超高b值弥散加权联合T2加权序列诊断外周带前列腺癌的价值

Value of ultra-high b-value diffusion-weighted imaging combined with T2-weighted imaging in the diagnosis of peripheral prostate cancer

    摘要
  • 摘要:
    目的 探讨超高b值弥散加权成像（DWI）联合T2加权成像（T2WI）诊断外周带前列腺癌（PCa）的临床应用价值。
    方法 选取2018年12月1日至2019年10月1日在佛山市第一人民医院行超声引导下前列腺靶点穿刺、临床病理学确诊并于穿刺前后1个月内行前列腺MRI检查的PCa患者41例，年龄49~89岁，中位年龄69岁。所有患者均行3.0T超高b值（分别为2000、3000 s/mm2）的DWI及T2WI脂肪抑制序列MRI成像。以前列腺靶点穿刺病理学结果为“金标准”，分别计算T2WI、DWI（b=2000 s/mm2）、DWI（b=3000 s/mm2）、T2WI+DWI（b=2000 s/mm2）、T2WI+DWI（b=3000 s/mm2）对PCa的诊断灵敏度、特异度和准确率。采用受试者工作特征（ROC）曲线分析计算各方法诊断PCa的曲线下面积。
    结果 41例患者中，PCa患者26例（通过临床结合穿刺点位置确诊为外周带PCa），良性前列腺增生患者15例。T2WI、DWI（b=2000 s/mm2）、DWI（b=3000 s/mm2）、T2WI+DWI（b=2000 s/mm2）、T2WI+DWI（b=3000 s/mm2）诊断PCa的灵敏度分别为0.962（25/26）、0.962（25/26）、0.962（25/26）、0.923（24/26）、0.923（24/26），特异度分别为0.400（6/15）、0.667（10/15）、0.876（13/15）、0.800（12/15）、1.000（15/15），准确率分别为0.756（31/41）、0.854（35/41）、0.926（38/41）、0.878（36/41）、0.951（39/41），ROC曲线下面积分别为0.681、0.814、0.914、0.872、0.972（P=0.056、0.001、＜0.001、＜0.001、＜0.001）。
    结论 T2WI+DWI（b=3000 s/mm2）序列图像诊断PCa具有较高的准确率，有望成为一种可靠的诊断前列腺疾病的无创性检查方法。

     

    Abstract:
    Objective To investigate the clinical value of ultra-high b-value diffusion-weighted imaging (DWI) combined with T2-weighted imaging (T2WI) in the diagnosis of peripheral prostate cancer (PCa).
    Methods Forty-one patients who underwent ultrasound-guided prostate target puncture, clinicopathological diagnosis, and prostate MRI within one month before and after the puncture were selected from December 1, 2018 to October 1, 2019 in the First People's Hospital of Foshan. The patients' ages ranged from 49 to 89 years, with a median age of 69 years. All of the patients completed 3.0T ultra-high b-value DWI and T2WI fat suppression (2000 and 3000 s/mm2, respectively). With prostate target puncture pathology as the gold standard, the sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve were calculated for the different imaging methods in PCa diagnosis.
    Results Among all the 41 patients, 26 had PCa (the 26 cases were peripheral zone PCa confirmed by clinical diagnosis and puncture site location) and 15 had benign hyperplasia. The sensitivity of T2WI, DWI (b=2000 s/mm2), DWI (b=3000 s/mm2), T2WI+DWI (b=2000 s/mm2), and T2WI+DWI (b=3000 s/mm2) in PCa diagnosis was 0.962 (25/26), 0.962 (25/26), 0.962 (25/26), 0.923 (24/26), and 0.923 (24/26) respectively; the specificity was 0.400 (6/15), 0.667 (10/15), 0.876 (13/15), 0.800 (12/15), and 1.000 (15/15), respectively; the accuracy was 0.756 (31/41), 0.854 (35/41), 0.926 (38/41), 0.878 (36/41), and 0.951 (39/41), respectively; and the area under the ROC curve was 0.681, 0.814, 0.914, 0.872, and 0.972(P=0.056, 0.001, ＜0.001, ＜0.001, ＜0.001), respectively.
    Conclusions DWI (b=3000 s/mm2) combined with the T2WI image exhibited high accuracy in PCa diagnosis. It is expected to become a highly reliable noninvasive examination procedure for the diagnosis of PCa.

     

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