DWI联合MRS对前列腺癌诊断的价值

目的探讨联合磁共振扩散加权成像(DWI)及磁共振波谱分析(MRS)对前列腺癌(PCa)的诊断价值。材料与方法对经过病理证实的24例PCa和30例前列腺增生(BPH)患者进行DWI和MRS检查。测量PCa区和BPH患者外周带、中央腺体的ADC值,观察枸橼酸盐(Cit)、胆碱(Cho)、肌酸(Cr)的化学位移并测量(Cho+Cr)/Cit比值。分别将PCa区ADC值95%可信区间上界、(Cho+Cr)/Cit值95%可信区间上界作为鉴别PCa与BPH的阈值。分析DWI、MRS及DWI联合MRS三种检查方法对PCa诊断的敏感度、特异度、准确度。结果 PCa区、BPH患者外周带、中央腺体的平均ADC值分别为(0.83±0.12)×10–3 mm2/s、(1.82±0.26)×10–3 mm2/s、(1.46±0.16)×10–3 mm2/s(F=31.1,P0.05),两两间比较差异均有统计学意义(P值均0.05)。PCa区、BPH患者外周带、中央腺体的平均(Cho+Cr)/Cit值分别为1.55±0.11、0.53±0.16、0.64±0.13(F=18.2,P0.05)。PCa区与BPH患者外周带及中央腺体(Cho+Cr)/Cit差异有统计学意义(P0.05),BPH患者外周带与中央腺体(Cho+Cr)/Cit差异无统计学意义(P0.05)。DWI诊断PCa的敏感度、特异度、准确度分比为79.17%、80%、79.63%。MRS诊断PCa的敏感度、特异度、准确度分比为87.5%、86.67%、87.03%。DWI联合MRS诊断PCa的敏感度、特异度、准确度分别为91.67%、93.33%、92.59%。结论 DWI联合MRS对PCa诊断优于单独运用DWI及MRS。

The value of diagnosis for prostate cancer by combining DWI with MRS

Objective: To investigate the value of diagnosis for prostate cancer (PCa) by combining diffusion weighted imaging (DWl) with magnetic resonance spectroscopy (MRS). Materials and Methods: Twenty-four cases of PCa and 30 cases of benign prostate hyperplasia (BPH) proved by pathology were examined by DWI and MRS. Apparent diffusion coefficient (ADC) values of cancerous regions and peripheral zone and central glands in BPH were measured. The chemical shift of citrate (Cit), choline (Cho), creatine (Cr) spectra, and the ratio of (Cho+Cr)/Cit were observed in MRS. The upper bound of 95 confidence interval of PCa ADC and (Cho+Cr)/Cit was set as the threshold value. The sensitivity, specificity and accuracy of DWI, MRS and DWI+MRS in the diagnosis of PCa were analyzed. Results: The ADC value of cancerous, peripheral zone and central glands in BPH were (0.83±0.12)×10–3 mm2/s, (1.82±0.26)×10–3 mm2/s, (1.46±0.16)×10–3 mm2/s (F=31.1, P<0.05). The (Cho+Cr)/Cit value of cancerousperipheral zone and central glands in BPH were 1.55±0.11, 0.53±0.16, 0.64±0.13 (F= 18.2, P<0.05). There were significant difference between cancerous and peripheral zone, central glands of BPH in the value of (Cho+Cr)/Cit respectively (P<0.05). There was no significant difference between peripheral zone and central glands of BPH in the value of (Cho+Cr)/Cit (P>0.05).The diagnostic sensitivity, specificity and accuracy of DWI were 79.17%, 80%, 79.63%, respectively. The diagnostic sensitivity, specificity and accuracy of MRS were 87.5%, 86.67%, 87.03%, respectively. The diagnostic sensitivity, specificity and accuracy of DWI+MRS were 91.67%, 93.33%, 92.59%, respectively. Conclusions: The combined application with DWI and MRS was better than DWl or MRS alone in the diagnosis for prostate cancer.