Value of MRI apparent diffusion coefficient for screening prostate cancer
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摘要:
目的探讨1.5 T磁共振表观扩散系数（ADC）值对前列腺癌（PCA）的筛查价值。 方法选取2015年1月~2018年7月本院病理确诊的PCA患者40例作为PCA组，同期选取前列腺良性病变患者60例作为良性组，两组均给予1.5 T-MRI检查，比较两组前列腺影像报告和数据系统（PI-RADS）评分及ADC值、eADC值。 结果PCA组eADC值高于良性组、ADC值低于良性组，差异有统计学意义（P<0.05），PCA组与良性组PI-RADS评分差异有统计学意义（P<0 05="" roc="" pca="" pi-rads="">3分为临界值为55.00%、83.33%、72.00%，ADC值以<0.95 mm2/s为临界值为85.00%、75.00%、79.00%，PI-RADS评分联合ADC值为95.00%、70.00%、80.00%，二者联合敏感度高于二者单独，其准确度及Youden指数也大于二者单独。 结论1.5 T-MRI的ADC值可作为PCA筛查的重要指标，且可有效提高PI-RADS评分对PCA的筛查效能，值得临床作进一步推广。 Abstract:ObjectiveTo explore the value of 1.5 T magnetic resonance (MRI) apparent diffusion coefficient (ADC) in screening prostate cancer (PCA). MethodsForty patients with PCA were selected from January 2015 to July 2018 in our hospital as PCA group. At the same time, 60 benign prostate lesions were selected as benign group. The patients in two groups were given 1.5 T-MRI examination. The prostate imaging reporting and data system (PI-RADS) scores, anisotropy ADC and eADC values of the two groups were compared. ResultsThe eADC value in group PCA was significantly higher than that in benign group (P<0.05). The difference of PI-RADS score between group PCA and benign group was significant (P<0.05). In the diagnosis of PCA sensitivity, specificity and accuracy, the critical value of the PI-RADS score were 55.00%, 83.33%, 72.00%, and<0.95 mm2/s as the critical value of 85.00%, 75.00%, 79.00%. The PI-RADS score combined with ADC value 95.00%, 70%, 80.00%. The sensitivity of combination of the two was significantly higher than that of the two alone. The accuracy and Youden index were also greater than the two alone. ConclusionThe ADC value of 1.5 T-MRI can be used as an important indicator of PCA screening. It can effectively improve the screening effect of PI-RADS score on PCA. It is worth for further clinical promotion. -
Key words:
- magnetic resonance /
- ADC value /
- prostate cancer /
- screening price
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图 1 男，70岁，MRI诊断为PCA（B期，局限于中央腺体偏右侧，总体评分为5分），病理证实为PCA
A: 压脂T2WI示中央腺体偏右侧结节状低信号（箭）, 局部边界不清, 最大径>1.5 cm, 评分5分; B: DWI示病灶呈明显高信号（箭）, 最大径>1.5 cm，评分5分; C: 表观扩散系数（ADC）图示局灶性明显低信号（箭）; D: SI-T曲线, 病灶呈速升下降型（阳性）.
图 2 男, 69岁, MRI诊断为良性前列腺, 病理证实为良性前列腺增生
A: 压脂T2WI示中央腺体中线偏右侧结节状低信号灶（箭）, 边界不清, 评分为3分; B: DWI示病灶部分中等高信号（箭）; C: ADC图示局灶性明显低信号（箭）, 评分4分; D: SI-T曲线, 病灶呈速升平台型（阳性）, 总体评分由T2WI评分决定为3分.
