智能融合成像技术对中低风险前列腺特异性抗原人群的临床显著性前列腺癌诊断研究

目的:探讨核磁联合经直肠超声计算机软件融合成像引导前列腺靶向穿刺活检(software guided magnetic resonance imag?ing-ultrasound fusion targeted biopsies,MRUS-TB)在中低风险前列腺特异性抗原(prostate-specific antig...     

表观扩散系数预测直肠癌术前放化疗疗效分析

目的 探讨表观扩散系数(ADC)预测局部晚期直肠癌术前放化疗疗效的作用。方法 2007 —2011年间前瞻性纳入病理证实的临床Ⅱ、Ⅲ期直肠腺癌患者 70例。均行术前同期放化疗,盆腔放疗 44.0~50.4 Gy分 22~28次,同期化疗卡培他滨每天1650 mg/m²第 1~35天+奥沙利铂50 mg/m²每周1次共5次,放化疗后 4~8周行根治性手术。疗前常规行盆腔MRI及扩散加权成像检查,测量ADC值并行术后病理反应评级。Mann-Whitney U检验法分析组间ADC值差异,Kaplan-Meier法计算生存率并Logrank法检验。结果 70例患者中7例(10%) pCR、38例(54%)降期。中位随访34个月, 22例(31%)复发。疗前、疗中、疗后平均ADC值分别为(1.09±0.19)×10^－3、(1.28±0.19)×10^－3、(1.47±0.24)×10^－3 mm²/s。预后较好组(pCR、降期、无复发)疗前平均ADC值低于预后不良组(P=0.049、0.001、0.029)。取疗前ADC值1.06×10^－3mm²/s为界值预测降期,ROC曲线下面积为0.737(95% CI=0.618~0.856)。疗前ADC值<1.06×10^－3mm²/s组3年DFS和DMFS均高于≥1.06×10^－3 mm²/s组,分别为86%比58%(P=0.01)和90%比60%(P=0.01)。 结论 疗前ADC值与局部晚期直肠癌术前同期放化疗疗效有一定相关性,对预测直肠癌术前放化疗疗效有一定意义。     

表观弥散系数预测局部晚期鼻咽癌对含多西他赛新辅助化疗敏感性的价值

目的:探讨表观弥散系数(ADC)预测局部晚期鼻咽癌对含多西他赛新辅助化疗敏感性的价值.方法:集2013年3月到2015年7月的鼻咽癌III期及IV期患者34例,分别在新辅助化疗前1周内及2周期新辅助化疗结束后1周进行磁共振扫描,采集不同时间点鼻咽癌原发灶的扩散加权图像(DWI)并分析获得的表观扩散系数(ADC),根据RECIST 1.1指南分别进行疗效分组(化疗高反应和化疗低反应组),采用独立样本t检验比较不同疗效组间不同时间点的ADC值,并应用Spearson等级相关性分析评价ADC值与肿瘤消退率的相关性.结果:新辅助化疗前,化疗高反应组的ADC值治疗前低于化疗低反应组[(1.32±0.25)×10-3mm2/s vs (1.61±0.24)×10-3mm2/s,P=0.001];化疗高反应组的ADC值治疗后为(2.12±0.26)×10-3mm2/s,而化疗低反应组的ADC值治疗后为(1.70±0.45)×10-3mm2/s,差异有统计学意义(P=0.032);化疗高反应组ADC值变化率(△ADC)明显高于化疗低反应组[(63.1±35.6)% vs (14.3±36.9)%,P=0.021];ADC值治疗前与肿瘤消退率负相关(r=-0.451,P=0.007),ADC值治疗后和ADC值变化率(△ADC)与肿瘤消退率正相关(r=0.667,P=0.005;r=0.550,P=0.027).结论:核磁共振表观弥散系数对鼻咽癌新辅助化疗疗效可以进行早期评价,有助于早期进行治疗方案的调整.     

