Sun Hongmei, Du Fengli, Liu Yan, Li Qian, Liu Xinai, Wang Tongming
Department of Magenetic Resonance Imaging (MRI), Henan Province Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Chinese Medicine), Zhengzhou, China.
Henan University of Chinese Medicine, Zhengzhou, China.
Front Oncol. 2022 Dec 12;12:925186. doi: 10.3389/fonc.2022.925186. eCollection 2022.
This study investigated the diagnostic utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) parameters for distinguishing between benign and malignant prostate tumors when serum prostate-specific antigen (PSA) level is ≥10 ng/ml.
Patients with prostate cancer (PCa) and benign prostatic hyperplasia (BPH) with serum PSA ≥10 ng/ml before treatment were recruited. Transrectal ultrasound-guided biopsy or surgery was performed for tumor classification and patients were stratified accordingly into PCa and BPH groups. Patients underwent DCE-MRI and DWI scanning and the transfer constant (K), rate constant (K), fractional volume of the extravascular extracellular space, plasma volume (V), and Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) score were determined. The apparent diffusion coefficient (ADC) was calculated from DWI. The diagnostic performance of these parameters was assessed by receiver operating characteristic (ROC) curve analysis, and those showing a significant difference between the PCa and BPH groups were combined into a multivariate logistic regression model for PCa diagnosis. Spearman's correlation was used to analyze the relationship between Gleason score and imaging parameters.
The study enrolled 65 patients including 32 with PCa and 33 with BPH. Ktrans (P=0.006), Kep (P=0.001), and Vp (P=0.009) from DCE-MRI and ADC (P<0.001) from DWI could distinguish between the 2 groups when PSA was ≥10 ng/ml. PI-RADS score (area under the ROC curve [AUC]=0.705), Ktrans (AUC=0.700), Kep (AUC=0.737), Vp (AUC=0.688), and ADC (AUC=0.999) showed high diagnostic performance for discriminating PCa from BPH. A combined model based on PI-RADS score, Ktrans, Kep, Vp, and ADC had a higher AUC (1.000), with a sensitivity of 0.998 and specificity of 0.999. Imaging markers showed no significant correlation with Gleason score in PCa.
DCE-MRI and DWI parameters can distinguish between benign and malignant prostate tumors in patients with serum PSA ≥10 ng/ml.
本研究探讨了动态对比增强磁共振成像（DCE-MRI）和扩散加权成像（DWI）参数在血清前列腺特异性抗原（PSA）水平≥10 ng/ml时鉴别前列腺良恶性肿瘤的诊断效用。
招募治疗前血清PSA≥10 ng/ml的前列腺癌（PCa）和良性前列腺增生（BPH）患者。经直肠超声引导下进行活检或手术以进行肿瘤分类，患者据此被分为PCa组和BPH组。患者接受DCE-MRI和DWI扫描，并测定转运常数（Ktrans）、速率常数（Kep）、血管外细胞外间隙分数容积、血浆容积（Vp）以及前列腺影像报告和数据系统第2版（PI-RADS v2）评分。从DWI计算表观扩散系数（ADC）。通过受试者工作特征（ROC）曲线分析评估这些参数的诊断性能，将在PCa组和BPH组之间显示出显著差异的参数纳入多变量逻辑回归模型以诊断PCa。采用Spearman相关性分析Gleason评分与影像参数之间的关系。
该研究纳入65例患者，其中32例为PCa，33例为BPH。当PSA≥10 ng/ml时，DCE-MRI的Ktrans（P = 0.006）、Kep（P = 0.001）和Vp（P = 0.009）以及DWI的ADC（P < 0.001）能够区分这两组。PI-RADS评分（ROC曲线下面积[AUC] = 0.705）、Ktrans（AUC = 0.700）、Kep（AUC = 0.737）、Vp（AUC = 0.688）和ADC（AUC = 0.999）在鉴别PCa和BPH方面显示出较高的诊断性能。基于PI-RADS评分、Ktrans、Kep、Vp和ADC的联合模型具有更高的AUC（1.000），敏感性为0.998，特异性为0.999。影像标志物与PCa中的Gleason评分无显著相关性。
DCE-MRI和DWI参数能够在血清PSA≥10 ng/ml的患者中鉴别前列腺良恶性肿瘤。
