拉伸指数和单指数模型DWI应用于前列腺癌和前列腺增生鉴别诊断的对照
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摘要
目的探讨拉伸指数模型扩散加权成像(diffusion weighted imaging,DWI)应用于前列腺癌和前列腺增生鉴别诊断的价值,并与传统单指数模型进行对比。材料与方法回顾性分析经病理学证实的前列腺癌患者61例和前列腺增生患者49例的多b值(0～2000s/mm~2)DWI检查,获得病变的表观扩散系数(apparent diffusion coefficient,ADC)、分布扩散系数(distributed diffusion coefficient,DDC)和拉伸指数α。采用独立样本t检验比较两组之间各参数的差异,并用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价各参数鉴别前列腺癌和前列腺增生的能力。结果前列腺癌的ADC、DDC和α值分别为(0.714±0.170)×10~(-3)mm~2/s、(0.711±0.262)×1 0~(-3)m m~2/s和0. 7 3 0±0. 0 7 0,前列腺增生分别为(1. 1 3 9±0. 1 6 3)×1 0~(-3)m m~2/s、(1.435±0.267)×10~(-3)mm~2/s和0.766±0.067,前列腺癌的各参数均低于前列腺增生,差异具有统计学意义(P<0.01)。DDC值和ADC值的曲线下面积(area under the curve,AUC)分别为0.955、0.950,两者无统计学差异(P>0.05)。α值的AUC明显低于DDC值和ADC值(P<0.05)。前列腺癌的ADC值和DDC值与Gleason评分呈负相关(P<0.05)。结论拉伸指数模型的DDC值可用于鉴别前列腺癌和前列腺增生。与单指数模型比较,拉伸指数模型并未展现出更多优势。
Objective: To compare the value of stretched-exponential model and monoexponential model diffusion weighted imaging(DWI) in the differentiation of prostate cancer(PCa) and benign prostatic hyperplasia(BPH). Materials and Methods: The data of DWI(b from 0 to 2000 s/mm~2) of 61 PCa patients and 49 BPH patients confirmed by pathology were retrospectively analyzed. The parameters apparent diffusion coefficient(ADC), distributed diffusion coefficient(DDC) and α values of these lesions were calculated. All parameters were compared between PCa and BPH using independent-samples t test, and their diagnostic performance was analyzed by receiver operating characteristic(ROC) curves. Results: ADC,DDC and α values of PCa were(0.714±0.170)×10~(-3) mm~2/s,(0.711±0.262)×10~(-3) mm~2/s and0.730±0.070, while of BPH were(1.139±0.163)×10~(-3) mm~2/s,(1.435±0.267)×10~(-3) mm~2/s and0.766±0.067. All parameters in PCa were significantly lower than those in BPH(P<0.01).The area under the curves(AUCs) of DDC and ADC were 0.955 and 0.950, with no significant difference(P>0.05). The AUC in α was significantly lower than ADC and DDC(P<0.05).The ADC and DDC values of prostate cancer were negatively correlated to the Gleason scores(P<0.05). Conclusions: DDC derived from stretched-exponential model DWI can be used in differentiation of PCa and BPH. The stretched-exponential model was not superior to the monoexponential model.
Objective: To compare the value of stretched-exponential model and monoexponential model diffusion weighted imaging(DWI) in the differentiation of prostate cancer(PCa) and benign prostatic hyperplasia(BPH). Materials and Methods: The data of DWI(b from 0 to 2000 s/mm~2) of 61 PCa patients and 49 BPH patients confirmed by pathology were retrospectively analyzed. The parameters apparent diffusion coefficient(ADC), distributed diffusion coefficient(DDC) and α values of these lesions were calculated. All parameters were compared between PCa and BPH using independent-samples t test, and their diagnostic performance was analyzed by receiver operating characteristic(ROC) curves. Results: ADC,DDC and α values of PCa were(0.714±0.170)×10~(-3) mm~2/s,(0.711±0.262)×10~(-3) mm~2/s and0.730±0.070, while of BPH were(1.139±0.163)×10~(-3) mm~2/s,(1.435±0.267)×10~(-3) mm~2/s and0.766±0.067. All parameters in PCa were significantly lower than those in BPH(P<0.01).The area under the curves(AUCs) of DDC and ADC were 0.955 and 0.950, with no significant difference(P>0.05). The AUC in α was significantly lower than ADC and DDC(P<0.05).The ADC and DDC values of prostate cancer were negatively correlated to the Gleason scores(P<0.05). Conclusions: DDC derived from stretched-exponential model DWI can be used in differentiation of PCa and BPH. The stretched-exponential model was not superior to the monoexponential model.
引文
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[18]Peng Y,Jiang Y,Antic T,et al.Apparent diffusion coefficient for prostate cancer imaging:impact of B values.AJR Am J Roentgenol,2014,202(3):W247-253.
[19]Merisaari H,Toivonen J,Pesola M,et al.Diffusion-weighted imaging of prostate cancer:effect of b-value distribution on repeatability and cancer characterization.Magn Reson Imaging,2015,33(10):1212-1218.
[20]Epstein JI,Egevad L,Amin MB,et al.The 2014 international society of urological pathology(ISUP)consensus conference on gleason grading of prostatic carcinoma:definition of grading patterns and proposal for a new grading system.Am J Surg Pathol,2016,40(2):244-252.
[21]Liu W,Liu XH,Tang W,et al.Histogram analysis of stretchedexponential and monoexponential diffusion-weighted imaging models for distinguishing low and intermediate/high gleason scores in prostate carcinoma.J Magn Reson Imaging,2018,48(2):491-498.