TBC1结构域家族成员15蛋白、最小表观扩散系数对脑胶质瘤恶性程度及预后的预测价值

目的 探讨TBC1结构域家族成员15蛋白(TBC1D15)、最小表观扩散系数(ADC)对脑胶质瘤恶性程度及预后的预测价值.方法 选取132例脑胶质瘤患者,其中低级别胶质瘤患者56例,高级别胶质瘤患者76例,分析不同分级脑胶质瘤组织中TBC1D15蛋白、最小ADC值差异.绘制受试者工作特征(ROC)曲线,计算曲线下面积(...     

弥散加权成像对鉴别前列腺癌和前列腺增生的意义

目的:探讨前列腺弥散加权成像测得的ADC值结合常规MRI对鉴别前列腺癌和前列腺增生的价值.方法:选择前列腺增生病人15例,前列腺癌病人10例,分析采用b值为1000的ADC图及常规MR图像,结合常规MRI在ADC图上选取感兴趣区测量前列腺癌(PCa)、前列腺增生(BPH)外围带(PZ)和前列腺增生中央带(CG)的ADC值.比较差异性并分析重叠情况.结果:前列腺增生表现为信号不均,增生结节有的为T2WI高信号,有的为T2WI低信号,前列腺癌有时与增生结节难以鉴别.PCa的ADC值(0.67±0.06)×10-3mm2/s,前列腺增生外围带(PZ)的ADC值(1.52±0.18)×10-3mm2/s,前列腺增生中央带(CG)的ADC值(1.05±0.25)×10-3mm2/s,BPH的PZ与PCa及BPH的CG与PCa均有显著差异,BPH的PZ与PCa间无重叠,BPH的CG与PCa间有少量重叠.结论:DWI对鉴别前列腺癌和前列腺增生有意义,但由于分辨力的限制,测量ADC值时要参照常规MRI以使选取的区域更准确.     

磁共振弥散加权成像的表观弥散系数在直肠腺癌术前诊断中的应用

目的 探讨磁共振弥散加权成像(DWI)的表观弥散系数(ADC)在诊断直肠腺癌和评估直肠腺癌恶性程度中的应用.方法 比较82例经病理学检查确诊的直肠腺癌患者(观察组)与82例无直肠病变者(对照组)的ADC值,并在观察组中比较磁共振成像(MRI)和DWI对直肠腺癌T分期诊断的准确性.结果 观察组ADC平均值为(0.89±0.12)×10-3mm2/s,低于对照组ADC平均值(1.45±0.15)×10-3mm2/s,差异有统计学意义(P﹤0.05).对于直肠腺癌的诊断,ADC的最佳分界值为1.26×10-3mm2/s,敏感度为96.1%,特异度为97.5%;低分化、中分化和高分化直肠腺癌的ADC值分别为(0.80±0.10)×10-3mm2/s、(0.95±0.11)×10-3mm2/s和(1.23±0.18)×10-3mm2/s,不同分化程度的ADC值比较,差异有统计学意义(P﹤0.05).对于直肠腺癌,MRI分期诊断的准确性为74.39%,DWI分期诊断的准确性为86.59%,两者比较,差异有统计学意义(P﹤0.05).结论 直肠腺癌的不同分化程度与ADC值相关,DWI可以增加直肠腺癌术前分期诊断的准确率.     

PSAT 在前列腺穿刺活检中的意义

目的:探讨前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法:对120例患者行前列腺穿刺活检,其中PSA≥4ng/ml者105例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者15例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果:120例患者中经前列腺穿刺诊断为前列腺癌(PCa)63例,活检阳性率52.5,其中15例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,前列腺小细胞癌2例,腺癌4例,良性前列腺增生8例;42例>20ng/ml者中32例为PCa,活检阳性率76.2;63例PSA4-20ng/ml者中24例为PCa,活检阳性率38.1;29例PSA4-10ng/ml者中10例为PCa,活检阳性率34.5。血清PSA4-20ng/ml患者,PSAD≥0.13或PSAT≥0.15时,敏感性均为100,特异性为20.5或17.9,阳性预测值为43.6或42.9,可避免12.7(8/63)或11.1(7/63)阴性穿刺结果。血清PSA4-20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为11.18±4.49和10.05±4.29ng/ml(P=0.318);PSAD分别为0.45±0.33和0.26±0.15(P=0.003);PSAT分别为0.94±0.65和0.43±0.24(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.576、0.676和0.77,PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论:PSA4-20ng/ml时,PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

