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ADC值及Ktrans值与前列腺癌Gleason评分的相关性研究

作者:何永胜 戚 轩 张 敏 杨宏楷

所属单位:安徽省马鞍山市人民医院影像科(安徽 马鞍山 243000)

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摘要

目的 探讨前列腺癌表观弥散 系数(ADC)值及容积转换常数(Ktrans)与前 列腺癌病理分级(Gleason评分)的相关 性,并对两者进行比较。方法 回顾性分 析病理证实的前列腺癌患者30例,根据 病理结果中的Gleason评分将患者分为 高分化、中分化及低分化组,比较组间 ADC值及Ktrans值的差异,并分析ADC值、 Ktrans值及Gleason评分间的相关性。结 果 三组前列腺癌ADC值及Ktrans值组间整 体差异均具有统计学意义(P<0.01)。 ADC值与Gleason评分、Ktrans值呈负相 关(r=-0.633,P<0.01,r=-0.609,P <0.01),Ktrans与Gleason评分呈正相关 (r=0.579,P<0.01)。高分化组与中低 分化组之间的ADC值及Ktrans值差异均具有 显著统计学意义(P<0.01),利用ROC 曲线分析显示ADC值与Ktrans值的曲线下面 积分别为0.861、0.838,区分高分化组 与中低分化组的敏感性和特异性分别为 83.3%、88.9%,75.0%、77.8%。结论 前 列腺癌的ADC值及Ktrans值与Gleason评分之 间具有相关性,且ADC值与Gleason评分 之间的相关性较Ktrans值高,它们能够在 一定程度上帮助预测前列腺癌的分化程 度。

Objective To evaluate the correlation among ADC value, Ktrans value and pathology grade(Gleason score) of prostate cancer. Methods A retrospective analysis was carried with 30 patients with prostate cancer confirmed by pathology, According to the gleason score, we divided the patients into three groups, high grade, medium grade and slow grade, Then comparing the variation between the value of ADC and Ktrans, and analyzing the correlation between ADC, Ktrans and gleason score. Results There were statistical difference in ADC and Ktrans among these three groups(P<0.01). The value of ADC in prostate cancer showed negative correlation with Gleason score and Ktrans value(r=-0.633, P<0.01, r=-0.609, P<0.01), Ktrans value showed positive correlation with Gleason score (r=0.579, P<0.01), there were statistical differences between highgrade and medium, slow grade group in ADC and Ktrans value (P<0.01). ROC curves showed that the area under the ROC curve of ADC and Ktrans were 0.861, 0.838, the sensitivity, specificity of ADC, Ktrans were83.3%, 88.9% and 75.0%, 77.8% respectively. Conclusion There were significant correlation between ADC value, Ktrans value and Gleason scores of prostate cancer, and the correlation between ADC value and Gleason score were higher than Ktrans, they could help to predict the differentiation degree of prostate cancer.

【关键词】表观弥散系数;容积转换常 数;前列腺癌;Gleason评分

【中图分类号】R737.25

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.02.021

前言

前列腺癌(Prostate Cancer,PCa)是老年男性常见的恶性肿瘤之 一,肿瘤的分期及分级直接影响着临床治疗方案的选择和对预后的判 断,而前列腺穿刺活检术是一种有创的检查方法,会带来一些严重的 并发症,其发生率为2%~4%[1]。因此,寻找一种安全、无创的检查方 法用以预测前列腺癌的分期及分级尤为重要。常规MRI是目前诊断前列 腺疾病常用的影像学检查,但仅限于形态学诊断,准确性欠佳[2],随 着扩散加权成像(diffusion weighted imaging,DWI)和动态增强扫描 (dynamic contrast-enhanced MRI,DCE-MRI)等定量影像检查技术的 发展,已逐渐开始应用在前列腺癌的诊断中。本研究旨在探讨ADC值及 K trans值与前列腺癌Gleason评分的相关性。