3.0T磁共振双参数成像及多参数成像对前列腺良恶性肿瘤诊断价值的比较

doi:10.3969/j.issn.1004-583X.2022.08.009

摘要/Abstract

摘要：

目的探讨3.0T磁共振T2WI、DWI双参数成像(bp-MRI)对前列腺良性病变和前列腺癌的鉴别诊断价值。方法回顾性分析2018-2020年住院行直肠超声引导下经会阴前列腺穿刺活检病例,所有病例术前均行多参数前列腺磁共振检查(mp-MRI),由两名影像诊断医生基于T2WI、DWI的双参数MRI(bp-MRI)对是否存在前列腺癌进行PI-RADS v2评分并测量ADC值,以前列腺穿刺和手术病理结果作为金标准,统计其诊断的准确性和两名观察者之间的一致性,以及ADC值诊断前列腺良恶性病变的准确性,并与血清生物标志物前列腺特异性抗原(PSA)进行比较。结果共有210个病例纳入研究,其中前列腺癌106例,前列腺良性病变104例。医生1和医生2利用bp-MRI判断良恶性病变的准确性AUC值分别为0.821(P<0.05)和0.805(P<0.05), 观察者间一致性强,Kappa值为0.812。mp-MRI判断良恶性病变的准确性AUC为0.806(P<0.05), bp-MRI与mp-MRI诊断效能差异无统计学意义(P>0.05)。利用ADC值诊断前列腺良恶性病变时,两名医生测量的ADC值一致性组内相关系数(ICC)为0.795(P<0.01), 具有高度的一致性,以两者的平均值作为最终的ADC值,其诊断前列腺良恶性病变的AUC为0.89(P<0.05),高于总前列腺特异性抗原( TPSA)和游离前列腺特异性抗原(FPSA)、FPSA/TPSA值(P<0.05)。判断前列腺癌的ADC最佳截断值为801.4 mm²/s,其敏感性为87.5%,特异性为81.6%。结论 3.0T磁共振bp-MRI和mp-MRI对前列腺癌良恶性诊断准确性差异无统计学意义,以801.4 mm²/s为ADC阈值有助于前列腺癌和良性病变的鉴别,因此对比剂过敏、肾功能不全病例可以优先选择bp-MRI。

关键词: 前列腺肿瘤, 磁共振成像, 表观扩散系数, 弥散加权成像, 前列腺特异性抗原

Abstract:

Objective To explore the value of 3.0T bi-parametric magnetic resonance imaging (bp-MRI) of T2WI and DWI in the differential diagnosis of benign prostate disease and prostate neoplasms. Methods The patients receiving transrectal ultrasound-guided transperineal prostate biopsy hospitalized from 2018 to 2020 were retrospectively analyzed, and all cases received pre-operative multi-parameter prostate magnetic resonance imaging (mp-MRI). Two radiologists scored the prostate imaging-reporting and data system version 2 (PI-RADS v2) and measured apparent diffusion coefficient (ADC) value to confirm the presence of prostate cancer based on bp-MRI of T2WI and DWI, and the biopsy and surgical pathology were considered to be gold standards, the accuracy of corresponding diagnosis, consistency between two observers, as well as the accuracy of the ADC value in the diagnosis of benign and malignant prostate neoplasms were counted, and such indices were compared with the serum biomarker PSA. Results A total of 210 cases including 106 cases of prostate cancer and 104 cases of benign prostatic lesions were included in the study. The area under the curve (AUC) for discriminating benign and malignant nodules based on bp-MRI between Doctor 1 and Doctor 2 was 0.821 (P<0.05) and 0.805 (P<0.05) respectively high inter-observer consistency and KAPPA value in 0.812. The accuracy of AUC of mp-MRI in discriminating benign and malignant lesions was 0.806 (P<0.05), and the difference between bp-MRI and mp-MRI in discriminating benign and malignant prostate lesions wasn't statistically significant (P>0.05). The intraclass correlation efficient (ICC) of ADC value measured by two doctors was 0.795 (P<0.01), the mean value was considered to be the final ADC value due to high consistency, and the value of AUC for discriminating benign and malignant nodules based on ADC value was 0.89 (P<0.05), being higher than that of the total prostate specific antigen(TPSA), free prostate specific antigen (FPSA) and FPSA/TPSA(P<0.05). ADC was found to have the optimal cut-off value in 801.4 mm²/s, sensitivity of 87.5% and specificity of 81.6% in discriminating prostate cancer. Conclusion The difference between 3.0Tbp-MRI and mp-MRI in the diagnosis of benign and malignant prostate lesions wasn't statistically significant, the value of 801.4 mm²/s used as ADC threshold makes for discriminating between benign and malignant lesions.Conclusively, bp-MRI is considered to be a preferred choice in cases suffering from contrast agent allergy or renal insufficiency.