表 1 两组ADC值及eADC值比较（Mean±SD）
Groups n ADC（× 10-3 mm2/s） eADC PCA 40 0.81±0.21 0.55±0.08 Benign 60 1.10±0.21 0.43±0.10 t 6.832 6.430 P <0.001 <0.001 
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表 2 两组PI-RADS评分的比较
Groups PCA Benign Statistical result Cases 40 60 Z=-4.763 M（P25，P75） 4（2，5） 2（1, 3） P<0.001
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表 3 不同方法诊断PCA的效能分析比较
Parameter Sensitivity specificity accuracy Youden
indexROC area
under curve
（AUC）ADC（× 10-3 mm2/s） 85.00% 75.00% 79.00% 0.60 0.847 PI-RADS 55.00% 83.33% 72.00% 0.38 0.774 PI-RADS + ADC 95.00% 70.00% 80.00% 0.65 0.825
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[1] 黄亚强. 基于蛋白质组学的前列腺癌间质标记物筛选及MYL9表达的临床观察[D]. 广州: 南方医科大学, 2015. [2] Heger Z, Cernei N, Gumulec J, et al. Determination of common urine substances as an assay for improving prostate carcinoma diagnostics[J]. Oncol Rep, 2014, 31(4): 1846-54. doi: 10.3892/or.2014.3054 [3] Shiota M, Yokomizo A, Takeuchi A, et al. Co introduction of a steroid with docetaxel chemotherapy for metastatic castration resistant prostate cancer affectsPSA flare[J]. BJU Int, 2016, 118(6): 880-4. doi: 10.1111/bju.2016.118.issue-6 [4] Turkbey B, Choyke PL. Multiparametric MRI ang prostate cancer diagnosis and risk stratification[J]. Curr Opin Urol, 2012, 22(4): 310-5. doi: 10.1097/MOU.0b013e32835481c2 [5] Schimmller L, Quentin M, Arov C, et al. Inter-reader agree-ment of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard[J]. Eur Radiol, 2013, 23(11): 3185-90. doi: 10.1007/s00330-013-2922-y [6] Rosenkrantz AB, Kim S, Lim RP, et al. Prostate cancer localiza-tion using multiparametric Mr imaging:comparison of prostate imaging reporting and data system(PI-RADS)and liket scales[J]. Radiology, 2013, 269(2): 482-92. doi: 10.1148/radiol.13122233 [7] 李慧燕. 前列腺癌及良性前列腺增生DKI及T1rho成像的初步研究[D]. 广州: 南方医科大学, 2016. [8] 陆应军, 赵文露, 杨毅, 等. T_2WI+DWI配合PI-RADS对前列腺癌的诊断价值[J]. 医学影像学杂志, 2016, 26(5): 881-4. [9] 王卓楠, 马超豪, 罗天友, 等. ADC值和标化ADC值诊断前列腺癌恶性程度价值的比较[J]. 重庆医学, 2015, 44(29): 4102-5. doi: 10.3969/j.issn.1671-8348.2015.29.024 [10] Li J, Gregory SG, Garcia-Blanco MA, et al. Using circulat-ing tumor cells to inform on prostate cancer biology and clinical utility[J]. Crit Rev Clin Lab Sci, 2015, 52(4): 191-210. doi: 10.3109/10408363.2015.1023430 [11] Roethke MC, Kuru TH, Schultze S, et al. 欧洲泌尿生殖放射学会PI-RADS评分系统在3.0 T多参数前列腺MR成像中的应用价值:联合靶向MR/经直肠超声引导下前列腺活检[J]. 国际医学放射学杂志, 2014, 37(02): 195-6. [12] 中华放射学杂志前列腺疾病诊疗工作组, 中华放射学杂志编辑委员会. 前列腺病MR检查和检查共识[J]. 中华放射学杂志, 2014, 48(7): 531-4. doi: 10.3760/cma.j.issn.1005-1201.2014.07.002 [13] Barentsz JQ, Richenberg J, Clements R, et al. ESUR prostate Mr guideline 2012[J]. EurRadio, 2012, 22(4): 746-57. [14] 张 发, 蔡忠林, 梁梦天, 等. RNA结合蛋白HuR与前列腺癌的关系[J]. 