前列腺癌小视野、常规表观扩散系数与穿刺标本Gleason评分及肿瘤累及组织百分比的相关性比较
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摘要
目的:比较前列腺癌小视野与常规表观扩散系数(apparent diffusion coefficient,ADC)值与穿刺标本Gleason评分、肿瘤累及组织百分比的相关性。方法:选取31例行小视野及常规扩散加权成像(diffusion weighted imaging,DWI)检查后经病理学检查证实的前列腺癌患者,以穿刺位置为单位,评价肿瘤可见性,测量所有前列腺癌的ADC值并进行比较,比较两种序列之间前列腺癌ADC值与Gleason评分和肿瘤累及组织百分比的相关关系,并单独评估不同肿瘤累及组织百分比(≤10%、11%～40%、41%～70%、71%～100%)组穿刺标本ADC值与Gleason评分的相关性。结果:共统计114处穿刺阳性位置的数据,小视野ADC图上肿瘤可见率(100/114)显著高于常规ADC图(86/114)(P<0.05)。小视野与常规DWI上全部前列腺癌样本ADC值与Gleason评分呈负相关关系(r=-0.42和-0.41,P<0.05),累及组织71%～100%组前列腺癌ADC值亦与Gleason评分呈负相关(r=-0.62和-0.56,P<0.05),但其余各组无显著相关关系。前列腺癌ADC值与累及组织百分比亦呈负相关关系(r=-0.69和-0.63,P<0.05),且相关系数高于ADC值与Gleason评分的相关性。结论:小视野前列腺ADC图可提高肿瘤的可见率,但ADC值受Gleason评分及肿瘤百分比的影响,对Gleason评分预测效果有限。
Objective: To compare the correlations of conventional and reduced field-of-view(FOV) apparent diffusion coefficient(ADC) with Gleason score and percentage of tumor involvement in prostate core biopsy. Methods: A total of 31 patients were confirmed prostate cancer by biopsy after conventional and reduced FOV diffusion weighted imaging(DWI). The cancer visibility on conventional and reduced FOV ADC maps was compared. The ADC value of cancer was measured by the two protocols, and the relationships between ADC value and Gleason score, percentage of tumor involvement were investigated. The relationship between ADC value and Gleason score was further assessed in biopsy samples with different percentages of tumor involvement(≤10%, 11%-40%, 41%-70%, 71%-100%). Results: For 114 positive biopsy sites, cancer visibility on reduced FOV ADC map(100/114) was higher than that on conventional ADC map(86/114)(P<0.05). Negative correlation between ADC value and Gleason score was observed for whole-sample(r=-0.42 and-0.41, P<0.05). There was a negative correlation between ADC value and Gleason score in the samples with 71%-100% of tumor involvement(r=-0.62 and-0.56, P<0.05). ADC value was also negatively correlated with percentage of tumor involvement(r=-0.69 and-0.63, P<0.05), and the correlation coefficient was higher than that between ADC value and Gleason score. Conclusion: Reduced FOV ADC map could improve the visibility of prostate cancer, but ADC value is influenced by Gleason score and percentage of tumor involvement. So ADC value is limited in the prediction of Gleason score.
Objective: To compare the correlations of conventional and reduced field-of-view(FOV) apparent diffusion coefficient(ADC) with Gleason score and percentage of tumor involvement in prostate core biopsy. Methods: A total of 31 patients were confirmed prostate cancer by biopsy after conventional and reduced FOV diffusion weighted imaging(DWI). The cancer visibility on conventional and reduced FOV ADC maps was compared. The ADC value of cancer was measured by the two protocols, and the relationships between ADC value and Gleason score, percentage of tumor involvement were investigated. The relationship between ADC value and Gleason score was further assessed in biopsy samples with different percentages of tumor involvement(≤10%, 11%-40%, 41%-70%, 71%-100%). Results: For 114 positive biopsy sites, cancer visibility on reduced FOV ADC map(100/114) was higher than that on conventional ADC map(86/114)(P<0.05). Negative correlation between ADC value and Gleason score was observed for whole-sample(r=-0.42 and-0.41, P<0.05). There was a negative correlation between ADC value and Gleason score in the samples with 71%-100% of tumor involvement(r=-0.62 and-0.56, P<0.05). ADC value was also negatively correlated with percentage of tumor involvement(r=-0.69 and-0.63, P<0.05), and the correlation coefficient was higher than that between ADC value and Gleason score. Conclusion: Reduced FOV ADC map could improve the visibility of prostate cancer, but ADC value is influenced by Gleason score and percentage of tumor involvement. So ADC value is limited in the prediction of Gleason score.
