MRI多b值DWI及ADC值在前列腺移行区癌诊断中的临床价值
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摘要
目的探讨MRI多b值弥散加权成像(multiple b-value diffusion-weighted imaging, MB-DWI)及表观扩散系数(apparent diffusion coefficient, ADC)在前列腺移行区(transition zone, TZ)癌诊断中的临床价值。方法选取2015年4月—2018年4月我院收治的71例可疑TZ癌,均行MRI、前列腺穿刺活组织病理检查及手术病理检查,其中28例为TZ癌(TZ癌组),43例为良性前列腺增生[(benign prostate hyperplasia, BPH),BPH组]。所有患者均行MRI T2WI和MB-DWI检查,并以病理检查结果为"金标准",采用受试者工作特征(receiver operating characteristic, ROC)曲线分析标准化ADC(ADC_(standard))、快速ADC(ADC_(fast))、慢速ADC(ADC_(slow))及快速扩散所占比例(f_(fast))在前列腺良恶性病变中的水平变化,观察MB-DWI各参数对TZ癌的诊断价值。结果在T2WI图像上,TZ癌组均表现为低或等信号影,边界清晰,其中23例可见低信号"包膜影";BPH组6例表现为高信号结节,9例表现为低信号结节,28例表现为高低信号混杂结节,且31例结节可见"包膜"。在弥散加权成像图像上,TZ组24例表现为高信号结节,4例表现为等信号结节;BPH组14例表现为稍高信号结节,29例表现为等信号结节。BPH组ADC_(slow)、ADC_(standard)、f_(fast)均高于TZ癌组,差异有统计学意义(P<0.05)。MB-DWI各参数诊断TZ癌的ROC曲线下面积从大到小依次为f_(fast)、ADC_(standard)、ADC_(fast)、ADC_(slow)。结论采用MB-DWI诊断TZ癌可有效减少良性病变的干扰,提高诊断灵敏度和特异度,且f_(fast)诊断价值最高。
Objective To explore the clinical value of MRI multiple b-value diffusion-weighted imaging(MB-DWI) and apparent diffusion coefficient(ADC) in the diagnosis of transition zone(TZ) prostate cancer. Methods Seventy-one patients with suspected TZ prostate cancer treated in our hospital from April 2015 to April 2018 were selected and given MRI, prostate biopsy and surgical pathology. There were 28 cases of TZ cancer(TZ group) and 43 cases of benign prostate hyperplasia(BPH, BPH group). All patients were given MRI T2 WI and MB-DWI. The results of pathological examination were taken as gold standards, and the receiver operating characteristic(ROC) curve was used to analyze the changes of standard apparent diffusion coefficient(ADC_(standard)), fast ADC(ADC_(fast)) or slow ADC(ADC_(slow)) and fast diffusion ratio(f_(fast)) in benign and malignant prostate lesions, and the diagnostic value of various MB-DWI parameters on TZ cancer was observed. Results On T2 WI images, TZ group showed TZ low or equal signal shadows and clear boundary, including 23 cases showing low signal "envelope shadow". Six cases in BPH group showed high signal nodules, 9 cases showed low signal nodules and 28 cases showed high-low signal mixed nodules, including 31 nodules showing "envelope". On DWI images, 24 cases in TZ group showed high signal nodules and 4 cases showed equal signal nodules. Fourteen cases in BPH group showed slightly higher signal nodules and 29 cases showed equal signal nodules. The ADC_(slow), ADCstandard and ffast in BPH group were higher than those in TZ group, and there were significant differences(P<0.05). The area under the ROC curve of MB-DWI parameters in the diagnosis of TZ cancer from large to small were f_(fast), ADC_(standard), ADC_(fast) and ADC_(slow). Conclusion MB-DWI for the diagnosis of TZ cancer can effectively reduce the interference caused by benign lesions, and improve the sensitivity and specificity of diagnosis, and the diagnostic value of ffast is the highest.
Objective To explore the clinical value of MRI multiple b-value diffusion-weighted imaging(MB-DWI) and apparent diffusion coefficient(ADC) in the diagnosis of transition zone(TZ) prostate cancer. Methods Seventy-one patients with suspected TZ prostate cancer treated in our hospital from April 2015 to April 2018 were selected and given MRI, prostate biopsy and surgical pathology. There were 28 cases of TZ cancer(TZ group) and 43 cases of benign prostate hyperplasia(BPH, BPH group). All patients were given MRI T2 WI and MB-DWI. The results of pathological examination were taken as gold standards, and the receiver operating characteristic(ROC) curve was used to analyze the changes of standard apparent diffusion coefficient(ADC_(standard)), fast ADC(ADC_(fast)) or slow ADC(ADC_(slow)) and fast diffusion ratio(f_(fast)) in benign and malignant prostate lesions, and the diagnostic value of various MB-DWI parameters on TZ cancer was observed. Results On T2 WI images, TZ group showed TZ low or equal signal shadows and clear boundary, including 23 cases showing low signal "envelope shadow". Six cases in BPH group showed high signal nodules, 9 cases showed low signal nodules and 28 cases showed high-low signal mixed nodules, including 31 nodules showing "envelope". On DWI images, 24 cases in TZ group showed high signal nodules and 4 cases showed equal signal nodules. Fourteen cases in BPH group showed slightly higher signal nodules and 29 cases showed equal signal nodules. The ADC_(slow), ADCstandard and ffast in BPH group were higher than those in TZ group, and there were significant differences(P<0.05). The area under the ROC curve of MB-DWI parameters in the diagnosis of TZ cancer from large to small were f_(fast), ADC_(standard), ADC_(fast) and ADC_(slow). Conclusion MB-DWI for the diagnosis of TZ cancer can effectively reduce the interference caused by benign lesions, and improve the sensitivity and specificity of diagnosis, and the diagnostic value of ffast is the highest.
