前列腺癌：应用扩散加权和动态对比增强磁共振成像鉴别中央腺体癌与前列腺良性增生。
Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging.
机构信息
Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA.
出版信息
Radiology. 2010 Dec;257(3):715-23. doi: 10.1148/radiol.10100021. Epub 2010 Sep 15.
PURPOSE
To analyze the diffusion and perfusion parameters of central gland (CG) prostate cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and to determine the role of these parameters in the differentiation of CG cancer from benign CG hyperplasia.
MATERIALS AND METHODS
In this institutional review board-approved (with waiver of informed consent), HIPAA-compliant study, 38 foci of carcinoma, 38 SH nodules, and 38 GH nodules in the CG were analyzed in 49 patients (26 with CG carcinoma) who underwent preoperative endorectal magnetic resonance (MR) imaging and radical prostatectomy. All carcinomas and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The apparent diffusion coefficient (ADC), the contrast agent transfer rate between blood and tissue (K(trans)), and extravascular extracellular fractional volume values for all carcinoma, SH, and GH foci were calculated. The mean, standard deviation, 95% confidence interval (CI), and range of each parameter were calculated. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed for differentiation of CG cancer from SH and GH foci.
RESULTS
The average ADCs (× 10(-3) mm(2)/sec) were 1.05 (95% CI: 0.97, 1.11), 1.27 (95% CI: 1.20, 1.33), and 1.73 (95% CI: 1.64, 1.83), respectively, in CG carcinoma, SH foci, and GH foci and differed significantly, yielding areas under the ROC curve (AUCs) of 0.99 and 0.78, respectively, for differentiation of carcinoma from GH and SH. Perfusion parameters were similar in CG carcinomas and SH foci, with K(trans) yielding the greatest AUCs (0.75 and 0.58, respectively). Adding K(trans) to ADC in ROC analysis to differentiate CG carcinoma from SH increased sensitivity from 38% to 57% at 90% specificity without noticeably increasing the AUC (0.79).
CONCLUSION
ADCs differ significantly between CG carcinoma, SH, and GH, and the use of them can improve the differentiation of CG cancer from SH and GH. Combining K(trans) with ADC can potentially improve the detection of CG cancer.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100021/-/DC1.
目的
分析中央腺体（CG）前列腺癌、基质增生（SH）和腺体增生（GH）的扩散和灌注参数，并确定这些参数在区分 CG 癌与良性 CG 增生中的作用。
材料与方法
本研究经机构审查委员会批准（豁免知情同意），并符合 HIPAA 规定，共纳入 49 例患者（26 例 CG 癌），这些患者术前均行直肠内磁共振（MR）成像和根治性前列腺切除术。所有 MR 图像上的癌灶和增生灶均基于组织病理学相关性进行定位。计算所有癌灶、SH 和 GH 灶的表观扩散系数（ADC）、血-组织对比剂转移率（K(trans)）和血管外细胞外分数容积值。计算每个参数的平均值、标准差、95%置信区间（CI）和范围。采用受试者工作特征（ROC）曲线和多变量逻辑回归分析对 CG 癌与 SH 和 GH 灶进行区分。
结果
CG 癌、SH 灶和 GH 灶的平均 ADC 值（×10(-3)mm(2)/sec）分别为 1.05（95%CI：0.97，1.11）、1.27（95%CI：1.20，1.33）和 1.73（95%CI：1.64，1.83），差异有统计学意义，ROC 曲线下面积（AUC）分别为 0.99 和 0.78，用于区分癌与 GH。CG 癌与 SH 灶的灌注参数相似，K(trans)的 AUC 最大（分别为 0.75 和 0.58）。在 ROC 分析中，将 K(trans)与 ADC 联合用于区分 CG 癌与 SH，在保持特异性 90%的情况下，敏感性从 38%提高到 57%，而 AUC 无明显增加（0.79）。
结论
CG 癌、SH 和 GH 之间的 ADC 值有显著差异，使用 ADC 值可提高 CG 癌与 SH 和 GH 的区分度。联合应用 K(trans)和 ADC 值可能有助于提高 CG 癌的检出率。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100021/-/DC1.
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