Key words: prostate neoplasms, magnetic resonance imaging, apparent diffusion coefficient, diffusion weighted imaging, prostate specific antigen

中图分类号:

R737.25

钟叶, 徐俊, 刘陈平, 武刚. 3.0T磁共振双参数成像及多参数成像对前列腺良恶性肿瘤诊断价值的比较[J]. 临床荟萃, 2022, 37(8): 723-727.

Zhong Ye, Xu Jun, Liu Chenping, Wu Gang. Comparison on the diagnostic value of 3.0T two-parameter MRI and multi- parameter imaging in benign & malignant prostate neoplasms[J]. Clinical Focus, 2022, 37(8): 723-727.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.08.009

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I8/723

图/表 5

表1 两组年龄和肿瘤指标特征比较

组别	例数	年龄(岁)	TPSA (ng/ml)	FPSA (ng/ml)	FPSA/TPSA
前列腺癌	106	73.8±7.4	18.2(12.9, 85.6)	3.6(1.9, 10.1)	0.14(0.10, 0.22)
良性前列腺病变	104	68.6±8.5	10.9(6.3, 25.4)	2.1(1.3, 5.3)	0.2(0.13, 0.30)
统计值		$t$ =3.328	$Z$ =-3.564	$Z$ =-2.439	$Z$ =-2.153
$P$ 值		0.001	0.001	0.015	0.031

表1 两组年龄和肿瘤指标特征比较

组别	例数	年龄(岁)	TPSA (ng/ml)	FPSA (ng/ml)	FPSA/TPSA
前列腺癌	106	73.8±7.4	18.2(12.9, 85.6)	3.6(1.9, 10.1)	0.14(0.10, 0.22)
良性前列腺病变	104	68.6±8.5	10.9(6.3, 25.4)	2.1(1.3, 5.3)	0.2(0.13, 0.30)
统计值		$t$ =3.328	$Z$ =-3.564	$Z$ =-2.439	$Z$ =-2.153
$P$ 值		0.001	0.001	0.015	0.031

表2 bp-MRI与mp-MRI判断前列腺良恶性病变的诊断准确性

	AUC值	95% $C I$	标准误	$P$ 值
医生1 bp-MRI	0.821	0.736~0.906	0.043	<0.01
医生2 bp-MRI	0.805	0.717~0.893	0.045	<0.01
mp-MRI	0.806	0.721~0.891	0.044	<0.01

表2 bp-MRI与mp-MRI判断前列腺良恶性病变的诊断准确性

	AUC值	95% $C I$	标准误	$P$ 值
医生1 bp-MRI	0.821	0.736~0.906	0.043	<0.01
医生2 bp-MRI	0.805	0.717~0.893	0.045	<0.01
mp-MRI	0.806	0.721~0.891	0.044	<0.01

表3 两名医生利用bp-MRI诊断前列腺良恶性病变的结果(例)

	PI-RADS v2评分	医生1
	PI-RADS v2评分	1	2	3	4	5	合计
医生2	1	92	0	0	2	0	94
	2	0	6	2	2	2	12
	3	8	0	8	0	0	16
	4	0	0	0	2	0	2
	5	8	0	0	0	78	86
	合计	108	6	10	6	80	210

表4 ADC值与TPSA、FPSA、FPSA/TPSA判断前列腺癌和良性病变的准确性

变量	AUC	标准误	$P$ 值	95% $C I$	最佳截断值	敏感性(%)	特异性(%)
ADC(mm²/s)	0.890	0.039	0.001	0.814~0.966	801.4	81.6	87.5
TPSA(ng/ml)	0.732	0.052	0.001	0.630~0.834	12.6	77.3	57.4
FPSA(ng/ml)	0.644	0.059	0.018	0.529~0.760	1.8	79.5	44.7
FPSA/TPSA	0.631	0.060	0.031	0.514~0.748	0.12	47.7	80.9

表4 ADC值与TPSA、FPSA、FPSA/TPSA判断前列腺癌和良性病变的准确性

变量	AUC	标准误	$P$ 值	95% $C I$	最佳截断值	敏感性(%)	特异性(%)
ADC(mm²/s)	0.890	0.039	0.001	0.814~0.966	801.4	81.6	87.5
TPSA(ng/ml)	0.732	0.052	0.001	0.630~0.834	12.6	77.3	57.4
FPSA(ng/ml)	0.644	0.059	0.018	0.529~0.760	1.8	79.5	44.7
FPSA/TPSA	0.631	0.060	0.031	0.514~0.748	0.12	47.7	80.9

图1 ADC、TPSA、FPSA、FPSA/TPSA判断前列腺癌和良性病变的ROC曲线

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