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前列腺癌磁共振动 态增强联合波谱成 像的诊断价值

作者:王书健 郑春生 黄柿兵 杨龙林 刘建平

所属单位:南京鼓楼医院集团安庆市石化医院 影像科 (安徽 安庆 246002)

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摘要

目的 分析前列腺癌的磁共振波 谱成像(1 H-MRS)及动态增强磁共振成像 (DCE-MRI)表现,探讨1 H-MRS及DCE对前列 腺癌的诊断价值。方法 回顾性分析26例 前列腺癌(Pca)及32例前列腺增生(BHP)的 MR征象,全部患者行MRS及DCE检查,分析 病例的MRS 及DCE图像,测量Pca及BHP 的 (Cho+Cr)/Cit值。DCE共采集37次图像, 分析Pca及BHP的SI-T曲线变化规律。结果 在DCE-MRI检查中前列腺癌都表现为比正 常的前列腺组织明显早期强化,26例PCa 病人SI-T曲线24例表现为III型,2例表现 为II型曲线,32例BPH病人SI-T曲线16例 表现为I型曲线,8例表现为II型曲线,8 例表现为III型曲线,DCE-MRI诊断的敏 感性、特异性及准确率分别能达到92%、 75%,82%;Pca患者中有4例(Cho+Cr)/ Cit<0.99,22例(Cho+Cr)/Cit>0.99, BPH 组有8例(Cho+Cr)/Cit>0.99,24例 (Cho+Cr)/Cit<0.99,MRS诊断的敏感 性、特异性及准确率分别能达到 85%、 89.1%,86%。结论 DCE-MRI对Pca敏感度 较高,特异度较低,而1 H-MRS对Pca敏感 性较低,联合1 H-MRS的量化指标与DCEMRI图像表现的SI-T曲线可提高前列腺癌 诊断的正确率,并且可以直观显示病变部 位、范围及转移情况,结合常

Objective To analyze the magnetic resonance spectrum imaging of prostate cancer (1 H-MRS) and dynamic enhanced magnetic resonance imaging (DCE-MRI) performance, and explore the value to the diagnosis of prostate cancer. Methods A retrospective analysis of 26 cases of prostatic carcinoma (Pca) and 32 cases of hyperplasia of prostate (BHP) signs of MR, MRS and DCE examination, all patients analyzed cases of MRS and DCE image, Pca and BHP (Cho+Cr)/Cit value.DCE collect altogether 37 image, the analysis of Pca and BHP SI-T curve change rule. Results In DCE-MRI in prostate cancer are characterized by strengthening early than in normal prostate tissue, 26 patients with PCa SI -T curve of 24 cases of type III, 2 case of type II, 32 cases of BPH patients SI-T curve 16 cases of type I, 8 cases of II type, 8 cases of type III, DCE MRI diagnostic sensitivity, specificity and accuracy were 92%, 75%, 82%,4 cases of patients with Pca Cr (Cho)/Cit < 0.99, 22 cases (Cho + Cr)/Cit>0.99, BPH group has 8 cases (Cho + Cr)/Cit > 0.99, 24 cases (Cho + Cr)/Cit<0.99, MRS diagnostic sensitivity, specificity and accuracy were 85%, 89%, 86%. Conclusion MRI for DCE-higher sensitivity of Pca and specific degree is low, and 1 H-MRS low sensitivity to Pca, joint 1 H-MRS quantitative indicators and DCE MRI images show SI-T curve can improve the accuracy of diagnosis of prostate cancer, and can directly show the position and size of lesions and transfer situation, combined with conventional MRI, an accurate staging evaluation of Pca.

【关键词】前列腺癌;磁共振成像;磁共 振波谱成像

【中图分类号】R737.25

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.08.030

前言

前列腺癌(Prostate cancer,Pca)老年男性常见恶性肿瘤之一, 在美国发病率已高于肺癌[1],近年来我国前列腺癌的发病率也在逐年 上升[2]。但是Pca起病隐匿,传统检查方法依靠直肠指检、前列腺特异 性抗原和超声检查,检查的特异性不高,对于局限于前列腺包膜内的 肿瘤难以诊断。磁共振成像具有很好的软组织分辨力,常规MRI平扫结 合1H-MRS及动态增强磁共振成像(DCE-MRI)的快速发展,被公认为前列 腺疾病的最佳检查方法[3-4]。