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1. 复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海,200032
2. 海军军医大学(第二军医大学)长海医院影像科,上海,200433
Published Online:29 September 2019,
Published:29 September 2019
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陈?阳,阳青松,陆建平 . DWI单、双指数模型对中央腺体前列腺癌及良性前列腺增生的鉴别诊断价值[J]. 中国癌症杂志, 2019, 29(8): 583-589.
CHEN Yang, YANG Qingsong, LU Jianping. Differentiation of central gland prostate cancer from benign prostatic hyperplasia by using monoexponential and biexponential DWI models[J]. China Oncology, 2019, 29(8): 583-589.
陈?阳,阳青松,陆建平 . DWI单、双指数模型对中央腺体前列腺癌及良性前列腺增生的鉴别诊断价值[J]. 中国癌症杂志, 2019, 29(8): 583-589. DOI: 10.19401/j.cnki.1007-3639.2019.08.004.
CHEN Yang, YANG Qingsong, LU Jianping. Differentiation of central gland prostate cancer from benign prostatic hyperplasia by using monoexponential and biexponential DWI models[J]. China Oncology, 2019, 29(8): 583-589. DOI: 10.19401/j.cnki.1007-3639.2019.08.004.
背景与目的:鉴别中央腺体前列腺癌(central gland prostate cancer
CGPCa)与良性前列腺增生(benign prostatic hyperplasia
BPH)一直是临床工作的难点之一,传统的检查方法不能很好地区分两者。弥散加权成像(diffusion weighted imaging,DWI)单、双指数模型可以定量反映组织弥散及血流灌注信息。探究DWI单、双指数模型定量参数(单指数:ADC
total
,双指数:ADC
slow
、ADC
fast
及f值)对CGPCa与BPH的鉴别诊断价值。方法:回顾性分析在海军军医大学(第二军医大学)长海医院经前列腺穿刺病理学检查证实的36例CGPCa、48例BPH[25例基质型增生(stromal hyperplasia,SH)和23例腺体型增生(glandular hyperplasia,GH)]患者的MRI检查及临床资料。MRI检查包含多b值(0、50、100、150、200、500、800、1 000、1 500、2 000 s/mm
2
)DWI扫描。在DWI图像上画取感兴趣区(region of interest,ROI),获得CGPCa、SH及GH患者ADC
total
、ADC
slow
、ADC
fast
及f值。采用方差分析、LSD-t检验比较各参数差异性,受试者工作特征(receiver operating characteristic,ROC)曲线分析各参数鉴别CGPCa与BPH的效能,并比较ROC曲线的曲线下面积的差异。结果:3组病理类型两两之间ADC
total
和ADC
slow
差异均有统计学意义(P<0.000 1)。CGPCa与SH之间f值差异有统计学意义(P=0.002);CGPCa与GH、GH与SH之间f值差异无统计学意义(P=0.053、P=0.201)。3组病理类型ADC fast 差异无统计学意义(P=0.685)。在CGPCa与BPH鉴别诊断中,ADC
total
、ADC
slow
ROC曲线的曲线下面积均为0.998,诊断效能均较高。f值ROC曲线的曲线下面积为0.674,显著小于ADC
total
、ADC
slow
(P<0.000 1),诊断效能较低。结论:DWI单指数模型参数ADC
total
、双指数模型参数ADC
slow
均可以反映组织内细胞结构附近的水分子弥散情况,对鉴别CGPCa与BPH具有较大价值。
Background and purpose: Differentiating central gland prostate cancer (CGPCa) from benign prostatic hyperplasia (BPH) has always been one of the difficult clinical problems. Traditional examination methods can not be used to distinguish them well. Monoexponential and biexponential diffusion weighted imaging (DWI) models can quantitatively reflect the information of tissue diffusion and blood perfusion. This study aimed to investigate the value of parameters derived from monoexponential and biexponential DWI models (parameter derived from monoexponential DWI: ADC
total
; parameters derived from biexponential DWI: ADC slow
ADC fast and f) for distinguishing CGPCa from BPH. Methods: We retrospectively analyzed the megnatic resonance imaging (MRI) and clinical data of 36 patients with CGPCa and 48 patients with BPH [25 patients with stromal hyperplasia (SH) and 23 patients with glandular hyperplasia (GH)]proved by prostate biopsy at Changhai Hospital
Naval Medical University
Second Military Medical University. MRI examinations included multiple-b-value (0
50
100
150
200
500
800
1 000
1 500
2 000 s/mm
2
) DWI. Drawing the region of interest (ROI)
we could measure the values of ADC
total
ADC
slow
ADC
fast
and f value for the three pathological types. ANOVA and LSD-t test were used to compare the differences of the parameters. By using the receiver operating characteristic (ROC) curves
the diagnostic performances of these parameters were calculated in differentiating CGPCa from BPH. Results: Among the three groups
there were significant differences in both ADC
total
and ADC
slow
(P0.000 1)
while there was no difference in ADC
fast
(P=0.685). There was significant difference in f value between CGPCa and SH (P=0.002) only. In differentiating CGPCa from BPH
the areas under the ROC curves for ADC
total
and ADC
slow
were the same (0.998)
and the diagn
ostic performances of ADC
total
and ADC
slow
were high. The areas under the ROC curve for f value was 0.674. There were significant differences in the areas under the ROC curves between ADC
total
ADC
slow
and f value (P0.000 1). Conclusion: Parameters derived from monoexponential DWI (ADC
total
) and biexponential DWI (ADC
slow
) both can reflect the diffusion of water molecules near the cell structure in tissues
which are of great value in distinguishing CGPCa from BPH.
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