3.0T MR超高b值扩散加权成像在前列腺癌诊断中的应用价值
发布时间：2018-07-15 17:20
【摘要】：目的探讨3.0T MR超高b值扩散加权成像（DWI）对前列腺癌诊断的临床应用价值。 材料与方法我们对2012年12月至2013年6月期间所收集的56例临床怀疑前列腺癌的住院患者行MR检察，患者主诉主要为尿频、夜尿增多及PSA升高。根据穿刺病理活检及手术病理结果将患者分为两组：前列腺癌组，32例，年龄51~86岁，平均（68.4±7.2）岁，PSA范围（5.55~61.52）ng/ml。前列腺良性病变组，，24例，年龄49~78岁，平均（70.4±6.8）岁，PSA范围（6.25~62.23）ng/ml。所有患者均行MR常规序列T1WI、T2WI及DWI（b值分别为0s/mm2、1000s/mm2、1500s/mm2及2000s/mm2）检查，然后将常规序列T1WI、T2WI与不同b值DWI进行组合分为三组：即MR常规序列（包括T1WI及T2WI）联合DW（Ib=1000s/mm2）（A组）；MR常规序列（包括T1WI及T2WI）联合DWI（b=1500s/mm2）（B组）；MR常规序列（包括T1WI及T2WI）联合DWI（b=2000s/mm2）（C组）。分别测量不同b值下，前列腺癌组及前列腺良性病变组的ADC值，采用t检验比较不同b值时两者间ADC值的差异；对A、B、C三组行受试者工作特性曲线（Receiveroperating characteristic curves，ROC）分析，采用Z检验比较三组诊断前列腺癌的ROC曲线下面积(Areas under the receiver operating characteristic，AUC)差异，以确定诊断效能最高组；将b=1000s/mm2时DWI所得的ADC作为参考值，计算b=1500s/mm2及2000s/mm2时的相对ADC（rADC）值，绘制rADC值的ROC曲线，确定最佳诊断b值及相应b值下的最佳临界ADC值。 结果当b值分别为1000s/mm2、1500s/mm2、2000s/mm2时，前列腺癌组与前列腺良性病变组的ADC值(×10-3mm2/s)分别为（0.83±0.15）(范围0.543-1.15)与（1.29±0.06）（范围0.936-1.33）、（0.74±0.12）（范围0.471-1.09）与（1.17±0.08）（范围0.909-1.25）、（0.65±0.14）（范围0.418-0.971）与（1.02±0.07）（范围0.841-1.14），不同b值下前列腺癌组的ADC值与前列腺良性病变组比较，两者间的差异均具有明显的统计学意义（P＜0.05）；当b值分别为1000s/mm2、1500s/mm2、2000s/mm2时，前列腺良恶性病变间ADC值(×10-3mm2/s)重叠范围分别为（0.936~1.15）、（0.909~1.09）、（0.841~0.971）；A、B、C三组诊断前列腺癌的受试者工作特性曲线（ROC）下的面积分别为（0.938±0.290）、（0.966±0.200）、（0.998±0.003），C组ROC曲线下面积最大，其与B组及A组ROC曲线下面积的比较均有显著差异性（P值均＜0.05）；DWI（b=2000s/mm2）与DWI（b=1000s/mm2）的ADC值之比的rADC值诊断前列腺癌的ROC曲线下面积为（0.706±0.072），DWI（b=1500s/mm2）与DWI（b=1000s/mm2）的ADC值之比的rADC值诊断前列腺癌的ROC曲线下面积为（0.625±0.076），两者ROC曲线下面积差异具有明显统计学意义（P＜0.05）；单独以b=2000s/mm2DWI成像ADC值诊断前列腺癌的ROC曲线下面积上敏感性及特异性最大时所对应的ADC值为0.83×10-3mm2/s。 结论①发生于前列腺外周带或移行带的癌变组织其ADC值均明显小于前列腺良性病变组织。②DWI超高多b值成像中，前列腺良恶性病变间ADC值存在一定范围的重叠，但随着b值的增大，两者间ADC值重叠范围逐渐缩小。③以b=1000s/mm2DWI图像的ADC为参考值，b=2000s/mm2与其比值的rADC值ROC曲线下面积较b=1500s/mm2大，两者间差异具有明显统计学意义。④DWI联合MR常规序列诊断前列腺癌时，C组（b=2000s/mm2）诊断前列腺癌ROC曲线下面积最大，其与B组（b=1500s/mm2）或A组（b=1000s/mm2）之间的差异具有明显统计学意义，提示高b值有助于提高前列腺癌的诊断效能；b=2000s/mm2具有最佳诊断效能，并且其最佳诊断ADC阈值为0.83×10-3mm2/s。
[Abstract]:Objective to investigate the clinical value of 3.0T MR ultra high B diffusion-weighted imaging (DWI) in the diagnosis of prostate cancer.
