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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 187 -191. doi: 10.3877/cma.j.issn.1674-3253.2021.03.003

临床研究

体素内不相干运动及超高b值扩散峰度成像对前列腺癌的诊断价值研究
王明帅1, 李敏2, 史瑞华2, 王建文1, 牛亦农1, 蒋涛2, 张小东1, 平浩3,()   
  1. 1. 100043 北京,首都医科大学附属北京朝阳医院泌尿外科
    2. 100043 北京,首都医科大学附属北京朝阳医院放射科
    3. 100730 北京,首都医科大学附属北京同仁医院泌尿外科
  • 收稿日期:2020-10-29 出版日期:2021-06-01
  • 通信作者: 平浩
  • 基金资助:
    国家自然科学基金(面上项目81772698)

The diagnostic value of intravoxel incoherent motion and ultrahigh b-value diffusion kurtosis imaging in prostate cancer

Mingshuai Wang1, Min Li2, Ruihua Shi2, Jianwen Wang1, Yinong Niu1, Tao Jiang2, Xiaodong Zhang1, Hao Ping3,()   

  1. 1. Department of Urology, Capital Medical University, Beijing 100043, China
    2. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
    3. Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2020-10-29 Published:2021-06-01
  • Corresponding author: Hao Ping
引用本文:

王明帅, 李敏, 史瑞华, 王建文, 牛亦农, 蒋涛, 张小东, 平浩. 体素内不相干运动及超高b值扩散峰度成像对前列腺癌的诊断价值研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(03): 187-191.

Mingshuai Wang, Min Li, Ruihua Shi, Jianwen Wang, Yinong Niu, Tao Jiang, Xiaodong Zhang, Hao Ping. The diagnostic value of intravoxel incoherent motion and ultrahigh b-value diffusion kurtosis imaging in prostate cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 187-191.

目的

探讨体素内不相关运动(IVIM)及超高b值扩散峰度成像(DKI)模型参数对前列腺癌的诊断价值以及对Gleason评分的预测作用。

方法

2017年2月至2018年6月,共45例前列腺疾病患者进行多b值MRI检查,仪器采用Prisma MRI 3.0T。采用后期处理软件分析IVIM模型(b=0、50、100、150、200、400、800、1 200),获得纯扩散系数(Dt)、伪扩散系数(Dp)、灌注分数(f);分析DKI模型(b=0、400、800、1 200、2 000、3 000、4 000),获得峰度校正的扩散系数(D)、无量纲度量表观峰度系数(K)。经病理证实前列腺癌26例,良性病变19例,分别计算前列腺癌及良性病变的Dt值、Dp值、f值及D值和K值参数。根据前列腺病理分析所确定的Gleason评分(≥7为高分,<7为低分),使用这些参数鉴别病变等级。

结果

在前列腺癌中IVIM模型Dt值为0.60±0.15,明显低于良性病变(1.19±0.23) (P<0.001);而前列腺癌及良性病变的Dp值和f值差异无统计学意义。在前列腺癌和良性病变中DKI模型D值分别为0.78(0.68~0.88)及1.68(1.44~1.81),K值分别为0.95(0.89~1.00)及0.57(0.53~0.67),差异有统计学意义(P<0.001)。另外,DKI中K值可以显著区分在Gleason评分高分(1.03±0.12)及低分(0.61±0.09)前列腺癌病变等级,有助于诊断有临床意义前列腺癌。ROC评估诊断效能发现,Dt、D和K值的诊断效能明显优于Dp和f值。

结论

IVIM和超高b值DKI模型可能对前列腺癌有重要的鉴别诊断价值,并对Gleason评分有一定的预测作用。

Objective

To evaluate the efficacy of intravoxel incoherent motion (IVIM) and ultrahigh b-value diffusion kurtosis imaging (DKI) for prostate cancer detection and Gleason score prediction.

Methods

From February 2017 to May 2018, totally 45 patients suspected prostate cancer were performed 3T multi-parameters MRI of T2WI, DWI, IVIM and DKI model following pathological confirmed by transrectal ultrasound biopsy. Parameters were postprocessed by IVIM models including quantitation of diffusivity (Dt) and pseudo-diffusivity (Dp) and perfusion fraction (f) using 8 b values (b=0, 50, 100, 150, 200, 400, 800, 1200) and DKI models including the mean diffusivity (D) and kurtosis (K) using 7 b values (b=0, 400, 800, 1200, 2000, 3000, 4000). Correlation between Dt, Dp, f, D, K and Gleason scores were assessed.

Results

The pathologic result showed 26 cases prostate cancer and 19 cases benign prostatic hyperplasia (BPH). Only Dt had significant difference between prostate cancer and BPH in IVIM models [(0.60 ± 0.15) vs (1.19 ± 0.23), P<0.001]. In DKI models, D and K values were apparently different between prostate cancer and BPH [0.78(0.68-0.88) vs 1.68(1.44-1.81), P<0.001]; [0.95(0.89 -1.00) vs 0.57(0.53-0.67), P<0.001]. K value showed relatively higher correlations with Gleason score. The Dt, D and K exhibited higher area under the curve compared with Dp and f.

Conclusions

IVIM and ultrahigh b-value models may help to discriminate prostate from BPH and predict higher Gleason score.

图1 前列腺癌Gleason评分8分Dt值
表1 IVIM模型Dt、Dp及f值
图3 超高b值Dt、D和K的ROC曲线
表2 DKI模型D及K值
表3 超高b值Dt、D和K诊断效能
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