引文
[1]SHAISH H, TANEJA S S, ROSENKRANTZ A B. Prostate MR imaging:an update[J]. Radiol Clin North Am, 2017, 55(2):303-320.
[2]BENNDORF M, HAHN F, KR?NIG M, et al. Diagnostic performance and reproducibility of T2W based and diffusion weighted imaging(DWI)based PI-RADS v2 lexicon descriptors for prostate MRI[J]. Eur J Radiol, 2017, 93:9-15.
[3]汤洁,刘晓航.前列腺癌弥散加权成像与非影像学指标结合的Logistic回归预测模型[J].肿瘤影像学, 2014, 23(4):329-333.
[4]BOESEN L, CHABANOVA E, L?GAGER V, et al. Apparent diffusion coefficient ratio correlates significantly with prostate cancer Gleason score at final pathology[J]. J Magn Reson Imaging, 2015, 42(2):446-453.
[5]KIM T H, KIM C K, PARK B K, et al. Relationship between Gleason score and apparent diffusion coefficients of diffusionweighted magnetic resonance imaging in prostate cancer patients[J]. Can Urol Assoc J, 2016, 10(11-12):E377-E382.
[6]GLAZER D I, HASSANZADEH E, FEDOROV A, et al.Diffusion-weighted endorectal MR imaging at 3T for prostate cancer:correlation with tumor cell density and percentage Gleason pattern on whole mount pathology[J]. Abdom Radiol(NY), 2017, 42(3):918-925.
[7]ZELHOF B, PICKLES M, LINEY G, et al. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer[J]. BJU Int, 2009, 103(7):883-888.
[8]WANG X Z, WANG B, GAO Z Q, et al. Diffusion-weighted imaging of prostate cancer:correlation between apparent diffusion coefficient values and tumor proliferation[J]. J Magn Reson Imaging, 2009, 29(6):1360-1366.
[9]王奕,林园凯,周长圣,等.小视野弥散加权成像在前列腺癌诊断中的应用价值[J].医学研究生学报, 2016, 29(4):395-400.
[10]LI L, WANG L, DENG M, et al. Feasibility study of 3-T DWI of the prostate:readout-segmented versus single-shot echo-planar imaging[J]. AJR Am J Roentgenol, 2015, 205(1):70-76.
[11]WANG X, WANG J Y, LI C M, et al. Evaluation of the prostate imaging reporting and data system for magnetic resonance imaging diagnosis of prostate cancer in patients with prostatespecific antigen <20 ng/mL[J]. Chin Med J(Engl), 2016,129(12):1432-1438.
[12]ROSENKRANTZ A B, KONG X, NIVER B E, et al. Prostate cancer:comparison of tumor visibility on trace diffusionweighted images and the apparent diffusion coefficient map[J]. AJR Am J Roentgenol, 2011, 196(1):123-129.
[13]BORREN A, MOMAN M R, GROENENDAAL G, et al. Why prostate tumour delineation based on apparent diffusion coefficientischallenging:anexplorationofthetissue microanatomy[J]. Acta Oncol, 2013, 52(8):1629-1636.
[14]LANGER D L, VAN DER KWAST T H, EVANS A J, et al.Intermixed normal tissue within prostate cancer:effect on MR imaging measurements of apparent diffusion coefficient and T2--sparse versus dense cancers[J]. Radiology, 2008, 249(3):900-908.
[15]CHATTERJEE A, WATSON G, MYINT E, et al. Changes in epithelium, stroma, and lumen space correlate more strongly with Gleason pattern and are stronger predictors of prostate ADC changes than cellularity metrics[J]. Radiology, 2015, 277(3):751-762.
[16]KOBUST,VANDERLAAKJA,MAASMC,etal.Contribution of histopathologic tissue composition to quantitative MR spectroscopy and diffusion-weighted imaging of the prostate[J]. Radiology, 2016, 278(3):801-811.
[17]DE VISSCHERE P J, NAESENS L, LIBBRECHT L, et al. What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?[J]. Eur Radiol, 2016, 26(4):1098-1107.