Materials and methods 56 hospitalized patients with suspected prostate cancer collected from December 2012 to June 2013 were examined by MR. The main complaints were frequency of urination, nocturia and increased PSA. The patients were divided into two groups based on biopsy and surgical pathology: anterior adenocarcinoma group, 32 cases, age 51~86, average (68.4 + 7.2). ) years old, PSA range (5.55~61.52) ng/ml. benign prostatic lesion group, 24 cases, age 49~78 years, average (70.4 + 6.8) years old, PSA range (6.25~62.23) ng/ml. all patients with MR conventional sequence T1WI, T2WI and DWI (b values are respectively). The three groups: MR routine sequences (including T1WI and T2WI) combined with DW (Ib=1000s/mm2) (group A); conventional MR sequences (including T1WI and T2WI) combined DWI (b=1500s/mm2) (B group). The difference of ADC values between the two groups of B, A, B and C three groups were analyzed by Receiveroperating characteristic curves, ROC, and Z test was used to compare the difference between the three groups in the diagnosis of prostate cancer under the ROC curve. The ADC of DWI obtained at =1000s/mm2 is used as reference value, the relative ADC (rADC) value of b=1500s/mm2 and 2000s/mm2 is calculated, the ROC curve of rADC value is drawn, the best diagnostic B value and the optimal critical ADC value under the corresponding b value are determined.
Results when the b value was 1000s/mm21500s/mm22000s/mm2, the ADC value of the prostate cancer group and the benign prostatic lesion group (0.83 + 0.15) (range 0.543-1.15) and (1.29 + 0.06) (range 0.936-1.33), (0.74 + 0.12) (range 0.471-1.09) and (1.17 + 0.08) (0.65 + 0.14) (range 0.418-0.971) and (1.02 + 0.) (range 0.418-0.971) and (1.02 + 0.). 07) (range 0.841-1.14), the difference between the ADC value of prostate cancer group and benign prostatic lesion group under different b values has significant statistical significance (P < 0.05). When b value is 1000s/mm21500s/mm22000s/mm2, the overlap range of ADC value (x 10-3mm2/s) between benign and malignant prostate lesions is (0.936~1.15), (0.909~1.09), respectively. (0.841~0.971); the area under the working characteristic curve (ROC) of the three groups of A, B and C was (0.938 + 0.290), (0.966 + 0.200), (0.998 + 0.003), and the area under the ROC curve of group C was the largest. There were significant differences in the area under the B and A group ROC curves (P < 0.05). The rADC value of the ratio of C values was diagnosed under the ROC curve of the prostate cancer (0.706 + 0.072). The rADC value of the ADC value of DWI (b=1500s/mm2) and DWI (b=1000s/mm2) was (0.625 + 0.076) under the ROC curve of the prostate cancer, and the area difference under the ROC curve was statistically significant (P < 0.05). The sensitivity and specificity of the area under the ROC curve for the diagnosis of prostate cancer is ADC when the maximum value is 0.83 * 10-3mm2/s.
Conclusion (1) the ADC value of the cancerous tissues occurring in the peripheral zone of the prostate or the transitional zone of the prostate is significantly smaller than that of the benign prostatic lesions. (2) the ADC values of the benign and malignant prostate lesions overlap in a certain range in the DWI ultra high b value imaging, but with the increase of the b value, the overlap range of ADC values is gradually reduced. (3) AD of the b=1000s/mm2DWI image. C is a reference value, the area under the rADC value ROC curve of b=2000s/mm2 and its ratio is larger than b=1500s/mm2, and there is significant difference between them. (4) when DWI combined with MR routine sequence diagnosis of prostate cancer, C group (b=2000s/mm2) has the largest area under the ROC curve of prostate cancer, and there is a difference between the B group (b=1500s/mm2) or the group. Significant statistical significance, suggesting that high b value can help improve the diagnostic efficiency of prostate cancer; b=2000s/mm2 has the best diagnostic efficiency, and its best diagnostic ADC threshold is 0.83 x 10-3mm2/s.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25;R445.2
本文编号：2124815
[Abstract]:Objective to investigate the clinical value of 3.0T MR ultra high B diffusion-weighted imaging (DWI) in the diagnosis of prostate cancer.
