摘要
目的探讨体素内不相干运动(IVIM)弥散加权成像联合磁共振波谱分析(MRS)对前列腺癌(PCa)的诊断价值。方法经病理证实的37例PCa,49例良性前列腺增生(BPH)及21例正常前列腺组织患者纳入研究中,所有患者均行IVIM及MRS检查。计算并比较分析三组病例的纯弥散系数(D)、伪弥散系数(D*)、灌注分数(f)及(胆碱+肌酸)/枸橼酸盐(CC/C)值的差异。通过Logistic回归分析建立受试者工作特征(ROC)曲线,对比分析D、f、CC/C、IVIM、MRS、IVIM+MRS诊断PCa的ROC曲线下面积(AUC),计算IVIM、MRS、IVIM+MRS诊断PCa的敏感度、特异度。结果所有患者获得可分析的ROI共154个(包括PCa 46个,BPH 80个,正常前列腺组织28个)。PCa D值的中位数(四分位间距)[M(P25,P75)]值[0.86×10-3 mm2/s(0.69×10-3 mm2/s,1.01×10-3 mm2/s)]显著低于BPH和正常前列腺组织[1.24×10-3 mm2/s(1.13×10-3 mm2/s,1.52×10-3 mm2/s),1.47×10-3 mm2/s(1.37×10-3 mm2/s,1.72×10-3 mm2/s)](U=-11.340,P=0.000;U=-9.364,P=0.000),PCa f值的M(P25,P75)值[3.85%(2.91%,4.97%)]显著高于BPH和正常前列腺组织[2.15%(1.58%,2.70%)、1.89%(1.39%,2.48%)](U=-8.948,P=0.011;U=-6.807,P=0.000),PCa CC/C值的M(P25,P75)值[2.93(2.06,3.93)]显著高于BPH和正常前列腺组织[0.53(0.42,0.65)、0.49(0.40,0.55)](U=-8.232,P=0.000;U=-6.262,P=0.000),D*值无统计学差异(P>0.05)。各组诊断方法的AUC、敏感度和特异度分别为:IVIM:0.968、93.4%和91.7%;MRS:0.928、89.1%和93.5%,CC/C的最佳阈值为0.98;IVIM+MRS:0.991、95.8%和96.3%。结论 IVIM及MRS两种方法均可独立有效诊断PCa,两种技术结合较单独的任何一种更有助于PCa的诊断。
Objective To explore the diagnostic value of intravoxel incoherent motion(IVIM) diffusion-weighted imaging combined with magnetic resonance spectroscopy(MRS) for prostate cancer(PCa). Methods Thirty-seven patients with histologically proven PCa, forty-nine patients with benign prostatic hyperplasia(BPH) and twenty-one cases with normal prostate tissue were recruited in the study. IVIM and MRS were performed in all patients. The values of diffusion coefficient(D), pseudo-diffusion coefficient(D*), perfusion fraction(f) and(choline+creatinine)/citrate(CC/C) were calculated and compared among the three groups. Logistic regression analysis was used to construct the receiver operating characteristic(ROC) curve, the areas under the ROC curve(AUC) were compared between D, f, IVIM, MRS and IVIM+MRS. The sensitivity, specificity of IVIM, MRS and IVIM+MRS were calculated. Results There were 154 regions of interest(ROI) acquired images that could be analyzed, including 46 PCa, 80 BPH and 28 normal prostate tissue. The M value of D value in PCa[0.86×10-3 mm2/s(0.69×10-3mm2/s, 1.01×10-3 mm2/s)] was significantly lower than BPH and normal prostate tissue [1.24×10-3 mm2/s(1.13×10-3 mm2/s, 1.52×10-3 mm2/s), 1.47×10-3 mm2/s(1.37×10-3 mm2/s, 1.72×10-3 mm2/s)](U=-11.340, P=0.000; U=-9.364, P=0.000). The M value of f value in PCa[3.85%(2.91%, 4.97%)] was significantly higher than BPH and normal prostate tissue [2.15%(1.58%, 2.70%), 1.89%(1.39%, 2.48%)](U=-8.948, P=0.011; U=-6.807, P=0.000). The M value of CC/C value in PCa [2.93(2.06, 3.93)] was significantly higher than BPH and normal prostate tissue [0.53(0.42, 0.65), 0.49(0.40, 0.55)](U=-8.232, P=0.000; U=-6.262, P=0.000). D* value was not significantly different among the three groups(P>0.05). AUC, the sensitivity and the specificity for the detection of prostate cancer were 0.968, 93.4% and 91.7% for IVIM; 0.928, 89.1% and 93.5% for MRS, as the threshold was 0.98; and 0.991, 95.8% and 96.3% for the combined IVIM+MRS. Conclusions Prostate cancer can be diagnosed effecti
出处
《中华临床医师杂志（电子版）》
CAS
2016年第12期1699-1704,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
前列腺肿瘤
前列腺增生
体素内不相干运动
磁共振波谱学
Prostatic neoplasms
Prostatic hyperplasia
Intravoxel incoherent motion
Magnetic resonance spectroscopy