[22]Matoso A,Epstein JI.Grading of prostate cancer:past,present,and future.Curr Urol Rep,2016,17(3):25.
[23]Portalez D,Rollin G,Leandri P,et al.Prospective comparison of T2W-MRI and dynamic-contrast-enhanced MRI,3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies.Eur Radiol,2010,20(12):2781-2790.
[24]Sarici H,Telli O,Yigitbasi O,et al.Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score
[2]Cornud F,Legmann P,Delongchamps NB.Can multiparametric MRIrule in or rule out significant prostate cancer?Curr Opin Urol,2015,25(6):490-497.
[3]Katahira K,Takahara T,Kwee TC,et al.Ultra-high-b-value diffusionweighted MR imaging for the detection of prostate cancer:evaluation in201 cases with histopathological correlation.Eur Radiol,2011,21(1):188-196.
[4]Le Bihan D,Breton E,Lallemand D,et al.Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.Radiology,1988,168(2):497-505.
[5]Bennett KM,Schmainda KM,Bennett RT,et al.Characterization of continuously distributed cortical water diffusion rates with a stretchedexponential model.Magn Reson Med,2003,50(4):727-734.
[6]Kitzing YX,Prando A,Varol C,et al.Benign conditions that mimic prostate carcinoma:MR imaging features with histopathologic correlation.Radiographics,2016,36(1):162-175.
[7]Jensen JH,Helpern JA,Ramani A,et al.Diffusional kurtosis imaging:the quantification of non-gaussian water diffusion by means of magnetic resonance imaging.Magn Reson Med,2005,53(6):1432-1440.
[8]Shinmoto H,Tamura C,Soga S,et al.An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer.AJR Am JRoentgenol,2012,199(4):W496-500.
[9]Mazaheri Y,Hotker AM,Shukla-Dave A,et al.Model selection for high b-value diffusion-weighted MRI of the prostate.Magn Reson Imaging,2018,46:21-27.
[10]Vargas HA,Akin O,Franiel T,et al.Diffusion-weighted endorectal MRimaging at 3 T for prostate cancer:tumor detection and assessment of aggressiveness.Radiology,2011,259(3):775-784.
[11]Song ZQ,Du XD,Ma Jing,et al.The value of ADC values for prostate cancer diagnosis and clinical assessment.J Pract Radiol,2015,31(10):1653-1656.宋志强,杜向东,马静,等.ADC值在前列腺癌诊断及临床评估中的价值.实用放射学杂志,2015,31(10):1653-1656.
[12]Weinreb JC,Barentsz JO,Choyke PL,et al.PI-RADS prostate imaging:reporting and data system:2015,Version 2.Eur Urol,2016,69(1):16-40.
[13]Hectors SJ,Semaan S,Song C,et al.Advanced diffusion-weighted imaging modeling for prostate cancer characterization:correlation with quantitative histopathologic tumor tissue composition-A hypothesisgenerating study.Radiology,2017,286(3):918-928.
[14]Li C,Chen M,Wan B,et al.A comparative study of gaussian and nongaussian diffusion models for differential diagnosis of prostate cancer with in-bore transrectal MR-guided biopsy as a pathological reference.Acta Radiol,2018,59(11):1395-1402.
[15]Liu X,Zhou L,Peng W,et al.Comparison of stretched-Exponential and monoexponential model diffusion-weighted imaging in prostate cancer and normal tissues.J Magn Reson Imaging,2015,42(4):1078-1085.
[16]Feng Z,Min X,Margolis DJ,et al.Evaluation of different mathematical models and different b-value ranges of diffusion-weighted imaging in peripheral zone prostate cancer detection using b-value up to 4500 s/mm2.PLoS One,2017,12(2):e0172127.
[17]Min XD,Wang L,Feng ZY,et al.Different mathematical models of diffusion-weighted MR imaging in diagnosis of prostate cancer.Chin JRadiol,2015,49(11):838-842.闵祥德,王良,冯朝燕,等.MR扩散加权成像不同模型诊断前列腺癌的价值.中华放射学杂志,2015,49(11):838-842.
[18]Peng Y,Jiang Y,Antic T,et al.Apparent diffusion coefficient for prostate cancer imaging:impact of B values.AJR Am J Roentgenol,2014,202(3):W247-253.
[19]Merisaari H,Toivonen J,Pesola M,et al.Diffusion-weighted imaging of prostate cancer:effect of b-value distribution on repeatability and cancer characterization.Magn Reson Imaging,2015,33(10):1212-1218.
[20]Epstein JI,Egevad L,Amin MB,et al.The 2014 international society of urological pathology(ISUP)consensus conference on gleason grading of prostatic carcinoma:definition of grading patterns and proposal for a new grading system.Am J Surg Pathol,2016,40(2):244-252.
[21]Liu W,Liu XH,Tang W,et al.Histogram analysis of stretchedexponential and monoexponential diffusion-weighted imaging models for distinguishing low and intermediate/high gleason scores in prostate carcinoma.J Magn Reson Imaging,2018,48(2):491-498.
[22]Matoso A,Epstein JI.Grading of prostate cancer:past,present,and future.Curr Urol Rep,2016,17(3):25.
[23]Portalez D,Rollin G,Leandri P,et al.Prospective comparison of T2W-MRI and dynamic-contrast-enhanced MRI,3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies.Eur Radiol,2010,20(12):2781-2790.
[24]Sarici H,Telli O,Yigitbasi O,et al.Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score
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