小视野体素内不相干运动扩散加权成像在前列腺癌诊断中的应用价值
摘要
目的探讨小视野体素内不相干运动(IVIM)扩散加权成像(DWI)在前列腺癌诊断中的应用价值。方法经穿刺活检病理证实为前列腺癌的患者20例,患者穿刺术前均进行多b值小视野DWI扫描,将扫描数据传至GE ADW4.5工作站,采用Functool MADC软件分析多b值DWI图像,完成IVIM数据与图像重建。根据前列腺组织穿刺活检结果确定肿瘤区及非肿瘤区。对多b值DWI图像进行后处理,得到肿瘤区及非肿瘤区的IVIM模型参数,包括ADC值、真实扩散系数(D)、灌注相关扩散系数(D~*)和灌注分数(f)。比较肿瘤区及非肿瘤区IVIM各参数的差异,采用受试者工作特征(ROC)曲线评价各参数诊断前列腺癌的效能。结果 20例前列腺癌患者共获得可评估前列腺分区136个,其中肿瘤区60个、非肿瘤区76个。肿瘤区的ADC、D、f均小于非肿瘤区,肿瘤区D~*大于非肿瘤区(P均<0.05)。ADC、D、D~*、f诊断前列腺癌的ROC曲线下面积分别为0.962、0.789、0.871、0.972。根据敏感度与特异度之和的最大值选定最佳诊断阈值,ADC诊断阈值为0.738×10~(-3) mm~2/s,诊断的敏感度和特异度分别为86.8%、91.7%。D诊断阈值为0.488×10~(-3) mm~2/s,诊断的敏感度和特异度分别为68.4%、83.3%。D~*诊断阈值为6.835×10~(-3) mm~2/s,诊断的敏感度和特异度分别为66.7%、100.0%。f诊断阈值为35.45%,诊断的敏感度和特异度分别为92.1%、90.0%。结论小视野IVIM DWI有助于诊断前列腺癌,其中D~*及f可提供更多肿瘤相关信息,对前列腺癌的诊断效能较高。
引文
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[2] 王烨菁,傅忠星,王珏,等.2004～2011年上海市卢湾区社区人群前列腺癌发病与死亡分析[J].中国肿瘤,2017,26(6):438-441.
[3] Luciani A, Vignaud A, Cavet M, et al. Liver cirrhosis: intravoxel incoherent motion MR imaging-pilot study[J]. Radiology, 2008,249(3):891-899.
[4] Patel J, Sigmund EE, Rusinek H, et al. Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamiccontrast-enhanced MRI alone and in combination: preliminary experience[J]. J Magn Reson Imaging, 2010,31(3):589-600.
[5] 张莹,苗华栋,陈丽娟,等.3.0 T MR扩散加权成像与表观扩散系数诊断前列腺癌的比较[J].中国医学影像学杂志,2013,21(8):602-605.
[6] 张杨贵,陈珊红,温志玲,等.体素内不相干运动MRI与DWI对前列腺癌的诊断[J].中国CT和MRI杂志,2016,14(3):78-80.
[7] Le Bihan D, Breton E, Lallemand D. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging[J]. Radiology, 1988,168(2):497-505.
[8] 冷晓明,韩晓蕊,赵蔓,等.IVIM-DWI在前列腺癌与前列腺增生鉴别诊断中的应用价值及其与Gleason评分的相关性[J].放射学实践,2016,31(8):760-763.
[9] 叶锦堂,蔡文超,王岳,等.体素内不相干运动扩散加权成像对前列腺癌的诊断价值[J].放射学实践,2014,29(5):474-476.
[10] Shinmoto H, Tamura C, Soga S, et al. An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer[J]. AJR Am J Roentgenol, 2012,199(4):W496-W500.
[11] Dpfert J, Lemke A, Weidner A, et al. Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging[J]. Magn Reson Imaging, 2011,22(8):1053-1058.
[12] King AD, Vlantis AC, Tsang RK, et al. Magnetic resonance imaging for the detection of nasopharyngeal carcinoma[J]. AJNR Am J Neuroradiol, 2006,27(6):1288-1291.
[13] Guiu B, Petit JM, Capitan V, et al. Intravoxel incoherent motion diffusion-weighted imaging in nonalcoholic fatty liver disease:a 3.0-T MR study[J]. Radiology, 2012,265(1):96-103.
[14] 李健斐,王佳,李莹,等.小视野DWI与常规DWI在肾透明细胞癌诊断中的应用价值比较[J].山东医药,2016,56(46):56-58.
[15] 陈小溪,吴连明,张晓斐,等.前列腺癌IVIM弥散加权成像与Gleason评分的相关性研究[J].上海交通大学学报,2014,34(6):868-872.
[16] Langer DL, vander Kwast TH, Evans AJ, et al. Prostate tissue composition and MR measurements:investigating the ralationships between ADC,T2,K(trans),V(e),and corresponding histologic features[J]. Radiology, 2010,255(2):485-494.
[17] Valerio M, Zini C, Fierro D, et al. 3 T multiparametric MRI of the prostate :Does intravoxel incoherentmotion diffusion imaging have a role in the detection and stratification of the prostate cancer in the peripheral zone[J]. Eur J Radiol, 2016,85(4):790-794.