IVIM技术成像量化参数与前列腺癌病理特征的关系及联合诊断研究

目的 研究小视野体素内不相干运动（intravoxel incoherent motion，IVIM）技术成像量化参数与前列腺癌（prostate cancer，PC）病理特征的关系及联合诊断价值。 方法 选取PC患者62例作为观察组，良性前列腺增生症患者62例作为对照组。比较2组一般资料、IVIM技术成像量化参数［伪扩散系数（pseudo diffusion coefficient，D*）、灌注分数（perfusion fraction，f）、扩散系数（diffusion coefficient，D）、表观扩散系数（apparent diffusion coefficient，ADC）］，应用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析IVIM技术成像量化参数及联合诊断PC的价值，并比较不同病理特征患者IVIM技术成像量化参数，采用Spearman及Pearson分析IVIM技术成像量化参数与病理特征的相关性。 结果 观察组D、ADC低于对照组（P＜0.05）；2组D*、f差异无统计学意义（P＞0.05）。ROC分析结果显示，D、ADC诊断PC的AUC值分别为0.800、0.773； D、ADC联合诊断PC的AUC值为0.865，返回预测概率Logit(p)作为独立检验变量，结果显示，联合诊断的AUC值大于单一参数单独检测（P＜0.05）。不同2016版肾癌WHO泌尿课程/国际泌尿病理协会分级、D′Amico危险度、肿瘤T分期、Gleason评分患者D、ADC差异有统计学意义（P＜0.05）；不同肿瘤大小、PSA水平患者D、ADC差异无统计学意义（P＞0.05）。D、ADC与ISUP分级、Gleason评分、D′Amico危险度、肿瘤T分期呈负相关（P＜0.05）。 结论 IVIM技术成像量化参数中D、ADC诊断PC敏感度、特异度较高且参数值与病理特征关系密切，二者联合不仅可进一步提高诊断效能，还能为临床评价病理特征提供参考，便于治疗方案的制定。

Study on the relationship between the quantitative parameters of IVIM imaging and the pathological characteristics of prostate cancer and the combined diagnosis

Objective To study the relationship between the quantitative parameters of intravoxel incoherent motion(IVIM) imaging in small visual field and the pathological characteristics of prostate cancer(PC) and the value of combined diagnosis.Methods A total of 62 PC patients were selected as the observation group, and 62 patients with benign prostatic hyperplasia were selected as the control group. The general information and quantitative parameters of IVIM technology imaging ［pseudo diffusion coefficient(D*), perfusion fraction(f), diffusion coefficient(D), apparent diffusion coefficient(ADC)］ were compared between two groups. The receiver operating characteristic curve(ROC) was used to analyze the imaging quantitative parameters of IVIM technology and the value of the combined diagnosis of PC, and the imaging quantitative parameters of IVIM technology in patients with different pathological characteristics were compared. Spearman and Pearson were used for correlation analysis.Results The D and ADC of the observation group were lower than those of the control group(P＜0.05). There was no statistically significant difference in D* and f between two groups(P＞0.05). ROC analysis results showed that the AUC values of D and ADC in the diagnosis of PC were 0.800 and 0.773, respectively, and the AUC value of D combined with ADC in the diagnosis of PC was 0.865(P＜0.05). Logit(p) was used as an independent test variable, and the results showed that the AUC value of combined detection in the diagnosis was greater than that of single parameter detection alone(P＜0.05). No significant difference was found in D and ADC in patients with different 2016 editions of renal cancer WHO urology curriculum/International Society of Urological Pathology(ISUP) grade, D′Amico risk, tumor T stages, and Gleason scores(P＜0.05). There was no significant difference in D and ADC in patients with different tumor size and PSA level D(P＞0.05). D and ADC were negatively correlated with ISUP grade, Gleason score, D′Amico risk, and tumor T stages(P＜0.05).Conclusion Among the quantitative parameters of IVIM technology imaging, D and ADC have high sensitivity and specificity in diagnosing PC, and the parameter values are closely related to pathological characteristics. The combination of the two can not only further improve the diagnostic efficiency, but also provide a reference for clinical evaluation of pathological characteristics, and facilitate the formulation of treatment plans.