Materials and methods 56 hospitalized patients with suspected prostate cancer collected from December 2012 to June 2013 were examined by MR. The main complaints were frequency of urination, nocturia and increased PSA. The patients were divided into two groups based on biopsy and surgical pathology: anterior adenocarcinoma group, 32 cases, age 51~86, average (68.4 + 7.2). ) years old, PSA range (5.55~61.52) ng/ml. benign prostatic lesion group, 24 cases, age 49~78 years, average (70.4 + 6.8) years old, PSA range (6.25~62.23) ng/ml. all patients with MR conventional sequence T1WI, T2WI and DWI (b values are respectively). The three groups: MR routine sequences (including T1WI and T2WI) combined with DW (Ib=1000s/mm2) (group A); conventional MR sequences (including T1WI and T2WI) combined DWI (b=1500s/mm2) (B group). The difference of ADC values between the two groups of B, A, B and C three groups were analyzed by Receiveroperating characteristic curves, ROC, and Z test was used to compare the difference between the three groups in the diagnosis of prostate cancer under the ROC curve. The ADC of DWI obtained at =1000s/mm2 is used as reference value, the relative ADC (rADC) value of b=1500s/mm2 and 2000s/mm2 is calculated, the ROC curve of rADC value is drawn, the best diagnostic B value and the optimal critical ADC value under the corresponding b value are determined.
Results when the b value was 1000s/mm21500s/mm22000s/mm2, the ADC value of the prostate cancer group and the benign prostatic lesion group (0.83 + 0.15) (range 0.543-1.15) and (1.29 + 0.06) (range 0.936-1.33), (0.74 + 0.12) (range 0.471-1.09) and (1.17 + 0.08) (0.65 + 0.14) (range 0.418-0.971) and (1.02 + 0.) (range 0.418-0.971) and (1.02 + 0.). 07) (range 0.841-1.14), the difference between the ADC value of prostate cancer group and benign prostatic lesion group under different b values has significant statistical significance (P < 0.05). When b value is 1000s/mm21500s/mm22000s/mm2, the overlap range of ADC value (x 10-3mm2/s) between benign and malignant prostate lesions is (0.936~1.15), (0.909~1.09), respectively. (0.841~0.971); the area under the working characteristic curve (ROC) of the three groups of A, B and C was (0.938 + 0.290), (0.966 + 0.200), (0.998 + 0.003), and the area under the ROC curve of group C was the largest. There were significant differences in the area under the B and A group ROC curves (P < 0.05). The rADC value of the ratio of C values was diagnosed under the ROC curve of the prostate cancer (0.706 + 0.072). The rADC value of the ADC value of DWI (b=1500s/mm2) and DWI (b=1000s/mm2) was (0.625 + 0.076) under the ROC curve of the prostate cancer, and the area difference under the ROC curve was statistically significant (P < 0.05). The sensitivity and specificity of the area under the ROC curve for the diagnosis of prostate cancer is ADC when the maximum value is 0.83 * 10-3mm2/s.
Conclusion (1) the ADC value of the cancerous tissues occurring in the peripheral zone of the prostate or the transitional zone of the prostate is significantly smaller than that of the benign prostatic lesions. (2) the ADC values of the benign and malignant prostate lesions overlap in a certain range in the DWI ultra high b value imaging, but with the increase of the b value, the overlap range of ADC values is gradually reduced. (3) AD of the b=1000s/mm2DWI image. C is a reference value, the area under the rADC value ROC curve of b=2000s/mm2 and its ratio is larger than b=1500s/mm2, and there is significant difference between them. (4) when DWI combined with MR routine sequence diagnosis of prostate cancer, C group (b=2000s/mm2) has the largest area under the ROC curve of prostate cancer, and there is a difference between the B group (b=1500s/mm2) or the group. Significant statistical significance, suggesting that high b value can help improve the diagnostic efficiency of prostate cancer; b=2000s/mm2 has the best diagnostic efficiency, and its best diagnostic ADC threshold is 0.83 x 10-3mm2/s.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25;R445.2
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