3.0T MR多高b值DWI对前列腺癌诊断及与Gleason分级相关性分析

摘要

目的 探讨3.0T MR超高场强多高b值扩散加权成像(DWI)对前列腺癌(PCa)的诊断价值并分析其与Gleason分级相关性.方法 收集经手术及病理证实的病例78例,其中前列腺增生(BPH)41例、PCa 37例.PCa患者根据术后病理评分分级,分析其与表观扩散系数(ADC)值相关性.所有患者均采用飞利浦3.0T MR进行b值为0 s/mm2、1 000 s/mm2、1 500 s/mm2参数扫描,比较2种高b值下PCa、BPH信号强度与ADC值,并分析ADC值与Gleason分级相关性.结果 T2 WI结合b值为1 500 s/mm2对PCa诊断特异性、准确率高于T2WI结合b值为1 000 s/mm2.PCa术后Gleason评分为2～4分的ADC值＞5～6分的ADC值＞7分的ADC值＞8～10分的ADC值,且相对应病灶b值为1 500 s/mm2的ADC值小于为b值为1 000 s/mm2的ADC值,两者有统计学差异(P＜0.05).结论 高场强下高b值DWI结合T2信号对PCa及BPH有较高的鉴别诊断价值,且b值增高PCa、BPH特异性及准确性明显提高.ADC值与Gleason评分分级呈负相关.%Objective To investigate the diagnostic value of 3.0T MR high field high-b-value diffusion weighted imaging (DWI) in prostate cancer (PCa) and to analyze its correlation with Gleason classification.Methods A total of 78 cases proved by operation and pathology were collected,including 41 cases of benign prostatic hyperplasia(BPH) and 37 cases of PCa.PCa patients were classified according to postoperative pathological scores,and their correlation with ADC values was analyzed subsequently.Parameter scanning was performed in all patients by using Philps 3.0T MR with b value at 0 s/mm2,1 000 s/mm2 and 1 500 s/mm2.The signal intensity and ADC value of PCa and BPH were compared under two kinds of high-b-values,and the correlation between ADC value and Gleason classification was analyzed.Results It was found that the specificity and accuracy of T2WI combined with b value of 1 500 s/mm2 were higher than these of T2WI combined with b value of 1 000 s/mm2 for the diagnosis of PCa.The ranking result of ADC value corresponding to Gleason score of PCa after operation was:2-4 points ＞ 5-6 points ＞7 points ＞ 8-10 points.Besides,the ADC value of the corresponding lesion with b value of 1 500 s/mm2 was lower than that with b value of 1 000 s/mm2,and the difference was statistically significant (P＜0.05).Conclusion High field high-b-value DWI combined with T2WI is of high value in differential diagnosis of PCa and BPH,and the specificity and accuracy of PCa and BPH improve obviously with the increase of the b value.Additionally,the ADC value is negatively correlated with the Gleason score.