Value of DCE-MRI, DTI and their combination in the differential diagnosis of central prostate nodules
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摘要:
目的探讨MRI动态增强扫描（DCE-MRI）、扩散张量成像（DTI）及两者联合在前列腺中央区结节鉴别诊断中的价值。 方法选取2019年1月~2020年6月在我院就诊的前列腺中央区结节患者79例，共计91个结节，给予DCE-MRI、DTI检查，分析良恶性结节DCE-MRI、DTI参数差异。 结果经病理学诊断，91个结节中，恶性结节39个，良性结节52个；恶性结节DCE-MRI参数峰值时间为103.36±32.50 s，明显低于良性结节（P < 0.05），而强化率和容量转移常数分别为（4.90±1.10）%和12.20±4.11 min-1，明显高于良性结节（P < 0.05）；恶性结节时间-强度曲线（TIC）类型Ⅲ比例为84.62%，明显多于良性结节（P < 0.05）；良性结节TIC类型Ⅱ比例为80.77%，明显多于恶性结节（P < 0.05）；良恶性结节TIC类型Ⅰ比例比较差异无统计学意义（P>0.05）；恶性结节DTI参数表观扩散系数值为（1.03±0.22）×10-3 mm2/s，明显低于良性结节（P < 0.05），而各向异性分数为0.32±0.10，明显高于良性结节（P < 0.05）；峰值时间、强化率、容量转移常数、TIC类型、表观扩散系数、各向异性分数及联合诊断前列腺中央区恶性结节的ROC曲线下面积分别为0.870、0.883、0.868、0.838、0.903、0.885和0.933（P < 0.05）。 结论DCE-MRI、DTI及联合诊断在前列腺中央区结节鉴别诊断中有较好的应用价值，值得临床使用。 Abstract:ObjectiveTo investigate the value of dynamic contrast-enhanced MRI (DCE-MRI), diffusion tensor imaging (DTI) and their combination in the differential diagnosis of central prostate nodules. MethodsFrom January 2019 to June 2020, 79 patients with central prostate nodules in our hospital, 91 nodules, were examined by DCE-MRI and DTI, and the differences of parameters between benign and malignant nodules were analyzed. ResultsThe pathological diagnosis was made, among the 91 nodules; 39 were malignant and 52 were benign. The Tmax of DCE-MRI parameters of malignant nodules was 103.36 ± 32.50s, which was significantly lower than that of benign nodules (P < 0.05), while the enhancement rate and Ktrans were (4.90± 1.10)% and 12.20±4.11 min-1, which were significantly higher than those of benign nodules (P < 0.05). The proportion of TIC type Ⅲ in malignant nodules was 84.62%, which was significantly higher than that in benign nodules (P < 0.05). The proportion of TIC type Ⅱ in benign nodules was 80.77%, which was significantly higher than that in malignant nodules (P < 0.05). There was no significant difference in the proportion of TIC type Ⅰ between benign and malignant nodules (P>0.05). The ADC value of malignant nodules was (1.03±0.22)×10-3 mm2/s, which was significantly lower than that of benign nodules (P < 0.05), while the FA was 0.32 ± 0.10, which was significantly higher than that of benign nodules (P < 0.05). The area under ROC curve of Tmax, enhancement rate, Ktrans, TIC type, ADC, FA and combined diagnosis of central prostate malignant nodules were 0.870, 0.883, 0.868, 0.838, 0.903, 0.885 and 0.933, respectively (P < 0.05). ConclusionDCE-MRI, DTI and combined diagnosis have good application value in the differential diagnosis of central prostate nodules and is worthy of clinical use. -
图 1 患者影像图
A~D: 某患者58岁，中央区前列腺癌; A: T2WI; B: ADC; C: FA伪彩图; D: 病理结果显示为前列腺癌(HE染色, ×200); E~H: 某患者60岁，中央区良性结节，E: T2WI图; F: ADC图; G: FA维持图; H: 病理结果显示为良性结节.
Figure 1. Image of the patient
表 1 良恶性结节DCE-MRI参数比较
Table 1. Comparison of DCE-MRI parameters of benign and malignant nodules
组别 SImax（%） Tmax（s） R（%） Ktrans（min-1） TIC类型 Ⅰ Ⅱ Ⅲ 恶性（n=39） 142.20±21.65 103.36±32.50 4.90±1.10 12.20±4.11 2（5.13） 4（10.26） 33（84.62） 良性（n=52） 137.69±27.80 144.46±30.15 3.12±1.09 9.89±1.20 3（5.77） 42（80.77） 7（13.46） t/χ2 0.840 -6.224 7.679 3.846 0.000 44.328 45.801 P 0.403 0.000 0.000 0.000 1.000 0.000 0.000 SImax: 强化率; Tmax: 峰值时间; FA: 各向异性分数; Ktrans：容量转移常数. 
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表 2 良恶性结节DTI参数比较
Table 2. Comparison of DTI parameters of benign and malignant nodules
组别 ADC（×10-3 mm2/s） FA 恶性（n=39） 1.03±0.22 0.32±0.10 良性（n=52） 1.49±0.27 0.17±0.05 t -8.690 9.377 P 0.000 0.000
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表 3 DCE-MRI、DTI参数诊断价值
Table 3. Diagnostic Value of DCE-MRI, DTI Parameters
指标 曲线下面积 P 截断值 敏感度（%） 特异性（%） Tmax 0.870 0.000 110.20s 88.00 87.00 R 0.883 0.000 3.98% 88.50 86.90 Ktrans 0.868 0.000 11.50 min-1 87.60 86.20 TIC类型 0.838 0.000 Ⅲ 84.62 86.54 ADC 0.903 0.000 1.15×10-3 mm2/s 89.50 88.00 FA 0.885 0.000 0.27 88.20 87.00 联合诊断 0.933 0.000 - 92.00 89.00 R: 斜率; TIC: 时间-强度曲线; ADC: 表观弥散系数.
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