MR扩散加权成像在前列腺癌良恶性鉴别诊断中的应用价值及其敏感度、特异度和准确度分析
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摘要
目的分析MR扩散加权成像在前列腺癌良恶性鉴别诊断中的应用价值及其敏感度、特异度和准确度。方法将2017年1月至2019年1月期间因前列腺癌与良性前列腺则增生于我院进行治疗的40例患者作为研究对象,将20例前列腺癌患者纳入恶性组,将20例良性前列腺增生患者纳入良性组。对所有患者采用MR扩散加权成像方法进行扫描,后对比分析两组患者前列腺增生组织与膀胱内尿液的ADC值,分析对T_2WI、DWI和T_2WI+DWI3种不同诊断方式的敏感度、特异度和准确度差异。结果恶性组前列腺组织内平均ADC值明显低于良性组(P<0.05),两组膀胱内尿液平均ADC值对比无明显差异(P>0.05);恶性组T_2WI检查误诊9例,DWI检查误诊8例,T_2WI+DWI联合检查误诊3例;良性组MRT_2WI检查误诊3例,DWI检查误诊3例,MRT_2WI+DWI联合检查误诊2例;T_2WI+DWI诊断前列腺癌的敏感度、特异度和准确度最高,且在敏感度与准确度项目上显著高于T_2WI检查方式(P<0.05)。结论 MR扩散加权成像的前列腺癌良恶性鉴别诊断中的应用效果较好,T_2WI+DWI联合检查方式的应用可明显提高诊断敏感度、特异度和准确度,为临床医师对患者疾病类型的鉴别提供科学的数据支持,有临床推广应用价值。
Objective To analyze the value, sensitivity, specificity and accuracy of MR diffusion-weighted imaging in the differential diagnosis of benign and malignant prostate cancer. Methods 40 patients with prostate cancer and benign prostatic hyperplasia were treated in our hospital from January 2017 to January 2019. 20 patients with prostate cancer were included in the malignant group and 20 patients with benign prostatic hyperplasia were included in the benign group. All patients were scanned by MR diffusion weighted imaging. ADC values of prostate hyperplasia tissues and urine in bladder were compared between the two groups. Sensitivity, specificity and accuracy of three different diagnostic methods of T_2WI, DWI and T_2WI+DWI were analyzed. Results The average ADC value of prostate tissue in malignant group was significantly lower than that in benign group(P<0.05). There was no significant difference in the average ADC value of urine in bladder between the two groups(P>0.05). In malignant group, 9 cases were misdiagnosed by T_2WI, 8 cases were misdiagnosed by DWI, 3 cases were misdiagnosed by combined examination of T_2WI and DWI. 3 cases were misdiagnosed by T_2WI, 3 cases were misdiagnosed by DWI, 2 cases were misdiagnosed by combined examination of T_2WI and DWI in benign group. The sensitivity, specificity and accuracy of diagnosis of prostate cancer were the highest, and were significantly higher than those of T_2WI(P<0.05).Conclusion MR diffusion-weighted imaging has a good effect in differential diagnosis of benign and malignant prostate cancer. The application of combined examination of T_2WI and DWI can obviously improve the sensitivity, specificity and accuracy of diagnosis. It can provide scientific data support for clinicians to differentiate patients' disease types and has clinical application value.
Objective To analyze the value, sensitivity, specificity and accuracy of MR diffusion-weighted imaging in the differential diagnosis of benign and malignant prostate cancer. Methods 40 patients with prostate cancer and benign prostatic hyperplasia were treated in our hospital from January 2017 to January 2019. 20 patients with prostate cancer were included in the malignant group and 20 patients with benign prostatic hyperplasia were included in the benign group. All patients were scanned by MR diffusion weighted imaging. ADC values of prostate hyperplasia tissues and urine in bladder were compared between the two groups. Sensitivity, specificity and accuracy of three different diagnostic methods of T_2WI, DWI and T_2WI+DWI were analyzed. Results The average ADC value of prostate tissue in malignant group was significantly lower than that in benign group(P<0.05). There was no significant difference in the average ADC value of urine in bladder between the two groups(P>0.05). In malignant group, 9 cases were misdiagnosed by T_2WI, 8 cases were misdiagnosed by DWI, 3 cases were misdiagnosed by combined examination of T_2WI and DWI. 3 cases were misdiagnosed by T_2WI, 3 cases were misdiagnosed by DWI, 2 cases were misdiagnosed by combined examination of T_2WI and DWI in benign group. The sensitivity, specificity and accuracy of diagnosis of prostate cancer were the highest, and were significantly higher than those of T_2WI(P<0.05).Conclusion MR diffusion-weighted imaging has a good effect in differential diagnosis of benign and malignant prostate cancer. The application of combined examination of T_2WI and DWI can obviously improve the sensitivity, specificity and accuracy of diagnosis. It can provide scientific data support for clinicians to differentiate patients' disease types and has clinical application value.