[18]DONATI O F, MAZAHERI Y, AFAQ A, et al. Prostate cancer aggressiveness:assessment with whole-lesion histogram analysis of the apparent diffusion coefficient[J]. Radiology, 2014,271(1):143-152.
[2]BENNDORF M, HAHN F, KR?NIG M, et al. Diagnostic performance and reproducibility of T2W based and diffusion weighted imaging(DWI)based PI-RADS v2 lexicon descriptors for prostate MRI[J]. Eur J Radiol, 2017, 93:9-15.
[3]汤洁,刘晓航.前列腺癌弥散加权成像与非影像学指标结合的Logistic回归预测模型[J].肿瘤影像学, 2014, 23(4):329-333.
[4]BOESEN L, CHABANOVA E, L?GAGER V, et al. Apparent diffusion coefficient ratio correlates significantly with prostate cancer Gleason score at final pathology[J]. J Magn Reson Imaging, 2015, 42(2):446-453.
[5]KIM T H, KIM C K, PARK B K, et al. Relationship between Gleason score and apparent diffusion coefficients of diffusionweighted magnetic resonance imaging in prostate cancer patients[J]. Can Urol Assoc J, 2016, 10(11-12):E377-E382.
[6]GLAZER D I, HASSANZADEH E, FEDOROV A, et al.Diffusion-weighted endorectal MR imaging at 3T for prostate cancer:correlation with tumor cell density and percentage Gleason pattern on whole mount pathology[J]. Abdom Radiol(NY), 2017, 42(3):918-925.
[7]ZELHOF B, PICKLES M, LINEY G, et al. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer[J]. BJU Int, 2009, 103(7):883-888.
[8]WANG X Z, WANG B, GAO Z Q, et al. Diffusion-weighted imaging of prostate cancer:correlation between apparent diffusion coefficient values and tumor proliferation[J]. J Magn Reson Imaging, 2009, 29(6):1360-1366.
[9]王奕,林园凯,周长圣,等.小视野弥散加权成像在前列腺癌诊断中的应用价值[J].医学研究生学报, 2016, 29(4):395-400.
[10]LI L, WANG L, DENG M, et al. Feasibility study of 3-T DWI of the prostate:readout-segmented versus single-shot echo-planar imaging[J]. AJR Am J Roentgenol, 2015, 205(1):70-76.
[11]WANG X, WANG J Y, LI C M, et al. Evaluation of the prostate imaging reporting and data system for magnetic resonance imaging diagnosis of prostate cancer in patients with prostatespecific antigen <20 ng/mL[J]. Chin Med J(Engl), 2016,129(12):1432-1438.
[12]ROSENKRANTZ A B, KONG X, NIVER B E, et al. Prostate cancer:comparison of tumor visibility on trace diffusionweighted images and the apparent diffusion coefficient map[J]. AJR Am J Roentgenol, 2011, 196(1):123-129.
[13]BORREN A, MOMAN M R, GROENENDAAL G, et al. Why prostate tumour delineation based on apparent diffusion coefficientischallenging:anexplorationofthetissue microanatomy[J]. Acta Oncol, 2013, 52(8):1629-1636.
[14]LANGER D L, VAN DER KWAST T H, EVANS A J, et al.Intermixed normal tissue within prostate cancer:effect on MR imaging measurements of apparent diffusion coefficient and T2--sparse versus dense cancers[J]. Radiology, 2008, 249(3):900-908.
[15]CHATTERJEE A, WATSON G, MYINT E, et al. Changes in epithelium, stroma, and lumen space correlate more strongly with Gleason pattern and are stronger predictors of prostate ADC changes than cellularity metrics[J]. Radiology, 2015, 277(3):751-762.
[16]KOBUST,VANDERLAAKJA,MAASMC,etal.Contribution of histopathologic tissue composition to quantitative MR spectroscopy and diffusion-weighted imaging of the prostate[J]. Radiology, 2016, 278(3):801-811.
[17]DE VISSCHERE P J, NAESENS L, LIBBRECHT L, et al. What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?[J]. Eur Radiol, 2016, 26(4):1098-1107.
[18]DONATI O F, MAZAHERI Y, AFAQ A, et al. Prostate cancer aggressiveness:assessment with whole-lesion histogram analysis of the apparent diffusion coefficient[J]. Radiology, 2014,271(1):143-152.