磁共振ADC值定量分析在前列腺癌的诊断和Gleason分级中的应用价值

发布时间：2018-05-17 13:24

  本文选题：前列腺癌 + 磁共振成像　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的:评价磁共振ADC值定量分析在前列腺癌的诊断及鉴别诊断中的价值,探讨ADC值与前列腺癌Gleason评分的相关性,同时评价ADC值在前列腺癌的分级、治疗方案的选择及预后评价中的价值。材料与方法:回顾性分析青岛大学附属医院自2010年至2013年经超声引导下穿刺活检或手术病理证实的89例前列腺病例,根据病理将前列腺病灶分为前列腺癌组、前列腺增生组及正常组织组,记录各前列腺病灶对应磁共振检查的ROI的ADC值及前列腺癌各病灶的Gleason评分。对照病理结果分析前列腺癌、前列腺增生、正常前列腺组织的ADC值的差异,同时做ADC值诊断前列腺癌的ROC曲线分析。分析前列腺癌ADC值与Gleason评分之间的相关性及各评分组间ADC值的差异,同时做ADC值诊断中高危组前列腺癌的ROC曲线分析。结果:89例前列腺疾病患者一共获得有效ROI为543个,前列腺癌病灶对应的ROI为224个,前列腺增生病灶对应的ROI为276个,正常前列腺组织对应的ROI为43个。前列腺癌病灶与非癌灶对应ROI的ADC值有显著性差异(U=66250.50,p0.01);前列腺癌组、前列腺增生组、正常组织组的ADC值组间比较有显著性差异(F=382.359,P0.01);多重比较前列腺癌组与前列腺增生组、正常组的ADC值有统计学差异(P0.05),前列腺增生组、正常组织组间ADC值无统计学差异(P0.05);根据ROC曲线分析,截断值≤1.08×10~(-3)mm~2/s时,ADC值诊断前列腺癌的特异度和敏感度较高,分别为84.8%和95.9%,可获得较高的诊断效能;前列腺癌病灶的ADC值与Gleason评分呈负相关(r=-0.439,P0.01);各Gleason评分组ADC值组间比较有显著性差异(F=29.755,P0.01),多重比较Gleason评分=6分组与7分、8分、9分组的ADC值差异有显著性统计学意义(p0.01),Gleason评分=7分、8分、9分各组的ADC值差异无统计学差异(P0.05);根据ROC曲线,ADC值取截断值≤0.997×10~(-3)mm~2/s时,对区分中高危组前列腺癌(Gleason评分≥7分)与低危组前列腺癌(Gleason评分7分)的特异度和敏感度较高,分别为96.2%和60%,具有较高诊断效能。结论:磁共振功能成像中的DWI、ADC图及ADC值定量分析可用来鉴别前列腺癌、前列腺增生和正常前列腺组织,在前列腺疾病的诊断与鉴别诊断中有较高的敏感度和特异度,可作为前列腺疾病常规磁共振检查的重要补充。磁共振ADC值与前列腺癌的Gleason评分之间具有相关性,ADC值可为评估前列腺癌的分化及分级提供较为准确的定量依据,能为前列腺癌的治疗方案的选择提供较为可靠的定量依据。根据磁共振检查的ADC值可以无创性的评估前列腺癌的恶性程度和预后。
[Abstract]:Objective: to evaluate the value of quantitative analysis of ADC value in the diagnosis and differential diagnosis of prostate cancer, to explore the correlation between ADC value and Gleason score of prostate cancer, and to evaluate the value of ADC value in the grading of prostate cancer. The value of choice of treatment regimen and prognosis evaluation. Materials and methods: 89 cases of prostate cancer confirmed by ultrasound guided biopsy or surgery and pathology from 2010 to 2013 in the affiliated Hospital of Qingdao University were retrospectively analyzed. The prostate lesions were divided into prostate cancer group according to the pathology. The ADC value of ROI and Gleason score of prostate cancer were recorded in benign prostatic hyperplasia group and normal tissue group. The difference of ADC in prostate cancer, prostatic hyperplasia and normal prostate tissue was analyzed by comparing the pathological results. The ROC curve of ADC value in diagnosis of prostate cancer was also analyzed. To analyze the correlation between ADC value and Gleason score of prostate cancer, and the difference of ADC value among each score group, and to analyze the ROC curve of prostate cancer in high risk group of ADC value diagnosis at the same time. Results there were 543 effective ROI, 224 ROI, 276 ROI in benign prostatic hyperplasia and 43 ROI in normal prostate tissues in 89 cases of benign prostatic diseases. There was significant difference in ADC value between prostate cancer focus and noncancerous lesion corresponding to ROI. There was significant difference in ADC value between prostate cancer group, prostate hyperplasia group and normal tissue group, there was significant difference between prostate cancer group, prostate hyperplasia group and normal tissue group, and there was significant difference between prostate cancer group and prostate hyperplasia group (P 0.01), and there was no significant difference between prostate cancer group and prostate hyperplasia group. There was significant difference in ADC value between normal group (P 0.05) and normal tissue (P 0.05). According to ROC curve analysis, the diagnostic specificity and sensitivity of prostate cancer were higher when truncation value was less than 1.08 脳 10~(-3)mm~2/s. 84.8% and 95.9%, respectively, which can obtain higher diagnostic efficiency. There was a negative correlation between ADC value and Gleason score in prostate cancer, there was significant difference in ADC value between Gleason score group and ADC score group. There was significant difference in ADC value between multiple comparison Gleason score group and 7 group and 8 score group with 9 group. There was significant difference in ADC value between Gleason score group and Gleason score group (P < 0.01), and there was significant difference in ADC value between Gleason score group (P < 0.05) and Gleason score group (P < 0.05). There was a significant difference in ADC value between Gleason score group and Gleason score group (P < 0.05). There was no significant difference in ADC values among the groups with scores of 7, 8 and 9. When the truncation value of ROC curve was less than 0.997 脳 10~(-3)mm~2/s, there was no statistical difference between the two groups (P < 0.05). The specificity and sensitivity of Gleason score 鈮，

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