume(PV),fPSA and tPSA ratio(f/t),ADCmin,and ADCmean were smaller in the csPCa group than in the non-csPCa group,and the differences were statistically significant(P < 0.05).Stepwise logistic regression analysis and comparison of ROC curves yielded the best clinical indicator PSAD and imaging indicator ADCmean for predicting csPCa,with an AUC of 0.846 for PSAD and 0.898 for ADCmean,and an optimal cutoff value of 0.307 ng/mL2for PSAD,with a sensitivity of 66.67% and a specificity of 91.25%;ADCmean had an optimal cutoff value of 773.5 mm2/s,a sensitivity of 86.67%,and a specificity of 85.00%;the AUC of the two combined models was as high as 0.925,and the difference in diag

关 键 词：临床显著性前列腺癌 前列腺特异性抗原密度 磁共振成像 前列腺影像报告和数据系统 表观扩散系数 

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]