基于 3T MRI 的表观扩散系数（ADC）比值与常规 ADC 检测临床显著前列腺癌的比较。
Apparent Diffusion Coefficient (ADC) Ratio Versus Conventional ADC for Detecting Clinically Significant Prostate Cancer With 3-T MRI.
机构信息
Department of Radiology, Ronald Reagan UCLA Medical Center, BL-428 CHS, Rm B2-187A, 10833 Le Conte Ave, Los Angeles, CA 90095.
Department of Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, CA.
出版信息
AJR Am J Roentgenol. 2019 Sep;213(3):W134-W142. doi: 10.2214/AJR.19.21365. Epub 2019 Jun 19.
The purpose of this study is to evaluate the performance of the apparent diffusion coefficient ratio (ADC; the ADC of the suspected prostate cancer [PCa] focus on MRI divided by the ADC in a noncancerous reference area) with that of conventional ADC for detection of high-grade PCa (Gleason score [GS] ≥ 3 + 4) versus low-grade PCa (GS = 3 + 3) with whole-mount (WM) histopathologic analysis used as a reference. The cohort of this retrospective study included 218 men with 240 unilateral PCa lesions assessed by both 3-T multiparametric MRI and whole-mount histopathologic analysis. ROIs were placed on individual lesions verified by WM histopathologic analysis, to calculate the mean ADC (ADC) and lowest ADC within each lesion (ADC), and within non-tumor-containing regions of the same tumor zone but on the contralateral side (ADC), to calculate the background ADC. The ADC (the ADC divided by the ADC) was calculated. The performance of individual ADC and ADC values in discriminating PCa with a GS of 3 + 3 from PCa with a GS of 3 + 4 or greater was assessed using the AUC value. The ADC had a higher AUC value for discriminating PCa lesions with a GS of 3 + 3 from those with a GS of 3 + 4 or greater (the AUC value increased from 0.70 using the ADC and 0.67 using the ADC [the minimum ADC of the PCa lesion] to 0.80 for the ADC and 0.72 for the ADC [the ADC divided by the ADC]; = 0.043). When stratified by PCa zonal location, the ADC had significantly more robust accuracy in the transition zone (the AUC value increased from 0.63 for ADC to 0.87 for ADC; = 0.019) compared with the peripheral zone (the AUC value increased from 0.74 for ADC to 0.78 for ADC; = 0.44). When analyzed on the basis of endorectal coil use, the ADC performed nonsignificantly better in both the endorectal coil and non-endorectal coil subcohorts, although it performed better in the former. As an intrapatient-normalized diagnostic tool, the ADC ratio provided the best AUC value for discrimination of low-grade from high-grade PCa on 3-T MRI.
本研究旨在评估表观扩散系数比（ADC；磁共振成像上可疑前列腺癌[PCa]病灶的 ADC 除以无癌参考区域的 ADC）与常规 ADC 检测高级别 PCa（Gleason 评分[GS]≥3+4）与低级别 PCa（GS=3+3）的性能，以全距（WM）组织病理学分析为参考。本回顾性研究队列包括 218 名男性，共 240 个单侧 PCa 病变，通过 3-T 多参数 MRI 和全距组织病理学分析进行评估。在 WM 组织病理学分析验证的单个病变上放置 ROI，以计算每个病变的平均 ADC（ADC）和最低 ADC（ADC）以及同一肿瘤区域内但对侧无肿瘤区域的 ADC（ADC），以计算背景 ADC。计算 ADC（ADC 除以 ADC）。使用 AUC 值评估单个 ADC 和 ADC 值在区分 GS 为 3+3 的 PCa 与 GS 为 3+4 或更高的 PCa 方面的性能。ADC 用于区分 GS 为 3+3 的 PCa 病变与 GS 为 3+4 或更高的 PCa 病变的 AUC 值更高（AUC 值从使用 ADC 时的 0.70 增加到使用 ADC 时的 0.67 [PCa 病变的最低 ADC]，至 0.80 用于 ADC 和 0.72 用于 ADC [ADC 除以 ADC]；=0.043）。按 PCa 区域位置分层时，ADC 在移行区的准确性显著更高（AUC 值从 ADC 的 0.63 增加到 ADC 的 0.87；=0.019），而在外周区则较低（AUC 值从 ADC 的 0.74 增加到 ADC 的 0.78；=0.44）。根据直肠内线圈的使用进行分析时，ADC 在直肠内线圈和非直肠内线圈亚组中的表现均略有改善，尽管前者表现更好。作为一种患者内标准化的诊断工具，ADC 比值在 3-T MRI 上提供了区分低级别和高级别 PCa 的最佳 AUC 值。
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