摘要
目的 评价DWI在早期前列腺癌（PCa）诊断和鉴别诊断中的应用价值。方法 回顾性分析经病理证实且同时行T2WI、DWI检查的106例前列腺疾病患者资料,其中早期前列腺癌（PCa）35例、良性前列腺增生（BPH） 55例、前列腺炎16例.对T2WI、DWI和T2WI＋ DWI共3种方法所得的图像进行评分从而进行诊断,并与组织病理结果相对照.采用ROC曲线进行分析,并采用Z检验比较曲线下面积（Az）,计算3种检查方法诊断前列腺癌的敏感度、特异度和准确度.测量不同前列腺疾病患者的ADC值,并采用方差分析进行比较.结果 35例早期PCa中DWI漏诊7例,55例BPH中2例DWI将其误诊为PCa,16例前列腺炎中11例DWI将其误诊为PCa.T2WI、DWI、T2WI＋ DWI诊断早期PCa的Az值分别为0.846、0.874和0.947,T2WI和DWI的Az值分别与T2WI＋ DWI比较,差异均有统计学意义（Z值分别为3.262和2.402,P值分别为0.001和0.016）,T2 WI和DWI的Az值差异无统计学意义（Z =0.630,P=0.528）.T2WI、DWI、T2WI＋ DWI诊断早期PCa的敏感度分别为51.43％（18/35）、80.00％（28/35）和85.71％ （30/35）,特异度分别为90.14％（64/71）、81.69％（58/71）和88.73％（63/71）,准确度分别为77.36％（82/106）、81.13％（86/106）和87.74％（93/106）.早期PCa、BPH和前列腺炎3组病灶的ADC值分别为（723±183）×10^-3、（1 381±117）×10-3和（957±175）×10^-3mm^2/s,差异有统计学意义（F=131.94,P＜0.01）,两两比较差异也均有统计学意义（P值均＜0.05）.结论 DWI有助于早期PCa的检出,但同时也存在一定的漏诊和误诊,联合使用T2 WI和DWI可提高早期PCa诊断的敏感度和准确度。ADC值的定量测量有助于疾病的鉴别诊断。
Objective To evaluate the value of diffusion weighted imaging （DWI） in the diagnosis and differential diagnosis of early prostate cancer.Methods The data of 106 patients [35 with early prostate cancer （PCa）,55 with benign prostatic hyperplasia （BPH） and 16 with prostatitis] were retrospectively analyzed,who underwent T2WI,DWI,and T2WI ＋ DWI examination and all patients were confirmed by pathology.The data obtained from T2WI,DWI,and a combination of T2WI and DWI were scored and compared with pathological findings.The receiver operating characteristic （ROC） curves were analyzed for the area under the curve （Az） using Z test.Specificities,sensitivities and accuracies of the three protocols to diagnose PCa were evaluated.The ADC values of each prostate lesion were measured and compared with ANOVA test.Results DWI missed 7 in 35 early prostate cancer,misdiagnosed 2 in 55 BPH,and 11 in 16 prostatitis.The Az values of T2WI,DWI,and T2 WI ＋ DWI for the detection of early prostate cancer were 0.846,0.874,and 0.947,respectively.There was significant differences between T2WI ＋ DWI and T2WI alone （Z =3.262,P =0.001）,and between T2WI ＋ DWI and DWI alone （Z =2.402,P =0.016）.There was no significant difference between T2WI alone and DWI alone （Z =0.630,P =0.528）.The sensitivities,specificities,and accuracies of T2WI,DWI,and a combination of T2WI and DWI for the detection of early prostate cancer were 51.43 % （18/35）,80.00% （28/35）,and 85.71% （30/35） ;90.14% （64/71）,81.69% （58/71）,and 88.73% （63/71） ;77.36% （82/106）,81.13% （86/106）,and 87.74% （93/106） respectively.The ADC values for detecting early PCa,BPH,and prostatitis were （723 ± 183）×10^-3,（1 381 ± 117） × 10^-3,and （957 ± 175） × 10^-3 mm^2/s.These ADC values showed statistical significance（F =131.94,P 〈 0.01） among the three groups and also reached statistical significance between each two groups.Conclusions DWI is valuable in detecting early prostate cancer,but there are some misdiagnosis and false negatives.The combination of T2WI and DWI can improve the sensitivity and accuracy of early prostate cancer detection.The quantitative measurement of ADC value can differentiate early prostate cancer from benign prostatic hyperplasia and prostatitis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第2期114-118,共5页
Chinese Journal of Radiology
基金
国家自然科学基金资助项目（81271539）
江苏省卫生厅科研基金资助项目（H200862）
苏州市科教兴卫青年基金资助项目（KJXW2011012）
关键词
前列腺肿瘤
磁共振成像
弥散
对比分析
Prostatic neoplasms
Diffusion magnetic resonance imaging
Comparative study
