Value of MRI texture analysis combined with ZOOMit IVIM sequence for differential diagnosis of benign and malignant prostate nodules
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摘要:
目的 探究MRI纹理分析和基于并行发射平台选择性激发成像（ZOOMit）的体素内不相干运动（IVIM）序列对于前列腺结节良性和恶性的鉴别诊断价值。 方法 选取我院2021年3月~2022年8月收治的95例前列腺结节患者作为研究对象，共112个结节，根据结节良恶性将其分为良性组（n=59）和恶性组（n=53）。所有患者均行均MRI T2WI和ZOOMit IVIM序列扫描，形成平扫T2WI图像、表观扩散系数（ADC）、纯扩散系数（D）、伪扩散系数（D*）、灌注分数（f）伪彩图，获取纹理分析参数ADC、D、D*、f值，比较两种扫描序列的误诊率，采用ROC曲线评估个参数对于前列腺良恶性结节的诊断价值。 结果 MRI纹理分析、ZOOMit IVIM序列扫描单独及联合诊断前列腺结节的良恶性情况的误判率差异无统计学意义（P > 0.05）。与良性组相比，恶性组结节的平均ADC值、方差、D值和f值降低（P < 0.05），偏度、峰度和熵上升（P < 0.05），D*值的差异无统计学意义（P > 0.05）。ROC曲线分析可知，ADC值鉴别诊断前列腺良恶性结节的敏感度较高，D值鉴别诊断前列腺良恶性结节的特异性较高，ADC值、D值和f值联合诊断的整体效能最高。 结论 MRI纹理分析和ZOOMit IVIM序列对于鉴别前列腺结节的良恶性有较高的价值。 Abstract:Objective To investigate the value of MRI texture analysis and intravoxel incoherent motion (IVIM) sequences based on zoomed imaging with parallel transmission technique (ZOOMit) for the differential diagnosis of benign and malignant prostate nodules. Methods Ninety-five patients with prostate nodules in our hospital between March 2021 and August 2022 were selected. A total of 112 nodules were divided into benign group (n=59) and malignant group (n=53). All patients underwent MRI including T2* mapping and ZOOMit IVIM sequence scans before surgery, then the MRI plain scanning images, diffusion weighted imaging (DWI) images, parameters including apparent diffusion coefficient (ADC), diffusion coefficient of pure diffusion (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f) were obtained. The misjudgment rates of the two scanning sequences were compared. ROC curve was plotted to evaluate the diagnostic value of each parameter for benign and malignant prostate nodules. Results There was no significant difference in the misjudgment rate between benign and malignant prostate nodules diagnosed by MRI texture analysis and ZOOMit IVIM sequence scan alone and in combination (P > 0.05). Compared with benign group, malignant group had remarkably decreased ADCMean, variance, D value and f value (P < 0.05), notably increased skewness, kurtosis and entropy (P < 0.05), and slightly increased D* value (P > 0.05). Among the parameters in the differential diagnosis of benign and malignant prostate nodules, ADC value had high sensitivity and D value had high specificity, while the diagnostic efficacy of ADC combined with D and f values was the highest. Conclusion MRI texture analysis and ZOOMit IVIM sequence have high value in differentiating benign and malignant prostate nodules. -
Key words:
- MRI texture analysis /
- intravoxel incoherent motion /
- prostate /
- benign nodule /
- malignant nodule
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图 2 不同扫描模式所得前列腺图像比较
Figure 2. Comparison of prostate images obtained by different scanning modes. A: Image of nodules with slightly low signal intensity on T2WI; B: Image of nodules with high signal intensity on DWI; C: Image of nodules with low signal intensity on ADC map; D: Pseudo-colour map of pure diffusion coefficient D of IVIM; E: Pseudo-colour map of pseudo-diffusion coefficient D* of IVIM; F: Pseudo-colour map of perfusion fraction f of IVIM.
表 1 两种方法对于前列腺良恶性结节的误判情况比较
Table 1. Comparison of misjudgment rates of two scanning sequences for differential diagnosis of benign and malignant prostate nodules
Group Texture analysis ZOOMit IVIM sequence Combined diagnosis χ2 P Benign group (n=59) 15(25.42) 14(23.73) 9(15.25) 2.0776 0.3539 Malignant group (n=53) 20(37.74) 17(32.06) 12(22.64) 2.8909 0.2356 IVIM: Intravoxel incoherent motion. 
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表 2 两组结节的MRI纹理分析参数比较
Table 2. Comparison of MRI texture parameters between two groups (Mean±SD)
Group ADCMean (mm2/s) Variance Skewness Kurtosis Entropy Benign group (n=59) 1.12±0.16 3472.63±1020.41 0.30±0.11 -0.23±0.07 7.06±2.10 Malignant group (n=53) 0.91±0.19 2170.87±1019.54 0.51±0.15 0.56±0.11 10.49±2.27 t 6.3470 6.7435 8.5063 45.8087 8.3060 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 两组结节的ZOOMit IVIM序列参数比较
Table 3. Comparison of ZOOMit IVIM sequence parameters between two groups (Mean±SD)
Group D (mm2/s) D* (mm2/s) f (%) Benign group (n=59) 1.15±0.26 10.38±3.58 15.59±3.46 Malignant group (n=53) 0.81±0.11 11.57±4.04 11.37±2.15 t 8.8333 1.6528 7.6493 P < 0.001 1.1012 < 0.001 D: Diffusion coefficient of pure diffusion; D*: Pseudo-diffusion coefficient; f: Perfusion fraction.
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表 4 MRI纹理分析和ZOOMit IVIM序列参数诊断前列腺良恶性结节ROC曲线分析
Table 4. ROC curve analysis of MRI texture analysis and ZOOMit IVIM sequence parameters for differential diagnosis of benign and malignant prostate nodules.
Parameters Cut-off value AUC 95% CI P Sensitivity (%) Specificity(%) ADC 0.99 0.804 0.723-0.884 < 0.001 81.1 64.4 D 0.92 0.814 0.730-0.897 < 0.001 77.4 84.7 f 13.57 0.778 0.689-0.867 < 0.001 71.7 83.1 Combined test - 0.911 0.856-0.966 < 0.001 86.8 86.4
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