【摘要】：目的探討3.0T MR超高b值擴散加權成像（DWI）對前列腺癌診斷的臨床應用價值。 材料與方法我們對2012年12月至2013年6月期間所收集的56例臨床懷疑前列腺癌的住院患者行MR檢察，患者主訴主要為尿頻、夜尿增多及PSA升高。根據(jù)穿刺病理活檢及手術病理結果將患者分為兩組：前列腺癌組，32例，年齡51~86歲，平均（68.4±7.2）歲，PSA范圍（5.55~61.52）ng/ml。前列腺良性病變組，，24例，年齡49~78歲，平均（70.4±6.8）歲，PSA范圍（6.25~62.23）ng/ml。所有患者均行MR常規(guī)序列T1WI、T2WI及DWI（b值分別為0s/mm2、1000s/mm2、1500s/mm2及2000s/mm2）檢查，然后將常規(guī)序列T1WI、T2WI與不同b值DWI進行組合分為三組：即MR常規(guī)序列（包括T1WI及T2WI）聯(lián)合DW（Ib=1000s/mm2）（A組）；MR常規(guī)序列（包括T1WI及T2WI）聯(lián)合DWI（b=1500s/mm2）（B組）；MR常規(guī)序列（包括T1WI及T2WI）聯(lián)合DWI（b=2000s/mm2）（C組）。分別測量不同b值下，前列腺癌組及前列腺良性病變組的ADC值，采用t檢驗比較不同b值時兩者間ADC值的差異；對A、B、C三組行受試者工作特性曲線（Receiveroperating characteristic curves，ROC）分析，采用Z檢驗比較三組診斷前列腺癌的ROC曲線下面積(Areas under the receiver operating characteristic，AUC)差異，以確定診斷效能最高組；將b=1000s/mm2時DWI所得的ADC作為參考值，計算b=1500s/mm2及2000s/mm2時的相對ADC（rADC）值，繪制rADC值的ROC曲線，確定最佳診斷b值及相應b值下的最佳臨界ADC值。 結果當b值分別為1000s/mm2、1500s/mm2、2000s/mm2時，前列腺癌組與前列腺良性病變組的ADC值(×10-3mm2/s)分別為（0.83±0.15）(范圍0.543-1.15)與（1.29±0.06）（范圍0.936-1.33）、（0.74±0.12）（范圍0.471-1.09）與（1.17±0.08）（范圍0.909-1.25）、（0.65±0.14）（范圍0.418-0.971）與（1.02±0.07）（范圍0.841-1.14），不同b值下前列腺癌組的ADC值與前列腺良性病變組比較，兩者間的差異均具有明顯的統(tǒng)計學意義（P＜0.05）；當b值分別為1000s/mm2、1500s/mm2、2000s/mm2時，前列腺良惡性病變間ADC值(×10-3mm2/s)重疊范圍分別為（0.936~1.15）、（0.909~1.09）、（0.841~0.971）；A、B、C三組診斷前列腺癌的受試者工作特性曲線（ROC）下的面積分別為（0.938±0.290）、（0.966±0.200）、（0.998±0.003），C組ROC曲線下面積最大，其與B組及A組ROC曲線下面積的比較均有顯著差異性（P值均＜0.05）；DWI（b=2000s/mm2）與DWI（b=1000s/mm2）的ADC值之比的rADC值診斷前列腺癌的ROC曲線下面積為（0.706±0.072），DWI（b=1500s/mm2）與DWI（b=1000s/mm2）的ADC值之比的rADC值診斷前列腺癌的ROC曲線下面積為（0.625±0.076），兩者ROC曲線下面積差異具有明顯統(tǒng)計學意義（P＜0.05）；單獨以b=2000s/mm2DWI成像ADC值診斷前列腺癌的ROC曲線下面積上敏感性及特異性最大時所對應的ADC值為0.83×10-3mm2/s。 結論①發(fā)生于前列腺外周帶或移行帶的癌變組織其ADC值均明顯小于前列腺良性病變組織。②DWI超高多b值成像中，前列腺良惡性病變間ADC值存在一定范圍的重疊，但隨著b值的增大，兩者間ADC值重疊范圍逐漸縮小。③以b=1000s/mm2DWI圖像的ADC為參考值，b=2000s/mm2與其比值的rADC值ROC曲線下面積較b=1500s/mm2大，兩者間差異具有明顯統(tǒng)計學意義。④DWI聯(lián)合MR常規(guī)序列診斷前列腺癌時，C組（b=2000s/mm2）診斷前列腺癌ROC曲線下面積最大，其與B組（b=1500s/mm2）或A組（b=1000s/mm2）之間的差異具有明顯統(tǒng)計學意義，提示高b值有助于提高前列腺癌的診斷效能；b=2000s/mm2具有最佳診斷效能，并且其最佳診斷ADC閾值為0.83×10-3mm2/s。
[Abstract]:Objective to investigate the clinical value of 3.0T MR ultra high B diffusion-weighted imaging (DWI) in the diagnosis of prostate cancer.
