MR波谱成像对前列腺癌分化程度预估价值的初步研究

目的 初步探讨MRS检查的(胆碱+肌酸)/枸橼酸盐[(Cho+ Cr)/Cit,CC/C]值对前列腺癌分化程度及Gleason评分的预估作用.方法 回顾性分析行前列腺癌根治术后的5枚标本,将每枚标本按照MRS检查中最大横径兴趣层面剖开、取层,将层内每一兴趣区的CC/C值和病理切片的Gleason评分结果进行对照,通过绘制散点图及Spearman相关分析探讨二者的相关性,再根据CC/C值分别进行中高分化前列腺癌组(Gleason评分≤7分)及低分化癌组(Gleason评分＞7分)的ROC曲线下面积的假设检验,计算最佳诊断阈值(Cutoff值).结果 共取得有效病理诊断结果90个,其中有癌区70个,无癌区20个.MRS检查共得到CC/C值90个,以CC/C值＞0.86为确定癌标准,诊断前列腺癌区65个,与病理结果对照诊断正确区域59个；诊断无癌区25个,与病理结果对照诊断正确区域14个.经Spearman相关分析,CC/C值与对应区的Gleason评分呈正相关(r=0.746,P=0.000).中高分化前列腺癌组中,以ROC曲线下面积计算Cutoff值的假设检验无统计学意义(P＞0.05)；低分化癌组中,以ROC曲线下面积确定CC/C值为0.948最佳诊断阈值,敏感性为81.4％,特异性为75.0％,经Spearman分析低分化癌组中的Gleason评分与CC/C值亦呈正相关(r=0.605,P=0.000),提示CC/C值与低分化前列腺癌的分化程度具有相关性,当CC/C值大于0.948多为低分化癌,Gleason评分多＞7分.结论 CC/C值与Gleason评分呈正相关,MRS检查可用于预估前列腺癌的分化程度.

The preliminary study of using MR spectrum to predict the cellular differentiation of prostate cancer

Objective To investigate the feasibility of using the ratio of (Cho + Cr)/Cit derived by MRS to predict the differentiation grades of prostatic cancer and Gleason grading.Methods Five postoperative prostate specimens were spitted and layered according to the region of interest of MRS inspections.The correlation between the CC/C values of each region of interest in each layer and the Gleason scores of the corresponding pathological sections was analyzed.The optimum diagnostic cutoff value was determined by conducting the hypothesis test of the area below the ROC curve of the well and moderately differentiated groups and poorly differentiated ones on the basis of CC/C values with a Spearman test.Results A total of 90 regions with valid pathologic diagnosis were obtained,70 cancer-affected and 20 cancer-free.In MRS,a CC/C value above 0.86 was used as a criterion for defining a cancer-affected region As a result,65 cancer-affected regions and 25 cancer-free regions were identified,among which pathologic diagnosis confirmed 59 and 14,respectively.Spearman′s rank correlation analysis revealed that the CC/C values of the prostatic carcinoma had significant positive correlation with Gleason scores ( r =0.746,P =0.000).For the well and moderately differentiated groups,the hypothesis test about the cutoff value,which was obtained by calculating the area below the ROC curve,was of no statistical significance.For the poorly differentiated groups,the optimum cutoff value was defined as 0.948,and the sensitivity and specificity were 81.4％ and 75.0％,respectively.It was also observed that the Gleason scores of the poorly differentiated endemic regions had positive correlation with the CC/C values ( r =0.605,P =0.000 ),suggesting that CC/C value was associated with the differentiation grade of the poorly differentiated prostatic cancer.When CC/C value was above 0.948,the poorly differentiated prostatic cancer was typically detected and Gleason score was often above 7.Conclusions CC/C values has positive correlation with Gleason scores.MRS may be used to predict the differentiation of prostate cancer.