前列腺癌检测：T2加权成像、扩散加权成像、质子磁共振波谱成像及三种技术联合应用的比较

Prostate cancer detection: comparison of T2-weighted imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopic imaging, and the three techniques combined.

作者信息

Chen M, Dang H-D, Wang J-Y, Zhou C, Li S-Y, Wang W-C, Zhao W-F, Yang Z-H, Zhong C-Y, Li G-Z

机构信息

Department of Radiology, Beijing Hospital, Beijing, China. chenmin62@yahoo. com

出版信息

Acta Radiol. 2008 Jun;49(5):602-10. doi: 10.1080/02841850802004983.

DOI:10.1080/02841850802004983

PMID:18568549

Abstract

BACKGROUND

Magnetic resonance (MR) imaging has been established as the best imaging modality for the detection, localization, and staging of prostate cancer on account of its high resolution of soft tissue and the possibilities of multiplanar and multiparameter scanning.

PURPOSE

To evaluate T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), MR spectroscopy (MRS), and the combination of these three MR techniques in the diagnosis of prostate cancer, as correlated to histopathologic findings.

MATERIAL AND METHODS

MR imaging, including T2WI, DWI, and MRS, was performed at 1.5T with a body coil combined with a spine coil in 42 cases. Diagnosis was confirmed by histopathology through systematic transrectal prostate biopsy. Apparent diffusion coefficient (ADC) maps were obtained with two b values (0 and 1000 s/mm(2)). The metabolic maps of 3D-MRS imaging were analyzed for the ratio of (Cho+Cre)/Cit in each sextant. All cases were evaluated by T2WI, DWI, and MRS, and then by the three methods combined. The statistical indicators and the receiver operating characteristic (ROC) curve analysis of each method were compared to the results of histopathology obtained by transrectal prostate biopsy.

RESULTS

15 of 42 cases were confirmed to be cancerous, and 27 of 42 cases were noncancerous. All the 252 sextants were confirmed by biopsies, including 201 benign sextants and 51 malignant sextants. The sensitivity and the specificity for the detection of prostate cancer were 88.2% and 67.2% for T2WI, as the cutoff was 3; 82.4% and 81.6% for DWI, as the cutoff was 4; 84.3% and 98.0% for MRS, as the cutoff was 5; and 96.1% and 96.5% for the combined T2WI+DWI+MRS, as the cutoff was 4. In the ROC analysis, the correlative areas under the ROC curves (Az) were 0.848+/-0.030, 0.860+/-0.033, and 0.961+/-0.016 for T2WI, DWI, and MRS, respectively, and 0.978+/-0.009 for the combination of T2WI+DWI+MRS.

CONCLUSION

The accuracy of the detection of prostate cancer is increased through a combination of the three techniques. Moreover, MRS demonstrated higher accuracy compared with T2WI or DWI.

摘要

背景

由于磁共振（MR）成像具有软组织高分辨率以及多平面和多参数扫描的可能性，它已成为前列腺癌检测、定位和分期的最佳成像方式。

目的

评估T2加权成像（T2WI）、扩散加权成像（DWI）、磁共振波谱（MRS）以及这三种MR技术的联合应用在前列腺癌诊断中的价值，并与组织病理学结果进行相关性分析。

材料与方法

对42例患者采用体线圈联合脊柱线圈在1.5T设备上进行MR成像，包括T2WI、DWI和MRS。通过系统性经直肠前列腺活检的组织病理学检查确诊。采用两个b值（0和1000 s/mm(2)）获得表观扩散系数（ADC）图。分析三维MRS成像代谢图中各象限的（Cho+Cre）/Cit比值。所有病例先分别采用T2WI、DWI和MRS进行评估，然后采用三种方法联合评估。将每种方法的统计指标和受试者操作特征（ROC）曲线分析结果与经直肠前列腺活检获得的组织病理学结果进行比较。

结果

42例患者中15例确诊为癌，27例为非癌。所有252个象限均经活检证实，其中良性象限201个，恶性象限51个。T2WI检测前列腺癌的敏感度和特异度分别为88.2%和67.2%，截断值为3；DWI分别为82.4%和81.6%，截断值为4；MRS分别为84.3%和98.0%，截断值为5；T2WI+DWI+MRS联合检测分别为96.1%和96.5%，截断值为4。在ROC分析中，T2WI、DWI和MRS的ROC曲线下相关面积（Az）分别为0.848±0.030、0.860±0.033和0.961±0.016，T2WI+DWI+MRS联合检测的Az为0.978±0.009。