3.0 T MRI表观扩散系数值对前列腺癌的诊断价值及与预后因素相关性分析

摘要

目的:探讨3.0T MRI表观扩散系数(ADC)值在前列腺癌中诊断的价值,及其与病理Gleason评分和前列腺特异性抗原(PSA)的相关性.方法:回顾性分析2015年8月至2017年3月经病理证实的52例前列腺疾病病人的临床资料,其中前列腺癌(PCa)22例、前列腺增生(BPH)30例.所有病人均行常规MRI扫描,以b=0、800 s/mm2建立ADC图及测量病灶ADC值,根据ADC值来鉴别诊断PCa和BPH.并评估其与病理Gleason评分及PSA的相关性.结果:52例前列腺疾病病人ADC平均值为(1.028±0.310)×10-3 mm2/s,PCa病人ADC平均值为(0.788±0.204)×10-3 mm2,低于BPH的(1.204±0.251)×10-3 mm2/s(P<0.01).ADC值的ROC曲线下面积为0.903,具有较好的诊断价值.根据ROC曲线确定的ADC值最佳诊断界值点为0.831,灵敏度为72.7%,特异度为100.0%.ADC值与PSA之间呈负相关(r=-0.519,P<0.01),ADC值与Gleason评分之间呈负相关(r=-0.508,P<0.01).结论:ADC值定量评估对前列腺良恶性病变的鉴别具有一定的价值,ADC值高低可初步判定前列腺良恶性病变,进而指导临床选择合适的治疗方案.%Objective:To investigate the value of 3. 0T MRI apparent diffusion coefficient (ADC) in the diagnosis of prostate cancer, and its correlation with pathologic Gleason score and prostate specific antigen ( PSA) . Methods:The clinical data of 52 patients with prostate disease confirmed by pathology from August 2015 to March 2017 were retrospectively analyzed,including 22 cases of prostate cancer (PCa) and 30 cases of benign prostatic hyperplasia (BPH). So patients were routine MRI scan,b = 0,800 s / mm2 to establish the ADC and ADC lesions measured,according to the ADC value to identify the diagnosis of PCa and BPH. And to assess its association with pathologic Gleason score and PSA. Results:The average ADC of 52 patients with prostate disease was ( 1. 028 ± 0. 310) × 10 -3 mm2/s,PCa patients and BPH patients with ADC average significant difference,respectively (0. 788 ± 0. 204) × 10 -3 mm2/s and (1. 204 ± 0. 251) × 10 -3 mm2/s. The area under the ROC curve of the ADC value is 0. 903,which has a good diagnostic effect. According to the ROC curve to determine the ADC value of the best diagnostic value of 0. 831, the sensitivity of 72. 7%, specificity of 100. 0%. There was a negative correlation between the ADC value and the PSA(r= -0. 519,P<0. 01),and the ADC value was negatively correlated with the Glseason score(r= -0. 508,P<0. 01). Conclusions:The quantitative evaluation of ADC value is valuable for the identification of benign and malignant benign prostatic lesions. The low risk and high risk prostate cancer can be used to evaluate the clinical stage of PCa and guide the clinical selection of appropriate treatment Program.