3.0T体线圈1H-MRS诊断前列腺癌和前列腺增生

摘要

Objective:To discuss the value of proton magnetic resonance spectroscopy (MRS) with body coil at 3.0Trnin differential diagnosis of the prostate cancer from prostatic hyperplasia. Methods:MRI and MRS at a 3.0T scanner werernpreoperatively performed in 23 patients with prostate cancer and 34 patients with prostatic hyperplasia, which were conrnfirmed either by surgery or by biopsy. All the patients underwent conventional MR imaging, the diffusion-weighted imagingrn(DWI), and MRS with body coils at a 3.0T MR scanner. The relative values of citrate, choline and creatine were measured,rnand the value of the choline plus creatine-to-citrate (Cho+Cr/Cit) ratio was calculated for all voxels. Areas under the rernceiver operating characteristic curves (Az) were used to assess the accuracy of discrimination of cancer from prostatic hyrnperplasia tissues. P<0.05 indicated a statistically significant difference. Results:Mean Cho+Cr/Cit ratios for cancer tissuesrnwere 3.49±2. 05,1.19±0. 71 for hyperplasia tissues;they were significantly different (t=12. 755,P<0.01). Az for disrncrimination of definite cancer tissue from hyperplasia tissue was 0. 863 [95% confidence interval of the difference (0. 818,rn0. 907),P<0. 01] ,and the optimal threshold for the diagnosis of prostate cancer was 2.08 with a sensitivity of 73.9% andrna specificity of 88.5 %. Conclusion:MRS with body coil at 3.0T can discriminate cancer from prostatic hyperplasia, so it canrnbe applied to diagnosis or biopsy guidance for prostate disease.%目的:探讨3.0T体线圈磁共振波谱对前列腺癌和前列腺增生的诊断和鉴别诊断价值.方法:分析经手术或穿刺活检证实的23例前列腺癌和34例前列腺增生的MRI、MRS所见.所有病例均应用3.0T MR体线圈行MR常规检查、扩散加权成像及MRS检查.MRS测量每个体素的枸橼酸盐(Cit) 、胆碱(Cho) 、肌酸(Cr) 的相对值;( 胆碱+肌酸)/枸橼酸盐[(Cho+Cr)/Cit]的比值.受试者工作特性曲线(ROC)下的面积值用来评价前列腺癌与前列腺增生鉴别的准确性,P＜0.05表明有显著差异.分析病变区域的病理镜下所见.结果:前列腺癌患者癌体素的(Cho+Cr)/Cit平均值为3.49±2.05,增生体素的(Cho+Cr)/Cit平均值为1.19±0.71,两组间差异有显著统计学意义(t=12.755,P＜0.01).前列腺确定癌与增生前列腺组织的差别的ROC曲线下的面积(Az值)为0.863[95%可信区间为(0.818,0.907);P＜0.01],当切点值为2.08时,Youden指数为0.547,诊断前列腺癌的敏感度为73.9%,特异度为88.5%.结论:3.0T体线圈 MRS对前列腺癌和前列腺增生可以很好地鉴别诊断,可应用于临床诊断,指导临床医师穿刺检查.