多b值DWI联合PSA评估前列腺癌内分泌治疗效果及相关性研究

目的 探讨多b值3.0T磁共振扩散加权成像(DWI)联合血清前列腺特异性抗原(PSA)在前列腺癌(PCa)患者内分泌治疗前后疗效评估中的应用价值,并研究信号强度(SI)、表观扩散系数(ADC)与血清PSA的相关性.方法 40例经手术病理或穿刺活检确诊的PCa患者,在接受内分泌治疗前后分别检测血清PSA水平和进行b值=300,800,1 000 s/mm2 DWI扫描,并根据DWI测量不同b值条件下PCa区SI及ADC值,观察内分泌治疗前后血清PSA变化及不同b值条件下SI、ADC值的变化情况,并分别研究SI和ADC值与血清PSA的相关性.结果 (1)40例PCa患者接受内分泌治疗前后血清PSA分别为 (35.63±20.91) ng/mL、(5.98±3.84) ng/mL,差异有统计学意义(P<0.05).(2)不同b值条件下,40例PCa患者接受内分泌治疗前ADC值分别为(1.06±0.06)×10-3 mm2/s,(0.83±0.04)×10-3 mm2/s,(0.73±0.03)×10-3 mm2/s;治疗后ADC值升高,分别为(1.33±0.09)×10-3 mm2/s,(1.16±0.09)×10-3 mm2/s,(1.10±0.08)×10-3 mm2/s,差异均有统计学意义(P<0.05).40例PCa患者接受内分泌治疗前SI分别为809.09±79.06,417.42±26.65和327.42±25.26;治疗后SI分别为780.10±78.52,409.33±33.93和320.00±31.10,差异均无统计学意义(P>0.05).(3)Pearson相关分析显示PCa患者接受内分泌治疗前ADC值与血清PSA呈负相关(r300=-0.58,P<0.01;r800=-0.60,P<0.01;r1 000=-0.66,P<0.01).内分泌治疗后ADC值与血清PSA亦呈负相关(r300=-0.55,P<0.01;r800=-0.52,P<0.01;r1 000=-0.61,P<0.01).治疗前SI值与血清PSA呈负相关(r300=-0.09,P<0.01;r800=-0.18,P<0.01;r1 000=-0.28,P<0.01).结论 不同b值条件下,PCa患者内分泌治疗后ADC值升高,与PSA水平均呈负相关,以b值=1 000 s/mm2相关性最明显;DWI联合血清PSA可作为监测与评估PCa疗效的手段,更好地指导临床治疗PCa.

Correlation research of multi-b value DWI combined with PSA on the effect of endocrinotherapy for prostate cancer

Objective To investigate the value of multi-b value DWI combined with PSA evaluation on the effect of endocrinotherapy for prostate cancer (PCa), and to study the correlation between the signal intensity(SI), apparent diffusion coefficient(ADC) with PSA.Methods Forty patients with PCa diagnosed by pathology or biopsy were tested for serum PSA levels before and after endocrine therapy.All patients underwent DWI at b-value of 300,800 and 1 000 s/mm2 by using a GE Signa HDx 3.0T MRI scanner.The serum PSA,the value of SI and ADC at different b values before and after endocrine therapy,and their correlation with PSA were observed and measured, respectively.Results (1)The serum PSA before and after endocrine therapy were (35.63±20.91) ng/mL and (5.98±3.84) ng/mL, respectively.The difference was statistically significant (P<0.05).(2)On the condition of different b values, ADC values were (1.06±0.06)×10-3 mm2/s, (0.83±0.04)×10-3 mm2/s, (0.73±0.03)×10-3 mm2/s, respectively before endocrine therapy, and (1.33±0.09)×10-3 mm2/s, (1.16±0.09)×10-3 mm2/s, (1.10±0.08)×10-3 mm2/s, respectively after endocrine therapy.There were significant difference between the ADC values before endocrine therapy and those after endocrine therapy (P<0.05).SI were 809.09±79.06, 417.42±26.65 and 327.42±25.26 in 40 patients with Pca before the endocrine therapy, and 780.10±78.52,409.33±33.93 and 320.00±31.10 after endocrine therapy.The difference was not statistically significant (P>0.05).(3)Pearsoncorrelation analysis showed that ADC value was negatively correlated with serum PSA (r300=-0.58,P<0.01;r800=-0.60,P<0.01;r1 000=-0.66,P<0.01) before endocrine therapy.ADC value was also negatively correlated with serum PSA (r300=-0.55,P<0.01;r800=-0.52,P<0.01;r1 000=-0.61,P<0.01) after endocrine therapy.In addition,SI was negatively correlated with serum PSA (r300=-0.09,P<0.01;r800=-0.18,P<0.01;r1 000=-0.28,P<0.01) before the treatment, as well.Conclusion ADC value at different b values increased after endocrine therapy in Pca, and is negatively correlated with serum PSA.The correlation is the most significant at b value of 1 000 s/mm2.The combination of DWI and serum PSA could be used to monitor and evaluate the effect of endocrinotherapy for Pca, and better guide the clinical treatment of Pca.