目的:探究表观弥散系数(apparent diffusion coefficient,ADC)及指数化ADC(exponential ADC,eADC)在双参数磁共振成像(bi-parametric magnetic resonance imaging,bpMRI)诊断临床显著性前列腺癌中的应用价值。方法:回顾并分析2014年1月...目的:探究表观弥散系数(apparent diffusion coefficient,ADC)及指数化ADC(exponential ADC,eADC)在双参数磁共振成像(bi-parametric magnetic resonance imaging,bpMRI)诊断临床显著性前列腺癌中的应用价值。方法:回顾并分析2014年1月—2021年12月在首都医科大学电力教学医院就诊的101例临床怀疑为前列腺癌患者的临床、影像学及病理学资料。依据穿刺活检结果分为组1(临床显著性前列腺癌组)和组2(非临床显著性前列腺癌+非前列腺癌),由2名阅片者依据前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System,PI-RADS)指南评分标准分别按照bpMRI诊断方案和多参数MRI(multi-parametric MRI,mpMRI)诊断方案进行评分(记为bpMRI评分和mpMRI评分),并且测量病灶最大层面的ADC值和eADC值,将bpMRI评分和mpMRI评分分别与ADC值及eADC值联合构建logistic回归模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值、eADC值、bpMRI诊断方案、mpMRI诊断方案以及两者分别联合ADC值及eADC值对临床显著性前列腺癌的诊断价值,运用Z检验对比各方案的曲线下面积(area under curve,AUC)有无差异。结果:109例可疑病灶中,组1病灶共计50例,组2病灶共计59例。ADC值、eADC值、bpMRI评分及mpMRI评分是诊断临床显著性前列腺癌的有效指标(P<0.001),ADC值及eADC值的AUC值分别为0.888和0.931,差异无统计学意义(Z=1.512,P=0.1306)。BpMRI评分分别联合ADC值及eADC值的AUC值分别为0.973、0.978,高于单独运用bpMRI评分的AUC值(AUC=0.954),差异有统计学意义(Z=2.391,P=0.0168;Z=2.125,P=0.0336)。mpMRI评分分别联合ADC值及eADC值的AUC值分别为0.985、0.985,高于单独运用mpMRI评分的AUC值(AUC=0.974),但差异无统计学意义(Z=1.295,P=0.1953;Z=1.354,P=0.1757)。结论:ADC值和eADC值都是诊断临床显著性前列腺癌有价值的MRI定量指标,两者联合bpMRI评分可以显著地提高bpMRI的诊断效能与临床应用价值�展开更多
To analyze if clinically insignificant prostate cancer （CIPC） is more frequently detected with repeat prostate biopsies, we retrospectively analyzed the records of 2146 men diagnosed with prostate cancer after one o...To analyze if clinically insignificant prostate cancer （CIPC） is more frequently detected with repeat prostate biopsies, we retrospectively analyzed the records of 2146 men diagnosed with prostate cancer after one or more prostate biopsies. The patients were divided into five groups according to the number of prostate biopsies obtained, e.g, group I had one biopsy, group 2 had two biopsies and group 3 had three biopsies. Of the 2146 patients diagnosed with prostate cancer, 1956 （91,1%）, 142 （6.6%）, 38 （1.8%）, 9 （0.4%） and 1 （0.1%） men were in groups 1, 2, 3, 4 and 5, respectively. Groups 4 and 5 were excluded because of the small sample sizes. The remaining three groups （groups 1, 2 and 3） were statistically analyzed. There were no differences in age or prostate-specific antigen level among the three groups. CIPC was detected in 201 （10.3%）, 28 （19.7%） and 9 （23.7%） patients in groups 1, 2 and 3, respectively （P〈O.O01）. A multivariate analysis showed that the number of biopsies was an independent predictor to detect ClPC （0R=2.688 for group 2; 0R=4.723 for group 3）. In conclusion, patients undergoing multiple prostate biopsies are more likely to be diagnosed with CIPC than those who only undergo one biopsy. However, the risk still exists that the patient could have clinically significant prostate cancer. Therefore, when counseling patients with regard to serial repeat biopsies, the possibility of prostate cancer overdiagnosis and overtreatment must be balanced with the continued risk of clinically significant disease.展开更多