引文
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[15] 何永胜,许敏,戚轩,等.双指数模型参数对前列腺癌的诊断价值及与Gleason评分的相关性分析[J].医学影像学杂志,2017,27(3):507-511.
[16] 张永胜,史咏,崔凤,等.多参数MRI影像特征诊断前列腺移行区良恶性病变的影响因素分析[J].浙江医学,2017,39(12):971-975.
[17] 杨琛,彭婵娟.超声造影定量评价体系及其影响因素分析[J].中国肿瘤,2016,25(3):212-218.
[18] Ueno Y,Kitajima K,Sugimura K,et al.Ultra-high b-value diffusion-weighted MRI for the detection of prostate cancer with 3-T MRI[J].J Magn Reson Imaging,2013,38(1):154-160.
[2] King C R,Ferrari M,Brooks J D.Prognostic significance of prostate cancer originating from the transition zone[J].Urol Oncol,2009,27(6):592-597.
[3] 王希明,包婕,朱默,等.MR扩散加权成像单指数模型及体素内不相干运动模型参数直方图对移行区前列腺癌的诊断价值[J].临床放射学杂志,2018,37(4):627-632.
[4] Zhang K,Shen Y,Zhang X,et al.Predicting Prostate Biopsy Outcomes:A Preliminary Investigation on Screening with Ultrahigh B-Value Diffusion-Weighted Imaging as an Innovative Diagnostic Biomarker[J].PLoS One,2016,11(3):e0151176.
[5] 贺慧杰,王功伟.前列腺癌Gleason评分重复性初步研究[J].中华男科学杂志,2016,22(1):37-41.
[6] Siegel R L,Miller K D,Fedewa S A,et al.Colorectal cancer statistics,2017[J].CA Cancer J Clin,2017,67(3):177-193.
[7] 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析[J].临床肿瘤学杂志,2013,18(4):330-334.
[8] Rosenkrantz A B,Kim S,Campbell N,et al.Transition zone prostate cancer:revisiting the role of multiparametric MRI at 3 T[J].AJR Am J Roentgenol,2015,204(3):W266-W272.
[9] Pang Y,Turkbey B,Bernardo M,et al.Intravoxel incoherent motion MR imaging for prostate cancer:an evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations[J].Magn Reson Med,2013,69(2):553-562.
[10] Koo J H,Kim C K,Choi D,et al.Diffusion-weighted magnetic resonance imaging for the evaluation of prostate cancer:optimal B value at 3T[J].Korean J Radiol,2013,14(1):61-69.
[11] 谢瑜,李卓琳,丁莹莹.体素内不相干运动扩散加权成像在乳腺疾病诊断中的应用及进展[J].中国医学影像学杂志,2017,25(2):158-160.
[12] Suetsugu A,Jiang P,Moriwaki H,et al.Imaging nuclear-cytoplasm dynamics of cancer cells in the intravascular niche of live mice[J].Anticancer Res,2013,33(10):4229-4236.
[13] 何杰,张焱,程敬亮,等.双指数模型 DWI在乳腺良恶性病变鉴别诊断中的价值[J].实用放射学杂志,2014,30(7):1137-1140.
[14] Bokacheva L,Kaplan J B,Giri D D,et al.Intravoxel incoherent motion diffusion-weighted MRI at 3.0 T differentiates malignant breast lesions from benign lesions and breast parenchyma[J].J Magn Reson Imaging,2014,40(4):813-823.
[15] 何永胜,许敏,戚轩,等.双指数模型参数对前列腺癌的诊断价值及与Gleason评分的相关性分析[J].医学影像学杂志,2017,27(3):507-511.
[16] 张永胜,史咏,崔凤,等.多参数MRI影像特征诊断前列腺移行区良恶性病变的影响因素分析[J].浙江医学,2017,39(12):971-975.
[17] 杨琛,彭婵娟.超声造影定量评价体系及其影响因素分析[J].中国肿瘤,2016,25(3):212-218.
[18] Ueno Y,Kitajima K,Sugimura K,et al.Ultra-high b-value diffusion-weighted MRI for the detection of prostate cancer with 3-T MRI[J].J Magn Reson Imaging,2013,38(1):154-160.