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目的探讨磁共振动态对比增强(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量参数直方图分析对前列腺癌检出的应用价值。方法收集本院2016年10月至2017年6月行盆腔常规MRI、DWI和DCE-MRI扫描的患者72例,经病理证实的前列腺癌(prostate cancer,PCa)38例,前列腺增生(prostatic hyperplasia,BPH)18例,结合影像表现、实验室检查及随访观察诊断前列腺炎16例。利用第三方后处理软件(Omni Kinetic,OK),在病灶最大中心层面勾画感兴趣区,获得感兴趣区内DCE-MRI定量参数(Ktrans、Kep和Ve)的平均值及各百分位数值(5%、10%、25%、50%、75%、90%和95%),分别比较外周带PCa与前列腺炎、中央腺体PCa与BPH各参数值的差异,并分析诊断效能。结果外周带PCa组Ktrans平均值及各百分位数值均大于前列腺炎(平均值及50%、75%、90%和95%百分位数值P<0.05)。PCa组Kep平均值及各百分位数值均大于前列腺炎(P<0.05)。外周带PCa组Ve平均值及各百分位数值小于或等于前列腺炎(5%、10%、25%和50%百分位数值P<0.05)。中央腺体PCa与BPH渗透参数Ktrans、Kep、Ve的平均值及各百分位数值差异均无统计学意义(P>0.05)。外周带PCa组Ktrans和Kep高百分位数AUC大于平均值,低百分位数AUC最小,90%Kep诊断效能最大(AUC为0.932,敏感度78.3%,特异度92.9%);外周带PCa组Ve百分位数不具有诊断效能。结论基于DCE-MRI的直方图分析在外周带PCa与前列腺炎鉴别诊断中具有临床价值,Ktrans、Kep高百分位数诊断效能优于平均值和低百分位数。
Objective To investigate the value of quantitative contrast histogram analysis of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the detection of prostate cancer. Methods Totally 72 patients who underwent pelvic routine MRI, DWI and DCE-MRI scan from October 2016 to June 2017 in our hospital were collected. Pathologically confirmed 38 cases of prostate cancer (PCa), prostatic hyperplasia BPH) 18 cases, combined with imaging findings, laboratory tests and follow-up diagnosis of prostatitis in 16 cases. Using the third-party post-processing software (Omni Kinetic, OK), the region of interest was delineated at the largest focal lesion level to obtain the mean and the percentiles of the DCE-MRI quantitative parameters (Ktrans, Kep and Ve) in the region of interest The differences between the PCa and BPH values of peripheral glands and PCa were compared respectively and the diagnostic efficacy was analyzed. Results The average Ktrans and the percentiles of PCa in peripheral zone were higher than those in prostatitis (mean and 50%, 75%, 90% and 95% percentile values, P <0.05). The average value of Kep and each percentile value of PCa group were higher than that of prostatitis (P <0.05). Peripheral band PCa group Ve mean and each percentile less than or equal to prostatitis (5%, 10%, 25% and 50% percentile value P <0.05). There was no significant difference between the average values of PCa and BPH osmotic parameters Ktrans, Kep, Ve and each percentile of central gland (P> 0.05). The AUC of Ktrans and Kep high percentiles in the peripheral band PCa group were higher than the average value, the low percentile AUC was the smallest, and the diagnostic efficiency of 90% Kep was the highest (AUC 0.932, sensitivity 78.3%, specificity 92.9%); Group Ve percentiles did not have diagnostic efficacy. Conclusions The histogram analysis based on DCE-MRI has clinical value in the differential diagnosis of PCa and prostatitis in the peripheral zone. The diagnostic performance of Ktrans and Kep high percentiles is better than the average and the low percentile.