表观扩散系数直方图对肾透明细胞癌病理分级的诊断价值

目的 探讨表观扩散系数（apparent diffusion coefficient，ADC）直方图对肾透明细胞癌（clear cell renal cell carcinoma，CCRCC）病理分级的诊断价值。方法 对34例CCRCC患者的常规MRI及扩散加权成像（diffusion-weighted imaging，DWI）资料进行回顾性分析。依据病理结果，分为低级别组（19例）、高级别组（15例）。测量记录不同级别CCRCC的ADC直方图参数，包括ADC值的最大值、最小值、平均值、中位数、偏度值、峰度值。采用独立样本t检验或Mann-Whitney U检验比较不同级别CCRCC ADC直方图参数的差异。结果 低级别组CCRCC 的ADC直方图最小值、平均值、中位数均高于高级别组 ［（1.09±0.23）×10-3 mm²/s vs （0.81±0.09）×10^-3 mm²/s、（1.86±0.27）×10^-3 mm²/s vs （1.58±0.14）×10^-3 mm²/s以及（1.85±0.23）×10^-3 mm²/s vs （1.59±0.12）×10^-3 mm²/s，P＜0.05］，且低级别组ADC直方图以负偏态分布为主；两组ADC直方图的最大值、峰值差异无统计学意义（P＞0.05）。ADC值直方图的最小值鉴别低级别、高级别CCRCC的效能最高，曲线下面积（area under curve，AUC）为0.895，对应的最佳诊断阈值、Youden指数以及敏感度、特异度分别为0.898×10^-3 mm²/s、0.761、86.67%、89.47%。结论 表观扩散系数直方图有助于鉴别低级别、高级别CCRCC，ADC最小值诊断效能最优。       

A case of locally advanced prostate cancer in the transition zone

A 65-year-old man was referred to our hospital for the furtherevaluation and treatment of prostate     

Diagnostic performance of apparent diffusion coefficient parameters for glioma grading

This study was to evaluate the diagnostic performance of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) parameters derived from diffusion tensor imaging in the differentiation between grade II and III gliomas. The records of 60 patients (30 women, 30 men; mean age, 45.4 years) suspected of having gliomas who underwent an ADC image-guided stereotactic biopsy were retrospectively reviewed. The values of FA and ADC were measured, and the sensitivity, specificity, accuracy and area under the curve (AUC) of those parameters were calculated based on the receiver operating characteristic curve analysis. A predictive diagnostic equation was also constructed and evaluated. Significant differences in minimum ADC values were found in the quantitative analysis between the grade III and II glioma groups. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), accuracy and AUC for identifying grade III and II gliomas at the optimum cut-off value of 0.895?×?10^?3 mm²/s of minimum ADC were 81.0, 89.1, 77.3, 91.1, 86.6 and 0.87, respectively. The predictive diagnostic equation was superior to the single minimum ADC indicator with a sensitivity of 90.5%, a specificity of 84.8%, a PPV of 73.1%, an NPV of 95.1%, and an accuracy of 86.6%, respectively. The study provides evidence that minimum ADC values have a superior diagnostic performance in differentiating grade III and II gliomas, and the predictive diagnostic equation may be helpful in the differentiation.     

