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3.0T磁共振诊断前列腺癌的效能:T2WI联合DWI及DCE

作者:彭峰河1 沈秀芝1 蔡建新1 李艳翠1 孔广起2 彭如臣1

所属单位:1.首都医科大学附属北京潞河医院放射科 2.首都医科大学附属北京潞河医院泌尿外科(北京 101149)

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摘要

目的基于第二版前列腺影像 报告和数据系统(PI-RADS V2)评分比较 3.0 T磁共振T2WI联合DWI及DCE序列诊 断前列腺癌的效能。方法 对123例经病 理证实的前列腺疾病患者的磁共振影像 学资料进行回顾性分析,所有患者均行 T2WI、DWI、动态增强MRI(DCE-MRI)检 查,依据PI-RADS V2评分标准与病理结果 对比分析T2WI、T2WI+DWI、T2WI+DCE、 T2WI+DWI+DCE四种方法对前列腺癌的诊断 能效。结果 共123例患者纳入本研究, 其中72例前列腺癌患者,51例非前列腺 癌患者。经MedCalc软件分析后T2WI、 T2WI+DWI、T2WI+DCE、T2WI+DWI+DCE四 种方法诊断前列腺癌的ROC曲线下面积 (AUC)分别为0.911、0.936、0.935、 0.962,AUC两两比较T2WI与T2WI+DWI、 T2WI与T2WI+DCE、T2WI与T2WI+DWI+DCE、 T2WI+DWI与T2WI+DWI+DCE、T2WI+DCE 与T2WI+DWI+DCE存在统计学差异,P值 分别为0.010、0.016、0.001、0.015、 0.012,T2WI+DWI与T2WI+DCE无统计学差 异(P=0.870),各组最佳诊断阈值均为PIRADS分值=3。四种方法诊断前列腺癌的能 效:T2WI+DWI+DCE序列的灵敏度、特异度 最高(93.1%、92.2%),T2WI最低(88.9%、 86.3%),T2WI+DWI(90.3%、88.2%)略高于 T2WI+ DCE(88.9%、88.2%)。结论 基于 PI-RADS V2评分3.0T磁共振各序列诊断前 列腺癌的能效不同,T2WI联合DWI、DCE诊 断效能最高,是诊断前列腺癌的最佳组合 序列。

Objective To explore the diagnostic efficacy of T2WI combined with DWI and DCE-MRI for detecting prostate cancer using 3.0 T MR scanner based on prostate imaging reporting and data system version 2(PI-RADS V2). Methods A total of 123 patients with pathologically confirmed prostate diseases were included for this retrospective study and all ceses were scanned with traditional MRI(T2WI) and functional MRI(DWI and DCE) before biopsy. The diagnostic efficacy of T2WI, T2WI+DWI, T2WI+DCE, T2WI+DWI+DCE compared with pathological results were analyzed according to PIRADS V2. Results Of the 123 prostate diseases patients, 72 were with prostate cancer and 51 with non-prostate cancer. The AUC of T2WI, T2WI+DWI, T2WI+DCE, T2WI+DWI+DCE for predicting prostate cancer based on PI-RADS score was 0.911, 0.936, 0.935, 0.962, respectively. Significant differences of AUC were found between T2WI and T2WI+DWI(P=0.010). T2WI and T2WI+ DCE(P=0.016), T2WI and T2WI+DWI+DCE(P=0.001), T2WI+DWI and T2WI+DWI+DCE(P=0.015), T2WI+ DCE and T2WI+DWI+DCE(P=0.012),but not between T2WI+DWI and T2WI+ DCE(P=0.870) through MedCalc software and the best cut-off point was PI-RADS 3 of each sequence. The sensitivity and specificity of T2WI, T2WI+DWI, T2WI+DCE, T2WI+DWI+DCE for predicting prostate cancer were 88.9% and 86.3%, 90.3% and 88.2%,88.9% and 88.2%,93.1% and 92.2%, respectively. Conclusion The diagnostic efficacy of 3.0T MR scanner for prostate cancer detection between sequences based on PI-RADS V2 were different and the combination of T2WI+DWI+DCE with the highest diagnostic value can be as the best combination approach.

【关键词】多参数磁共振成像;前列腺肿瘤;前列腺影像报告和数据系统

【中图分类号】R737.25;R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.12.035

前言

随着社会的发展,人口老龄化的加速,我国前列腺癌(prostate cancer,PCa)的发病率不断上升,已成为老年男性常见肿瘤之一,严 重威胁患者生存质量,因此早期诊断前列腺癌具有积极的临床意义。 磁共振检查具有多参数、多序列及软组织分辨率高等优势,已成为前 列腺癌检查的最佳方法之一[1]。而各扫描序列对前列腺癌的诊断能效 不同,选择最佳的扫描序列尤为重要。本研究使用3.0T磁共振比较常 规T2WI联合各功能成像诊断前列腺癌的能效,旨在发现一种最佳的前 列腺癌检查方法。