Materials and methods 56 hospitalized patients with suspected prostate cancer collected from December 2012 to June 2013 were examined by MR. The main complaints were frequency of urination, nocturia and increased PSA. The patients were divided into two groups based on biopsy and surgical pathology: anterior adenocarcinoma group, 32 cases, age 51~86, average (68.4 + 7.2). ) years old, PSA range (5.55~61.52) ng/ml. benign prostatic lesion group, 24 cases, age 49~78 years, average (70.4 + 6.8) years old, PSA range (6.25~62.23) ng/ml. all patients with MR conventional sequence T1WI, T2WI and DWI (b values are respectively). The three groups: MR routine sequences (including T1WI and T2WI) combined with DW (Ib=1000s/mm2) (group A); conventional MR sequences (including T1WI and T2WI) combined DWI (b=1500s/mm2) (B group). The difference of ADC values between the two groups of B, A, B and C three groups were analyzed by Receiveroperating characteristic curves, ROC, and Z test was used to compare the difference between the three groups in the diagnosis of prostate cancer under the ROC curve. The ADC of DWI obtained at =1000s/mm2 is used as reference value, the relative ADC (rADC) value of b=1500s/mm2 and 2000s/mm2 is calculated, the ROC curve of rADC value is drawn, the best diagnostic B value and the optimal critical ADC value under the corresponding b value are determined.
Results when the b value was 1000s/mm21500s/mm22000s/mm2, the ADC value of the prostate cancer group and the benign prostatic lesion group (0.83 + 0.15) (range 0.543-1.15) and (1.29 + 0.06) (range 0.936-1.33), (0.74 + 0.12) (range 0.471-1.09) and (1.17 + 0.08) (0.65 + 0.14) (range 0.418-0.971) and (1.02 + 0.) (range 0.418-0.971) and (1.02 + 0.). 07) (range 0.841-1.14), the difference between the ADC value of prostate cancer group and benign prostatic lesion group under different b values has significant statistical significance (P < 0.05). When b value is 1000s/mm21500s/mm22000s/mm2, the overlap range of ADC value (x 10-3mm2/s) between benign and malignant prostate lesions is (0.936~1.15), (0.909~1.09), respectively. (0.841~0.971); the area under the working characteristic curve (ROC) of the three groups of A, B and C was (0.938 + 0.290), (0.966 + 0.200), (0.998 + 0.003), and the area under the ROC curve of group C was the largest. There were significant differences in the area under the B and A group ROC curves (P < 0.05). The rADC value of the ratio of C values was diagnosed under the ROC curve of the prostate cancer (0.706 + 0.072). The rADC value of the ADC value of DWI (b=1500s/mm2) and DWI (b=1000s/mm2) was (0.625 + 0.076) under the ROC curve of the prostate cancer, and the area difference under the ROC curve was statistically significant (P < 0.05). The sensitivity and specificity of the area under the ROC curve for the diagnosis of prostate cancer is ADC when the maximum value is 0.83 * 10-3mm2/s.
Conclusion (1) the ADC value of the cancerous tissues occurring in the peripheral zone of the prostate or the transitional zone of the prostate is significantly smaller than that of the benign prostatic lesions. (2) the ADC values of the benign and malignant prostate lesions overlap in a certain range in the DWI ultra high b value imaging, but with the increase of the b value, the overlap range of ADC values is gradually reduced. (3) AD of the b=1000s/mm2DWI image. C is a reference value, the area under the rADC value ROC curve of b=2000s/mm2 and its ratio is larger than b=1500s/mm2, and there is significant difference between them. (4) when DWI combined with MR routine sequence diagnosis of prostate cancer, C group (b=2000s/mm2) has the largest area under the ROC curve of prostate cancer, and there is a difference between the B group (b=1500s/mm2) or the group. Significant statistical significance, suggesting that high b value can help improve the diagnostic efficiency of prostate cancer; b=2000s/mm2 has the best diagnostic efficiency, and its best diagnostic ADC threshold is 0.83 x 10-3mm2/s.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.25;R445.2

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