FDG-PET/CT and diffusion-weighted imaging for resected lung cancer: correlation of maximum standardized uptake value and apparent diffusion coefficient value with prognostic factors

Diffusion-weighted magnetic resonance imaging (DWI) is useful for detecting malignant tumors and the assessment of lymph nodes, as FDG-PET/CT is. But it is not clear how DWI influences the prognosis of lung cancer patients. The focus of this study is to evaluate the correlations between maximum standardized uptake value (SUVmax) of FDG-PET/CT and apparent diffusion coefficient (ADC) value of DWI with known prognostic factors in resected lung cancer. A total of 227 patients with resected lung cancers were enrolled in this study. FEG-PET/CT and DWI were performed in each patient before surgery. There were 168 patients with adenocarcinoma, 44 patients with squamous cell carcinoma, and 15 patients with other cell types. SUVmax was a factor that was correlated to T factor, N factor, or cell differentiation. ADC of lung cancer was a factor that was not correlated to T factor, or N factor. There was a significantly weak inverse relationship between SUVmax and ADC (Correlation coefficient r?=?? 0.227). In analysis of survival, there were significant differences between the categories of sex, age, pT factor, pN factor, cell differentiation, cell type, and SUVmax. Univariate analysis revealed that SUVmax, pN factor, age, cell differentiation, cell type, sex, and pT factor were significant factors. Multivariate analysis revealed that SUVmax and pN factor were independent significant prognostic factors. SUVmax was a significant prognostic factor that is correlated to T factor, N factor, or cell differentiation, but ADC was not. SUVmax may be more useful for predicting the prognosis of lung cancer than ADC values.     

良性前列腺增生及前列腺癌的ADC值与PAP、P504S、PSA表达的相关性研究

目的：探讨良性前列腺增生和前列腺癌的ADC值与前列腺相关标志物PAP、P504S、PSA表达的关系。方法收集经病理证实的65例前列腺疾病患者,其中良性前列腺增生30例,前列腺癌35例。病理检查前3个月内均行前列腺MRI、DWI检查,采用单次激发EPI序列,b值为0 s/mm2和800 s/mm2,并采用免疫组化检测组织标本中PAP、P504S、PSA的表达,分析ADC值与PAP、P504S、PSA表达的关系。结果良性前列腺增生和前列腺癌的ADC值分别为（1.73±0.21）×10-3 mm2/s和（1.34±0.15）×10-3 mm2/s,差异具有统计学意义（t=8.545,P=0.000）。PAP和PSA在良性前列腺增生和前列腺癌中均表达,差异无统计学意义（P均＞0.05）,P504S在前列腺癌中的表达显著高于良性增生（Z=-7.055,P=0.000）,双变量相关分析显示ADC值与P504S的表达呈显著负相（Spearman's相关系数r=-0.654,P=0.000）;结论 PAP和PSA不能区别前列腺良恶性病变;P504S可以作为前列腺癌标志物;ADC值可以定量评价良性前列腺增生和前列腺癌,且与P504S存在负相关,可以作为前列腺良恶性病变MRI诊断的参考指标。     

MR表观扩散系数阈值对鼻咽癌诊断价值的研究

目的：分析鼻咽癌治疗前瘤灶、复发瘤及放疗后非复发瘤的MR表观扩散系数（apparent diffusion coefficient, ADC）值差异,探讨磁共振扩散加权成像（diffusion-weighted imaging,DWI）对鼻咽癌及其复发瘤的诊断价值,并研究其ADC诊断阈值对鼻咽癌的诊断效能。方法收集鼻咽癌治疗前患者（初诊组）103例、放疗后局部复发患者（复发组）39例和放疗后非复发患者（非复发组）51例,分别行常规MR平扫、增强扫描及DWI序列（b=0、800 mm2/s）扫描检查,采用单因素方差分析3组ADC值的差异性;绘制受试者工作曲线（ROC）并对3组病例数据进行分析,确定鼻咽癌初诊组和复发组的ADC诊断阈值,分别计算其诊断鼻咽癌治疗前瘤灶、放疗后鼻咽部复发瘤和放疗后非复发瘤的敏感性、特异性以及约登指数,比较二者ADC诊断阈值的诊断效能。结果非复发组与初诊组、复发组患者的ADC值比较,差异均有统计学意义（P均约0.05）;复发组与初诊组患者ADC值的差异无统计学意义（P跃0.05）。采用常规MRI检查诊断鼻咽癌复发瘤时,其诊断的敏感性和特异性分别为71.8%和74.5%;取0.851×10-3 mm2/s作为初诊组的ADC诊断阈值时,其对治疗前瘤灶诊断的敏感性、特异性和约登指数分别为98.0%、94.9%和0.929,对复发瘤诊断的敏感性、特异性和约登指数分别为76.9%、98.0%和0.749;取0.887×10-3 mm2/s作为复发组ADC诊断阈值时,其对复发瘤诊断的敏感性、特异性和约登指数分别为87.2%、94.1%和0.813。采用Z检验对3种检查法诊断鼻咽癌复发瘤的结果进行差异性分析,显示其中MR DWI复发组ADC诊断阈值对鼻咽癌复发瘤的诊断效能最高（Z=2.044,P=0.041）。结论 DWI有助于鼻咽癌及其复发瘤的检出及诊断,且较常规MRI具有更高的诊断效能;通过鼻咽癌复发组获得的ADC诊断阈值较通过鼻咽癌初诊组获得的ADC诊断阈值对?     

