前列腺癌与前列腺增生的鉴别诊断：磁共振引导下腔内活检病理对照的体素内不相干运动直方图分析与单指数模型的比较。
Differentiation of prostate cancer and benign prostatic hyperplasia: comparisons of the histogram analysis of intravoxel incoherent motion and monoexponential model with in-bore MR-guided biopsy as pathological reference.
机构信息
Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing, 100730, China.
Graduate School of Peking Union Medical College, Beijing, China.
出版信息
Abdom Radiol (NY). 2020 Oct;45(10):3265-3277. doi: 10.1007/s00261-019-02227-5.
PURPOSE
To evaluate the diagnostic performance of histogram analysis of intravoxel incoherent motion (IVIM) parameters for differentiating prostate cancer (PCa) from benign prostatic hyperplasia (BPH), and compare with the monoexponential model, with in-bore MR-guided biopsy as pathological reference.
METHODS
Thirty patients were included in this study. DWI images were processed with Matlab R2015b software by IVIM and monoexponential model for quantitation of diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC). The multiparametric data were compared between PCa and BPH group. Correlations between parameters and Gleason scores of PCa were assessed with Spearman rank test. ROC analysis was used to evaluate and compare the diagnostic ability of each parameter for discriminating PCa from BPH. Logistic regression model was used to evaluate the diagnostic performance of combination of different histogram parameters.
RESULTS
Sixteen PCa lesions and 20 BPH nodules were analyzed in this study. For IVIM-derived D, the histogram mean, 75th, 90th, and max of PCa were significantly lower than BPH. PCa had significantly lower min and 10th D* than BPH. For f, histogram mean, min, 10th, 25th, 50th, 75th, 90th, max and skew showed significant differences between PCa and BPH. For ADC, PCa were significantly lower than BPH in terms of histogram mean, min, 10th, 25th, 50th, 75th, 90th, max and kurtosis. Histogram mean D and min, 25th D* show significantly negative correlation with Gleason score (r = - 0.582, - 0.534, - 0.554, respectively). Histogram max D and mean f and min ADC showed higher diagnostic performance than other parameters (AUC = 0.925, 0.881, 0.969, respectively). The IVIM model (combined with max D, min D* and mean f) (AUC = 0.950 [0.821, 0.995]) didn't show significant difference from the monoexponential model (AUC = 0.969 [0.849, 0.999], p = 0.23). Besides, combination of the IVIM and monoexponential model didn't improve diagnostic performance compared with the single model (p = 0.362 and 0.763, respectively).
CONCLUSIONS
Histogram analyses of IVIM and monoexponential model were both useful methods for discriminating PCa from BPH. The diagnostic performance of IVIM model seemed to be not superior to that of monoexponential model. Combination of IVIM and monoexponential model did not add significant information to the single model alone.
目的
评估体素内不相干运动（IVIM）参数直方图分析在鉴别前列腺癌（PCa）和前列腺良性增生（BPH）中的诊断性能，并与单指数模型进行比较，以腔内磁共振引导活检作为病理参考。
方法
本研究纳入 30 名患者。通过 IVIM 和单指数模型对 DWI 图像进行处理，以定量测量扩散系数（D）、假性扩散系数（D*）、灌注分数（f）和表观扩散系数（ADC）。比较 PCa 组和 BPH 组之间的多参数数据。使用 Spearman 秩检验评估参数与 PCa Gleason 评分之间的相关性。采用 ROC 分析评估和比较各参数鉴别 PCa 和 BPH 的诊断能力。使用逻辑回归模型评估不同直方图参数组合的诊断性能。
结果
本研究分析了 16 个 PCa 病灶和 20 个 BPH 结节。对于 IVIM 衍生的 D，PCa 的直方图均值、75 百分位、90 百分位和最大值明显低于 BPH。PCa 的 min 和 10 百分位 D明显低于 BPH。对于 f，PCa 的直方图均值、min、10 百分位、25 百分位、50 百分位、75 百分位、90 百分位、最大值和偏度与 BPH 之间存在显著差异。对于 ADC，PCa 的直方图均值、min、10 百分位、25 百分位、50 百分位、75 百分位、90 百分位、最大值和峰度均明显低于 BPH。直方图均值 D 和 min、25 百分位 D与 Gleason 评分呈显著负相关（r=-0.582、-0.534、-0.554）。直方图最大值 D、均值 f 和 min ADC 的诊断性能高于其他参数（AUC=0.925、0.881、0.969）。IVIM 模型（联合最大 D、最小 D*和平均 f）（AUC=0.950[0.821，0.995]）与单指数模型（AUC=0.969[0.849，0.999]）之间无显著差异（p=0.23）。此外，与单模型相比，IVIM 和单指数模型的组合并未提高诊断性能（p=0.362 和 0.763）。
结论
IVIM 和单指数模型的直方图分析都是鉴别 PCa 和 BPH 的有用方法。IVIM 模型的诊断性能似乎并不优于单指数模型。IVIM 和单指数模型的组合并没有为单模型增加显著的信息。
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