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目的确定单独或联合应用3TMRS和扩散加权成像活体评价前列腺癌侵袭性的效能,通过组织病理学在前列腺癌根治标本中确定兴趣区内前列腺癌的受累范围。材料与方法此回顾性研究获得单位伦理委员会批准,无需知情同意书。54例经穿刺证实为前列腺癌的病人,在前列腺切除术前进行MRS检查。根据组织病理图,选择包含肿瘤组织的MRS体素,计算(Cho+Cr)/Cit和Cho/Cr的代谢物比率。由于ADC的体素常小于MRS的体素,在每个MRS体素内以该区域25%的表观扩散系数作为该体素的ADC值,代表ADC图中最异常的肿瘤部分。每个肿瘤的最大代谢物比率和25%ADC值与肿瘤的侵袭性相关,用于确定肿瘤的侵袭性分类。综合两种方法,采用逻辑回归模型(LRM)评价所有数据。结果前列腺癌的侵袭性分类与外周带的最大(Cho+Cr)/Cit比率(ρ=0.36)、最大Cho/Cr比率(ρ=0.35)和最小25%ADC值(ρ=-0.63)之间存在显著相关性。在移行带,仅(Cho+Cr)/Cit和Cho/Cr比率存在相关性(ρ=0.58和ρ=0.60)。在鉴别侵袭性分类方面,与其他手段相比,采用LRM方式并未发现鉴别能力有所提高。结论本研究结果证实,MRS和扩散加权成像能够无创性地活体评价前列腺癌的侵袭性,两种检查方法效能相当。联合应用并没有提高诊断效能。虽然如此,移行带中的代谢物比率和外周带的ADC值具有较好的互补应用价值。
OBJECTIVE: To determine the efficacy of 3TMRS and diffusion-weighted imaging in assessing invasiveness of prostate cancer, either alone or in combination, and to determine the extent of prostate cancer involvement in the region of interest by histopathology in radical prostatectomy specimens. Materials and Methods This retrospective study was approved by the unit ethics committee without the need for informed consent. Fifty-four patients with prostate cancer who had been punctured were examined by MRS prior to prostatectomy. According to histopathology, MRS voxels containing tumor tissue were selected and ratios of (Cho + Cr) / Cit and Cho / Cr metabolites were calculated. Since the ADC voxels are often smaller than the MRS voxels, 25% of the apparent diffusion coefficient for that region within each MRS voxel is the ADC value for that voxel, representing the most abnormal tumor portion in the ADC plot. The maximum metabolite ratio and 25% ADC value for each tumor correlates with the aggressiveness of the tumor and is used to determine the aggressive classification of the tumor. Combining the two approaches, all data were evaluated using the Logistic Regression Model (LRM). Results There was significant difference between the aggressive classification of prostate cancer and the ratio of Cho + Cr / Cit (ρ = 0.36), the maximum Cho / Cr ratio (ρ = 0.35) and the minimum 25% ADC (ρ = -0.63) There is a significant correlation. In the transition zone, there is a correlation between (Cho + Cr) / Cit and Cho / Cr ratios (ρ = 0.58 and ρ = 0.60). In the identification of invasive classification, compared with other means, the use of LRM did not find the ability to identify increased. Conclusions The results of this study confirm that MRS and diffusion-weighted imaging can noninvasively assess the invasiveness of prostate cancer in vivo, with comparable efficacy for both assays. Combined use did not improve diagnostic performance. Nonetheless, the ratio of metabolites in the transition zone and the ADC value in the peripheral zone have good complementary value.