Predictive significance of mean apparent diffusion coefficient value for responsiveness of temozolomide-refractory malignant glioma to bevacizumab: preliminary report

Background

Recurrent glioblastoma after initial radiotherapy plus concomitant and adjuvant temozolomide is problematic. Here, patients with temozolomide-refractory high-grade gliomas were treated with bevacizumab (BV) and evaluated using apparent diffusion coefficient (ADC) for response.

Methods

Nine post-temozolomide recurrent or progressive high-grade glioma patients (seven with glioblastoma and two with anaplastic astrocytoma) were treated with BV monotherapy. Average age was 57 years (range, 22–78), median Karnofsky Performance Scale (KPS) was 70 (30–80) and median BV line number was 2 (2–5). Two had additional stereotactic radiotherapy within 6 months prior to BV. Magnetic resonance (MR) imaging after BV therapy was performed within 2 weeks with calculation of mean ADC (mADC) values of enhancing tumor contours.

Results

Post-BV treatment MR imaging showed decreased tumor volumes in eight of nine cases (88.9 %). Partial response was obtained in four cases (44.4 %), four cases had stable disease, and one had progressive disease. Of 15 evaluable enhancing lesions, 11 shrank and four did not. Pretreatment mADC values were above 1100 (10^?6 mm²/s) in all responding tumors, while all non-responding lesions scored below 1100 (p = 0.001). mADC decreased after the first BV treatment in all lesions except one. KPS improved in four cases (44.4 %). Median progression-free survival and overall survival for those having all lesions with high mADC (>1100) were significantly longer than those with a low mADC (<1100) lesion (p = 0.018 and 0.046, respectively).

Conclusions

Bevacizumab monotherapy is effective in patients with temozolomide-refractory recurrent gliomas and tumor mean ADC value can be a useful marker for prediction of BV response and survival.     

A novel expressed prostatic secretion (EPS)-urine metabolomic signature for the diagnosis of clinically significant prostate cancer

Objective:Significant efforts are currently being made to identify novel biomarkers for the diagnosis and risk stratification of prostate cancer (PCa). Metabolomics can be a very useful approach in biomarker discovery because metabolites are an important read-out of the disease when characterized in biological samples. We aimed to determine a metabolomic signature which can accurately distinguish men with clinically significant PCa from those affected by benign prostatic hyperplasia (BPH).Methods:We first performed untargeted metabolomics using ultrahigh-performance liquid chromatography tandem mass spectrometry on expressed prostatic secretion urine (EPS-urine) from 25 patients affected by BPH and 25 men with clinically significant PCa (defined as Gleason score ≥ 3 + 4). Diagnosis was histologically confirmed after surgical treatment. The EPS-urine metabolomic approach was then applied to a larger, prospective cohort of 92 consecutive patients undergoing multiparametric magnetic resonance imaging for clinical suspicion of PCa prior to biopsy.Results:We established a novel metabolomic signature capable of accurately distinguishing PCa from benign tissue. A metabolomic signature was associated with clinically significant PCa in all subgroups of the Prostate Imaging Reporting and Data System (PI-RADS) classification (100% and 89.13% of accuracy when the PI-RADS was in range of 1–2 and 4–5, respectively, and 87.50% in the more critical cases when the PI-RADS was 3).Conclusions:A combination of metabolites and clinical variables can effectively help in identifying PCa patients that might be overlooked by current imaging technologies. Metabolites from EPS-urine should help in defining the diagnostic pathway of PCa, thus improving PCa detection and decreasing the number of unnecessary prostate biopsies.     