文摘目的:探究表观弥散系数(apparent diffusion coefficient,ADC)及指数化ADC(exponential ADC,eADC)在双参数磁共振成像(bi-parametric magnetic resonance imaging,bpMRI)诊断临床显著性前列腺癌中的应用价值。方法:回顾并分析2014年1月—2021年12月在首都医科大学电力教学医院就诊的101例临床怀疑为前列腺癌患者的临床、影像学及病理学资料。依据穿刺活检结果分为组1(临床显著性前列腺癌组)和组2(非临床显著性前列腺癌+非前列腺癌),由2名阅片者依据前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System,PI-RADS)指南评分标准分别按照bpMRI诊断方案和多参数MRI(multi-parametric MRI,mpMRI)诊断方案进行评分(记为bpMRI评分和mpMRI评分),并且测量病灶最大层面的ADC值和eADC值,将bpMRI评分和mpMRI评分分别与ADC值及eADC值联合构建logistic回归模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值、eADC值、bpMRI诊断方案、mpMRI诊断方案以及两者分别联合ADC值及eADC值对临床显著性前列腺癌的诊断价值,运用Z检验对比各方案的曲线下面积(area under curve,AUC)有无差异。结果:109例可疑病灶中,组1病灶共计50例,组2病灶共计59例。ADC值、eADC值、bpMRI评分及mpMRI评分是诊断临床显著性前列腺癌的有效指标(P<0.001),ADC值及eADC值的AUC值分别为0.888和0.931,差异无统计学意义(Z=1.512,P=0.1306)。BpMRI评分分别联合ADC值及eADC值的AUC值分别为0.973、0.978,高于单独运用bpMRI评分的AUC值(AUC=0.954),差异有统计学意义(Z=2.391,P=0.0168;Z=2.125,P=0.0336)。mpMRI评分分别联合ADC值及eADC值的AUC值分别为0.985、0.985,高于单独运用mpMRI评分的AUC值(AUC=0.974),但差异无统计学意义(Z=1.295,P=0.1953;Z=1.354,P=0.1757)。结论:ADC值和eADC值都是诊断临床显著性前列腺癌有价值的MRI定量指标,两者联合bpMRI评分可以显著地提高bpMRI的诊断效能与临床应用价值�
文摘To analyze if clinically insignificant prostate cancer （CIPC） is more frequently detected with repeat prostate biopsies, we retrospectively analyzed the records of 2146 men diagnosed with prostate cancer after one or more prostate biopsies. The patients were divided into five groups according to the number of prostate biopsies obtained, e.g, group I had one biopsy, group 2 had two biopsies and group 3 had three biopsies. Of the 2146 patients diagnosed with prostate cancer, 1956 （91,1%）, 142 （6.6%）, 38 （1.8%）, 9 （0.4%） and 1 （0.1%） men were in groups 1, 2, 3, 4 and 5, respectively. Groups 4 and 5 were excluded because of the small sample sizes. The remaining three groups （groups 1, 2 and 3） were statistically analyzed. There were no differences in age or prostate-specific antigen level among the three groups. CIPC was detected in 201 （10.3%）, 28 （19.7%） and 9 （23.7%） patients in groups 1, 2 and 3, respectively （P〈O.O01）. A multivariate analysis showed that the number of biopsies was an independent predictor to detect ClPC （0R=2.688 for group 2; 0R=4.723 for group 3）. In conclusion, patients undergoing multiple prostate biopsies are more likely to be diagnosed with CIPC than those who only undergo one biopsy. However, the risk still exists that the patient could have clinically significant prostate cancer. Therefore, when counseling patients with regard to serial repeat biopsies, the possibility of prostate cancer overdiagnosis and overtreatment must be balanced with the continued risk of clinically significant disease.