引文
[1]陈翔,朱庆强,叶靖,等.高b值DWI对低PSA水平前列腺癌和前列腺增生伴间质炎的鉴别诊断价值[J].医学影像学杂志,2017,27(10):1974-1977.
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[12]宋惠贞,尹喜,张林.磁共振动态增强及扩散加权成像对前列腺癌灶诊断价值的Meta分析[J].中国医学影像学杂志,2016,24(9):701-705.
[13]刘佳琦,姜建,洪顺达,等.前列腺癌磁共振波谱与扩散加权成像诊断效能的Meta分析[J].中国医学影像学杂志,2017,25(9):77-81.
[14]谢宗玉,于娟,陈守康,等.3.0 TMRI表观扩散系数值对前列腺癌的诊断价值及与预后因素相关性分析[J].蚌埠医学院学报,2017,42(7):952-955.
[15]Terlikowska K M,Bozena D,Witkowska A M,et al.Preoperative HE4,CA125 and ROMA in the differential diagnosis of benign and malignant adnexal masses[J].Journal of Ovarian Research,2016,9(1):1-7.
[16]李鹏,黄英,李艳,等.多参数磁共振成像诊断和鉴别诊断外周带早期前列腺癌和前列腺炎[J].中华医学杂志,2016,96(37):2973-2977.
[2]Meng X F,Zhu S C,Sun S J,et al.Diffusion weighted imaging for the differential diagnosis of benign vs.malignant ovarian neoplasms[J].Oncology Letters,2016,11(6):3795-3802.
[3]张勇.1.5TMR扩散加权成像对前列腺癌诊断价值及其ADC值与Gleason评分、肿瘤标志物的相关性分析[J].广西医科大学学报,2017,34(7):1037-1040.
[4]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.
[5]薛海林,王利伟,陈谦,等.多b值弥散成像诊断中央区前列腺结节的价值[J].中国医疗设备,2017,32(11):71-73.
[6]中华医学会泌尿外科分会.前列腺癌诊断治疗指南[J].继续医学教育,2007,21(6):30-39.
[7]司慧勇,胡娟,王霄英,等.磁共振扩散加权成像表观扩散系数值在前列腺癌诊断中的应用价值[J].中国药物与临床,2017,17(2):204-205.
[8]常国庆,夏兆云.3.0T MR扩散加权成像联合表观扩散系数诊断前列腺癌的价值[J].陕西医学杂志,2016,45(12):1605-1606.
[9]刘康,张耀森,刘永.MR扩散加权成像与表观扩散系数在前列腺肿瘤中的应用比较[J].医学影像学杂志,2016,26(5):885-887.
[10]张刚,林骅.MR扩散加权成像诊断前列腺癌的临床研究[J].中国CT和MRI杂志,2016,14(10):99-101.
[11]王龙江,兰受昌,张国伟,等.3.0TMR动态增强成像在前列腺癌诊断中的应用研究[J].中国CT和MRI杂志,2017,15(5):121-123.
[12]宋惠贞,尹喜,张林.磁共振动态增强及扩散加权成像对前列腺癌灶诊断价值的Meta分析[J].中国医学影像学杂志,2016,24(9):701-705.
[13]刘佳琦,姜建,洪顺达,等.前列腺癌磁共振波谱与扩散加权成像诊断效能的Meta分析[J].中国医学影像学杂志,2017,25(9):77-81.
[14]谢宗玉,于娟,陈守康,等.3.0 TMRI表观扩散系数值对前列腺癌的诊断价值及与预后因素相关性分析[J].蚌埠医学院学报,2017,42(7):952-955.
[15]Terlikowska K M,Bozena D,Witkowska A M,et al.Preoperative HE4,CA125 and ROMA in the differential diagnosis of benign and malignant adnexal masses[J].Journal of Ovarian Research,2016,9(1):1-7.
[16]李鹏,黄英,李艳,等.多参数磁共振成像诊断和鉴别诊断外周带早期前列腺癌和前列腺炎[J].中华医学杂志,2016,96(37):2973-2977.