现代泌尿外科杂志, 2018, 23(9): 714-7. doi: 10.3969/j.issn.1009-8291.2018.09.018 [15] Thibault C, Massard C. New therapies in metastatic castrationresistant prostate cance[J]. Bull Cancer, 2015, 102(6): 501-8. doi: 10.1016/j.bulcan.2015.04.016 [16] Macleod LC, Chery LJ, Hu E, et al. Metabolic syndrome, dyslipidemia and prostate cancer recurrence after primary surgery or radiation in a veterans cohort[J]. Prostate Cancer Prostatic Dis, 2015, 18(2): 190-5. doi: 10.1038/pcan.2015.12 [17] 姬广海, 郑 义, 孛茹婷, 等. 多参数MRI对中央腺体前列腺癌的诊断价值[J]. 中国医学影像学杂志, 2016, 24(8): 591-5. doi: 10.3969/j.issn.1005-5185.2016.08.010 [18] 张 臻, 左孟哲, 王建良. 基于PI-RADS v2评分的Mp-MRI联合PSAD对中高级别前列腺癌预测价值的分析[J]. 临床肿瘤学杂志, 2017, 22(11): 1012-6. [19] 叶 靖, 肖 芹, 山 姆, 等. 超高b值扩散加权成像鉴别前列腺中央腺体癌和良性增生结节[J]. 临床放射学杂志, 2015, 34(6): 939-43. [20] 顾伟光, 赵文露, 钱林清. DWI的ADC值在前列腺癌内分泌治疗后疗效评价中的应用[J]. 医学影像学杂志, 2017, 27(12): 2357-60. [21] Jambor I, Kuisma A, Ramadan S, et al. Pro spective evaluation of planar bone scintigraphy,SPECT,SPECT/CT,18F-NaF PET/CT and whole body 1.5 T MRI,including DWI,for the detection of bone metastases in high risk breast and prostate cancer patients.SKEI.ETA clinical trial[J]. Acta Oncol (Madr), 2016, 55(1): 59-67. doi: 10.3109/0284186X.2015.1027411 [22] Barajas RF, Rubenstein JL, Chang JS, et al. Diffusion-weighted Mr imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma[J]. AJNR Am J Neuroradiol, 2010, 31(1): 60-6. doi: 10.3174/ajnr.A1750 [23] 马 娟, 王金英, 王 俭, 等. 磁共振扩散加权成像ADC、EADC脑泡型包虫病边缘带定量分析[J]. 新疆医科大学学报, 2015, 38(11): 1347-50. doi: 10.3969/j.issn.1009-5551.2015.11.005 [24] Hambrock T, Somford DM, Huisman HJ, et al. Relationship between apparent diffusion coefficients at 3.0-T Mr imaging and gleason grade in peripheral zone prostate cancer[J]. Radiology, 2011, 259(2): 453-61. doi: 10.1148/radiol.11091409 [25] 张永胜, 龚向阳, 陈 瑶, 等. 基于PI-RADS研究MRI多参数成像对移行区前列腺癌的诊断价值[J]. 临床放射学杂志, 2015, 34(6): 930-4. [26] 刘会佳, 赵娓娓, 任 芳, 等. DWI对前列腺癌疗效监测及ADC值与PSA相关性研究[J]. 放射学实践, 2014, 29(5): 487-90. [27] 温淑蓉. ADC直方图分析法鉴别中央带前列腺癌与T_2WI低信号增生结节的研究[J]. 放射学实践, 2016, 31(11): 1076-9. [28] 刘 莉, 吴 宁, 欧阳汉, 等. DWI在前列腺癌放疗疗效评估中的价值[J]. 放射学实践, 2014, 29(1): 77-80. [29] Borren A, Moman MR, Groenendeal G, et al. Why prostate tummour delineation based on apparent diffusion coefficient is challenging:an exploration of the tissue microanatomy[J]. Acta Oncol, 2013, 52(8): 1629-36. doi: 10.3109/0284186X.2013.787164 [30] 李艳君, 冯彦景, 查月芳. 10 g单丝在糖尿病周围神经病变筛查中的价值[J]. 河北医科大学学报, 2015, 36(8): 884-6, 910. doi: 10.3969/j.issn.1007-3205.2015.08.006 -
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