3.0T磁共振波谱成像结合T_2WI对前列腺癌与前列腺增生的鉴别诊断价值

目的:探讨3.0T磁共振波谱成像(magnetic resonance spectroscopy,MRS)结合T2WI对前列腺癌与前列腺增生的鉴别诊断价值。方法:回顾性分析49例经直肠超声引导下穿刺活检证实的前列腺病变患者的MRI资料,其中前列腺增生27例,前列腺癌22例,所有患者均行常规T2WI及MRS检查。T2WI分析前列腺的大小、形态、病变位置、信号特点和病变累及的范围等。MRS根据穿刺病理结果选择体素,测量相应体素的枸橼酸盐(Citrate,Cit)、胆碱(Choline,Cho)、肌酸(Creatine,Cre)的峰值、(Cho+Cre)/Cit的比值。数据经K-S检验证实为正态分布后,采用独立样本t检验进行比较。结果:22例前列腺癌病例中T2WI序列18例有典型的肿瘤征象,其中4例膀胱受累,12例精囊腺受累,4例直肠受累,盆腔淋巴结转移8例,骨盆转移11例。余4例未见明显前列腺癌征象。所有前列腺增生病例T2WI序列均具有典型的增生征象。前列腺癌病例共选取136个体素,MRS主要表现为Cit峰明显降低甚至消失,Cho峰显著升高,两者波峰可呈现倒置。前列腺增生病例共选取132个体素,MRS主要表现为Cit峰高耸,Cho峰及Cre峰较低。前列腺癌组(Cho+Cre)/Cit平均值为2.05±0.61,前列腺增生组为0.53±0.19,两组数据符合正态分布特点,差异具有统计学意义(t=-27.241,P<0.05)。结论:MRS结合T2WI对前列腺癌与前列腺增生的诊断和鉴别诊断,均具有较高的临床应用价值。

The value of 3 . 0 T magnetic resonance spectroscopy with T2 WI in the dif-ferential diagnosis between prostate cancer and benign prostatic hyperplasia

Objective: To investigate the value of 3.0T magnetic resonance spectroscopy with T2 WI in the differential diagnosis between prostate cancer( PCa) and benign prostatic hyperplasia( BPH). Methods: Retrospectively analyses MRI data of 49 patients with prostate diseases confirmed by transrectal ultrasound-guided needle biopsy. 27 patients were PCa and 22 patients were BPH. All patients were performed traditional MRI( T2WI) and magnetic resonance spectroscopy( MRS). T2 WI sequence observation was focused on the size and shape of the prostate gland,the location of the lesion,the signal features and the extent of the tumor. Select voxels according to the pathologic results,MRS findings were measured the metabolic concentration of citrate( Cit),choline( Cho) and creatine( Cre),and the ratio of( Cho + Cre) /Cit. The ratio of( Cho + Cre) /Cit were compared between the groups PCa and BPH by using independent samples t-test. Results: On T2 WI,18 cases had apparent sign of PCa among 22 cases. The affected adjacent structures included bladder( n= 4),seminal vesicle( n = 12),rectum( n = 4),pelvic lymph nodes fused in mass( n = 8) and bone of pelvic( n = 11). 4 cases had no apparent sign of PCa. All cases had apparent sign in BPH. On MRS,138 voxels were selected in PCa,Cit peak was apparently declined and Cho peak was obviously ascended. Oppositely,132 voxels were selected in BPH,Cit peak was obviously higher than Cho and Cre.The average ratio of( Cho + Cre) /Cit for PCa was 2. 05 ± 0. 61. While,in BPH,the average ratio of( Cho + Cre) /Cit was 0. 53 ± 0. 19.Independent samples t-test shows that their differences between PCa and BPH were statistically significant( t =- 27. 241,P < 0. 05).Conclusion: MRS and T2 WI can offer effective diagnosis and differential diagnosis between PCa and BPH,which had higher value of clinical application.