CAJ | 학술논문

目的比较DWI ADC值和经直肠超声引导穿刺所得Gleason评分评估前列腺癌侵袭性的作用.方法回顾性分析51例经穿刺活检确诊为前列腺癌,于1.5 TMR扫描仪上行前列腺DWI检查,并进行了前列腺癌根治术的患者资料.以前列腺癌根治术标本为参考,测量前列腺癌灶的ADC值,采用Pearson相关分析检验癌灶ADC值与前列腺癌根治术标本Gleason评分的相关性,以及穿刺活检所得Gleason评分与前列腺癌根治术标本Gleason评分的相关性,采用ROC曲线分析确定癌灶ADC值和穿刺活检所得Gleason评分区分前列腺低级别癌和中高级别癌的效能.结果前列腺穿刺活检评估前列腺癌根治术标本Gleason评分的准确率为41.2％ (21/51),11.8％ (6/51)患者Gleason评分被高估,47.0％ (24/51)患者GS被低估.51例患者前列腺癌灶的ADC值平均为(0.974±0.194)×10-3 mm2/s,35例中高级别前列腺癌平均ADC值为(0.907±0.160)×10-3 mm2/s,16例低级别前列腺癌平均ADC值为(1.121±0.185)×10-3 mm2/s.前列腺癌灶ADC值与前列腺癌根治术标本Gleason评分存在负相关性(r=-0.761,P＜0.01),而穿刺活检所得Gleason评分与前列腺癌根治术标本Gleason评分不存在相关性(r=0.187,P=0.189).ADC值和穿刺活检所得Gleason 评分区分前列腺低级别癌和中高级别癌的ROC曲线下面积分别为0.827和0.689.结论前列腺癌灶的ADC值预测前列腺癌侵袭性优于穿刺活检所得Gleason评分.
목적 비교DWI ADC치화경직장초성인도천자소득Gleason평분평고전렬선암침습성적작용.방법 회고성분석51례경천자활검학진위전렬선암,우1.5 TMR소묘의상행전렬선DWI검사,병진행료전렬선암근치술적환자자료.이전렬선암근치술표본위삼고,측량전렬선암조적ADC치,채용Pearson상관분석검험암조ADC치여전렬선암근치술표본Gleason평분적상관성,이급천자활검소득Gleason평분여전렬선암근치술표본Gleason평분적상관성,채용ROC곡선분석학정암조ADC치화천자활검소득Gleason평분구분전렬선저급별암화중고급별암적효능.결과 전렬선천자활검평고전렬선암근치술표본Gleason평분적준학솔위41.2％ (21/51),11.8％ (6/51)환자Gleason평분피고고,47.0％ (24/51)환자GS피저고.51례환자전렬선암조적ADC치평균위(0.974±0.194)×10-3 mm2/s,35례중고급별전렬선암평균ADC치위(0.907±0.160)×10-3 mm2/s,16례저급별전렬선암평균ADC치위(1.121±0.185)×10-3 mm2/s.전렬선암조ADC치여전렬선암근치술표본Gleason평분존재부상관성(r=-0.761,P＜0.01),이천자활검소득Gleason평분여전렬선암근치술표본Gleason평분불존재상관성(r=0.187,P=0.189).ADC치화천자활검소득Gleason 평분구분전렬선저급별암화중고급별암적ROC곡선하면적분별위0.827화0.689.결론 전렬선암조적ADC치예측전렬선암침습성우우천자활검소득Gleason평분.
Objective To retrospectively evaluate the utility of apparent diffusion coefficient (ADC) values in predicting aggressiveness of prostate cancer.Comparison was made with transrectal ultrasound-guided biopsy Gleason scores (GS) and prostatectomy GS.Methods Diffusion weighted images of 51 patients with biopsy-proven prostate cancer were obtained using 1.5 T MR with a pelvic phased-array coil.Regions of interest (ROIs) were drawn on areas of the suspicious lesion and the ADC values were calculated.The correlations between the ADC values and prostatectomy GS were assessed with Pearson correlation.The relationship between biopsy GS and prostatectomy GS were also evaluated.Meanwhile,receiver operating characteristic (ROC) curves were used to determine the ability of ADC values and biopsy GS in differentiating low-grade prostate cancer from intermediate/high grade prostate cancer.Results The accuracy of transrectal ultrasound-guided biopsy in predicting prostatectomy GS was 41.2％(21/51).Compared with prostatectomy GS,up to 11.8％ of the patients (n =6) was overestimated by biopsy,while 47.0％ (n =24) were underestimated.These 51 patients had a mean ADC value of (0.974 ±0.194) × 10-3 mm2/s.The mean ADC value of intermediate/high-grade tumors (n =35) was (0.907 ±0.160) ×10-3 mm2/s while that of low-grade tumors was (1.121 ±0.185) × 10-3 mm2/s (n =16).A significant negative correlation was found between mean ADC values of suspicious lesions and their prostatectomy GS (r =-0.761,P ＜ 0.01).No significant correlation was found between biopsy GS and prostatectomy GS (r =0.187,P =0.189).The area under the ROC curves of ADC and biopsy GS was 0.827 and 0.689,respectively.Conclusion The ADC values of cancerous areas in prostate perform better than biopsy GS in predicting aggressiveness of prostate cancer.