摘要
目的探讨三维氢质子MR波谱成像（3D^1HMRSI）对前列腺移行带癌的检出价值，并评估3D^1HMRSI判断移行带癌侵袭性的可行性。方法回顾性分析60例常规MR成像疑诊为移行带癌患者的3D^1HMRSI资料。参照穿刺活检病理结果，记录移行带癌和前列腺增生体素的（胆碱＋肌酸）／枸橼酸盐[（Cho＋Cre）／Cit]比值。采用独立大样本t^′检验比较移行带癌组和增生组（Cho＋Cre）／Cit比值，应用ROC分析评估（Cho＋Cre）／Cit比值对移行带癌的诊断效能。根据Gleason评分将移行带癌分为低危（Gleason评分〈7分）、中危（Gleason评分=7分）和高危（Gleason评分〉7分）3个组，将3个组移行带癌的（Cho＋Cre）／Cit比值进行秩和检验。采用秩相关分析（Cho＋Cre）／Cit比值与Gleason评分的相关性。结果25例为移行带癌，35例为良性前列腺增生。获取移行带癌体素177个，160个体素3D^1HMRSI表现为Cho峰与Cit峰倒置，（Cho＋Cre）／Cit比值增高。前列腺增生体素517个，大多数谱线形态类似正常外周带。移行带癌组与增生组（Cho＋Cre）／Cit比值分别为2．17±1．29和0．77±0．20，差异有统计学意义（t^′=14．38，P〈0．01）。（Cho＋Cre）／Cit比值用于诊断移行带癌，ROC曲线下面积为0．985（P〈0．01），当（Cho＋Cre）／Cit比值取1．08为诊断临界值时，灵敏度为92．7％，特异度为94．2％，准确度为93．8％。低、中、高危组移行带癌的体素数分别为57、64和56个，（Cho＋Cre）／Cit比值分别为1．43（1．16-1．87）、1．66（1．43-2．36）和2．32（1．86-3．30），差异有统计学意义（X^2=36．282，P〈0．01）。（Cho＋Cre）／Cit比值随着Gleason评分的升高而增大，二者呈正相关（r=0．555，P〈0．01）。结论3D^1HMRSI有助于移行带癌的早期检出，（Cho＋Cre）／Cit比值能鉴别移行带癌和增生组织，是有价值的评估移行带癌侵袭性的影像指标。
Objective To discuss the clinical value of three dimensional proton MR spectroscopic imaging（3 D^1 HMRSI） in the detection of transition zone （TZ） prostate cancer and evaluate the feasibility of 3D^1HMRSI for determining the aggressiveness of TZ cancer by analyzing its metabolic characteristics. Methods The 3D^1HMRSI data of sixty patients suspected TZ cancer in conventional MR examinations were retrospectively analyzed. The values of （ Cho ＋ Cre）/Cit of TZ cancer and benign prostatic hyperplasia （BPH） voxels were recorded and compared using independent sample t^′ test, and the area under the ROC curve was used to evaluate the diagnostic accuracy. Based on Gleason scores, TZ cancer voxels were divided into three groups, including low-risk （ Gleason score 〈 7 ）, intermediate-risk （ Gleason score = 7 ） and high- risk （Gleason score 〉 7）. The values of （Cho ＋ Cre）/Cit were compared among the three groups using Kruskal-Wallis test. The correlation of the value of （Cho ＋ Cre）/Cit and Gleason score was analyzed using rank correlation analysis. Results Among the 60 patients, histopathology confirmed TZ cancer in 25 patients and BPH in 35 patients. The inversion of Cho and Cit peak value with increased （Cho ＋ Cre）/Cit was detected in 160 out of 177 TZ cancer voxels. Most spectral curves of the 517 BPH voxels were similar with that of normal peripheral zone on 1HMRSI. The mean values of （ Cho ＋ Cre）/Cit of TZ cancer and BPHvoxels were 2. 17± 1.29 and 0.77± 0.20, respectively, with significant difference between them（t^′ = 14. 38,P 〈0. 01 ） . Using （ Cho ＋ Cre）/Cit for distinguishing TZ cancer, the area under ROC curve was 0. 985 （ P 〈 0. 01 ）. With the cut-off point 1.08, the sensitivity, specificity and accuracy of TZ cancer diagnosis was 92. 7% , 94. 2% and 93.8% , respectively. The number of low-risk, intermediate-risk and high-risk TZ cancer voxels were 57, 64 and 56 respectively, and the mean values of （ Cho ＋ Cre）/Cit of the three groups were 1.43 （ 1.16-1.87 ） , 1.66 （ 1.43-2.36 ） and 2.32 （ 1.86-3. 30 ） respectively, with significant difference among them （X^2= 36. 282, P 〈 0. 01 ）. The value of （Cho ＋ Cre）/Cit of TZ cancer increased with the increasing of Gleason score with positive correlation （ r = 0. 555, P 〈 0. 01 ）. Conclusions TZ cancer has a different metabolic profile from BPH. The value of （ Cho ＋ Cre）/Cit on 3D^1HMRSI could provide useful information for early detection and differentiation TZ cancer from BPH. Besides these, （ Cho ＋ Cre）/Cit is also a valuable imaging marker to evaluate the aggressiveness of TZ cancer.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第6期521-525,共5页
Chinese Journal of Radiology
基金
江苏省卫生科研资助项目（H200862）
关键词
前列腺肿瘤
前列腺增生
磁共振波谱学
Prostatic neoplasms
Prostatic hyperplasia
Magnetic resonance spectroscopy
