多体素MRS对PI-RADS 3分和4分结节的诊断价值

发布时间：2018-04-04 21:22

  本文选题：前列腺癌(PCa)　切入点：前列腺影像报告和数据系统(PI-RADS)　出处：《昆明医科大学》2017年硕士论文

【摘要】：目的:通过对前列腺外围带和中央腺体病灶进行PI-RADS V2分析评分,以手术或穿刺活检的病理检查结果为金标准,探讨MRS对PI-RADS V2评分3-4分结节的假阳性率和假阴性率及其原因。材料与方法:收集了 2015年3月至2016年12月在本院行前列腺检查且符合入选标准和排除标准的96例患者的临床和影像资料。入组的96例患者均行常规MRI、DWI、DCE及MRS检查,所有患者均经手术和穿刺活检取得的病理组织证实。依据第二版前列腺影像报告和数据系统(PI-RADS),由两名主治及以上从事前列腺MRI诊断的影像科医师,对入组病例行PI-RADS评分,同时对MRS结果进行分析。首先将96例患者分为外周带病变组和中央腺体病变组(以评分最高为标准),筛选出PI-RADS V2评分为3分和4分的结节,MRS结果以(Cho+ Cre)/Cit≥0.91为阳性,0.91为阴性,结果与组织病理学对照,计算3分和4分前列腺结节的MRS假阳性率和假阳性率,同时采用受试者特征曲线获得曲线下面积,分析MRS结果与病理结果的一致性。结果:1.本研究中的96例前列腺患者中,年龄51-85岁,平均(69. 06±6. 47)岁,病理证实癌31例,非癌65例,外围带病变32例,中央腺体病变64例。2.外围带PI-RADS评分3分结节17例,假阳性3例,假阴性1例。AUC=0.779。敏感性85. 7%,特异性70. 0%,假阳性率30. 0%,假阴性率14. 3%。外围带PI-RADS评分4分结节15例,假阳性1例,假阴性0例。AUC=0.917。敏感性100%,特异性83. 3%,假阳性率16. 7%,假阴性率0。3.中央腺体PI-RADS V2评分3分结节47例,假阳性7例,假阴性1例。AUC=0. 852。敏感性88. 9%,特异性81. 6%,假阳性率18. 4%,假阴性率11.1%。中央腺体PI-RADS评分4分结节17例,假阳性4例,假阴性0例。AUC=0. 818。敏感性100%,特异性63. 6%,假阳性率36. 4%,假阴性率0。4.造成前列腺患者诊断假阳性的16例中2例为出血,2例为慢性非特异性肉芽肿性炎,7例为BPH,5例为BPH伴慢性前列腺炎。造成假阴性的2例,1例是微小区域癌变,1例原因不确切。5.对外周带PI-RADS V2评分3分的结节,MRS诊断价值中等(AUC值位于0. 70～0.90之间),对外周带PI-RADS评分4分的结节,MRS诊断价值较高(AUC值0.90 ),对中央腺体PI-RADS评分3分和4分结节,MRS诊断价值中等(AUC值位于0.70～0.90之间)。结论:1.对外周带PI-RADS V2评分3分的结节和中央腺体PI-RADS评分3分和4分的结节,MRS诊断价值中等,对外周带PI-RADS V2评分4分的结节,MRS诊断价值较高。2. MRS假阳性的原因有出血,良性前列腺增生(尤其是基质增生结节),慢性非特异性肉芽肿性炎等有关;假阴性的原因可能与病变微小等有关。
[Abstract]:Objective: to study the false positive rate and false negative rate of PI-RADS V2 score in 3-4 subnodule of PI-RADS V2 score by using PI-RADS V2 analysis of peripheral prostate and central gland as the golden standard of pathological examination of operation or puncture biopsy, and to explore the causes of the false positive rate and false negative rate of PI-RADS V2 score in 3-4 sub-nodule of PI-RADS V2 score by MRS.Materials and methods: the clinical and imaging data of 96 patients who underwent prostate examination in our hospital from March 2015 to December 2016 and met the criteria of inclusion and exclusion were collected.All the 96 patients were examined by conventional MRII-DWII-DCE and MRS, all of them were confirmed by biopsy and operation.According to the second edition of prostatic imaging report and data system PI-RADS, two imaging physicians who were involved in the diagnosis of prostate MRI were evaluated with PI-RADS and the results of MRS were analyzed.At first, 96 patients were divided into peripheral lesion group and central glandular lesion group (with the highest score as the standard, the PI-RADS V2 scores of 3 and 4) were screened out. The results of Mrs with Cho Cre)/Cit 鈮，

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