摘要
目的探讨MR动态增强扫描(DCE-MRI)、扩散加权成像(DWI)和三维氢质子MR波谱分析(3D1H-MRS)在前列腺癌诊断中的价值。方法经穿刺活检、手术病理或随访证实的32例前列腺癌及64例前列腺增生患者,以及29例健康志愿者经MR常规扫描、DCE-MRI、DWI和MRS扫描,分别测量前列腺癌、前列腺增生病灶和正常前列腺中央腺区和正常周围带强化后的相对信号强度值、DWI信号强度值和表观扩散系数(ADC)值,以及胆碱／枸橼酸盐(Cho／Cit)和[Cho+肌酸(Cr)]／Cit比值,并经方差分析比较不同组织和病灶间差异。结果经DCE-MRI检查,22例前列腺癌患者中18例病灶区呈早期明显强化,并快速下降;40例前列腺增生患者中38例呈早期明显强化并逐渐上升至中晚期达峰值后缓慢下降,除0及120 s两时间段前列腺癌与前列腺增生组织两者之间差异无统计学意义(P>0．05)外,正常周围带、增生与癌三者的相对信号强度在其余每个时段均差异有统计学意义(P<0．05)。经DWI检查前列腺癌患者26例于ADC图上病灶呈明显低信号,ADC值为(104．23±26．15)×10-5mm2／s,43例前列腺增生患者病灶区平均ADC值为(175．21±64．86)×10-5mm2／s,除正常前列腺周围带与前列腺增生之间ADC值差异无统计学意义(P>0．05)外,前列腺癌、前列腺增生和正常前列腺中央腺区之间差异均有统计学意义(P<0．05)。MRS检查前列腺癌17例,其病灶区Cho／Cit比值为2．26±0．91,(Cho+Cr)／Cit比值为2．85±1．01,35例前列腺增生患者病灶区平均Cho／Cit比值为0．46±0．23,(Cho+Cr)／Cit比值为0．57±0．20。除正常前列腺周围带与正常前列腺中央腺区之间差异无统计学意义(P>0．05)外,前列腺癌、前列腺增生和正常前列腺组织其余各组间差异均有统计学意义(P<0．05)。DCE-MRI、DWI和MRS 3种检查方法在前列腺癌诊断敏感度、特异度和准确度均达70％以上,而通过3种检查方法的联合应用,其敏感度、特异度和准确度分别达87．50％、94．74％、92．59％。结论DCE-MRI、DWI和MRS 3种检查方法在前列腺癌诊断中具有特征性表现,而3种检查方法的联合应用又将极大地提高MRI诊断前列腺癌的正确诊断率。
Objective To explore the applying value of the diagnosis of dynamic contrast-enhanced MRI （DCE-MRI）, diffusion weighted imaging （DWI） and 3D ^1H-MR spectroscopy （MRS） in prostate cancer （PC）. Methods Thirty-two cases with PC and 64 cases with benign prostatic hyperplasia （BPH） which were confirmed with biopsy-proven, operation and follow-up, and 29 healthy volunteers underwent the examinations of DCE-MRI, DWI and MRS. The signal intensity, ADC value, and Cho/Cit ratio and （ Cho ＋ Cr）/Cit ratio were measured respectively on the lesions of PC and BPH, normal prostatic peripheral zone （PZ） and normal prostatic central gland （CG） of DCE-MRI, DWI and MRS. The results were statistically treated with ANOVA. Results The lesions showed obvious enhancement in the early phase of DCE-MRI and washed out in late phase in 18 of 22 cases with PC, who underwent the examination of DCE-MRI. The enhancement was obvious in early and strengthened gradually, and then went to decrease in late phase after peak value on the lesions in 38 of 40 cases with BPH. The signal intensities from different time and different lesions and tissues were treated statistically and the results showed that there were significant differences （P〈0.05） between PZ, PC and BPH in different time except 0 s and 120 s between PC and BPH （P 〉 0. 05 ）. The lesions were shown lower signal intensity on ADC map in 26 cases with PC, who were examined with DWI and the average ADC value was （ 104. 23 ±26. 15） ×10 ^-5 mm^2/s. The average ADC value of the lesions of 43 cases with BPH was （ 175.21 ±64. 86 ） × 10^-5 mm^2/s. The statistical analysis showed that there were significant differences between PC, BPH and CG except between PZ and BPH. Average Cho/Cit ratio and average （ Cho ＋ Cr）/Cit ratio of the lesions of PC were 2. 26 ±0. 91 and 2. 85 ± 1.01 respectively in 17 cases with PC, who were performed with MRS. The average Cho/Cit ratio and average （Cho ＋ Cr）/Cit ratio were 0. 46 ±0. 23 and 0. 57 ±0. 20 respectively in 35 cases with BPH. After the statistical analyzing, the results presented that there were significant differences between PC, BPH and normal prostatic tissues except between PZ and CG. The sensitivity, specificity and accuracy of DCE-MRI, DWI and MRS were all more than 70% in displaying PC. Furthermore, the sensitivity, specificity and accuracy of DCE-MRI, DWI and MRS had increased to 87. 50% , 94. 74% and 92.59% respectively with the combining use of this three examination methods. Conclusions DCE-MRI, DWI and MRS could present the specific findings in the diagnosis of PC. The combining application of the three examination methods will further increase the accurate diagnosis of PC.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第7期678-683,共6页
Chinese Journal of Radiology
关键词
磁共振成像
前列腺肿瘤
前列腺增生
Magnetic resonance imaging
Prostatic neoplasms
Prostatic hyperplasia