Point: the value of predicting life expectancy in men with clinically localized prostate cancer

The prediction of life expectancy in prostate cancer screening and treatment is a controversial topic that evokes various opinions regarding its validity. The authors believe incorporating life expectancy prediction into the treatment algorithms for prostate cancer is important. Using a combination of clinical judgment and specific predictive tools, physicians can estimate the life expectancy of patients with prostate cancer. These estimates can then be used to help guide treatment discussion. Estimating life expectancy benefits older men in whom decisions regarding the best form of treatment may be difficult.     

前列腺影像报告和数据系统评价外周带前列腺癌的诊断价值

目的探讨前列腺影像报告和数据系统(PI-RADSv2)对外周带前列腺癌的诊断应用价值。方法选取2015年6月至2016年12月间苏州大学附属第二医院收治的103例前列腺外周带疾病患者的多参数磁共振成像(mp-MRI)表现。由两位医师对前列腺外周带病变进行PI-RADSv2评分,以病理检查结果作为金标准,分析两位医师诊断的一致性。通过绘制受试者工作特征(ROC)曲线及敏感度和特异度等指标,评估PI-RADSv2对外周带前列腺癌的诊断效能。结果两位医师评估外周带前列腺癌、临床显著癌和非癌病变Kappa值分别为0.75、0.84和0.66。PI-RADSv2诊断外周带前列腺癌的敏感度和特异度分别为80.2%和75.1%。PI-RADSv2诊断外周带前列腺临床显著癌的诊断敏感度和特异度分别为89.7%和84.6%。结论两位医师评估前列腺外周带病变的PIRADS评分有较高一致性,对前列腺外周带临床显著癌的评分一致性高,且PI-RADSv2对外周带前列腺临床显著癌有较高的敏感度和特异度,对前列腺外周带病变诊断具有一定的指导意义。     

晚期结直肠癌组织表观弥散系数与化疗疗效的关系

目的 探讨晚期结直肠癌组织表观弥散系数（ADC）在化疗前、后的变化及其与化疗疗效的相关性。 方法 40例晚期结直肠癌患者采用FOLFOX 4方案化疗,具体为：奥沙利铂85mg／m2静滴,d1;亚叶酸钙200mg／m2静滴,d1、d2;氟尿嘧啶（5-FU）400mg／m2静推,d1、d2;5-FU 600mg／m2持续静滴22h,d1、d2。14天为1个周期,共化疗12个周期。化疗4个周期按RECIST 1.1标准评价疗效,并将患者分为有效组（CR+PR）和无效组（SD+PD）。于化疗前、第2个周期和第4个周期化疗后行磁共振弥散加权成像扫描,并记录肿瘤组织ADC值,分析肿瘤所有目标病灶长度总和的减少情况、ADC变化值及两者的相关性。结果 40例患者中有效组22例（CR 6例,PR 16例）,无效组18例（SD 11例,PD 7例）。第2个周期和第4个周期化疗后有效组的ADC值分别为（9.82±2.04）×10-4mm2／s和（10.09±1.95）×10-4mm2／s,较化疗前的（5.63±1.02）×10-4mm2／s明显升高（P=0.009,P=0.001）,而无效组化疗前后的ADC值无显著差异（P=0.412,P=0.654）。有效组化疗前ADC值低于无效组（P=0.021）。有效组化疗前ADC值和第2个周期化疗后的ADC变化值分别与第4个周期化疗后所有目标病灶长度总和的减少百分比呈负相关（r=-0.681,P=0.004）和正相关（r=0.749,P=0.002）。结论 晚期结肠癌组织化疗前ADC值及化疗后早期的ADC变化值可以作为预测晚期结直肠癌对化疗敏感性和化疗早期临床疗效评价的指标。