CAJ | 학술논문

目的评价DWI在早期前列腺癌(PCa)诊断和鉴别诊断中的应用价值.方法回顾性分析经病理证实且同时行T2WI、DWI检查的106例前列腺疾病患者资料,其中早期前列腺癌(PCa)35例、良性前列腺增生(BPH) 55例、前列腺炎16例.对T2WI、DWI和T2WI+ DWI共3种方法所得的图像进行评分从而进行诊断,并与组织病理结果相对照.采用ROC曲线进行分析,并采用Z检验比较曲线下面积(Az),计算3种检查方法诊断前列腺癌的敏感度、特异度和准确度.测量不同前列腺疾病患者的ADC值,并采用方差分析进行比较.结果 35例早期PCa中DWI漏诊7例,55例BPH中2例DWI将其误诊为PCa,16例前列腺炎中11例DWI将其误诊为PCa.T2WI、DWI、T2WI+ DWI诊断早期PCa的Az值分别为0.846、0.874和0.947,T2WI和DWI的Az值分别与T2WI+ DWI比较,差异均有统计学意义(Z值分别为3.262和2.402,P值分别为0.001和0.016),T2 WI和DWI的Az值差异无统计学意义(Z =0.630,P=0.528).T2WI、DWI、T2WI+ DWI诊断早期PCa的敏感度分别为51.43％(18/35)、80.00％(28/35)和85.71％ (30/35),特异度分别为90.14％(64/71)、81.69％(58/71)和88.73％(63/71),准确度分别为77.36％(82/106)、81.13％(86/106)和87.74％(93/106).早期PCa、BPH和前列腺炎3组病灶的ADC值分别为(723±183)×10-3、(1 381±117)×10-3和(957±175)×10-3mm2/s,差异有统计学意义(F=131.94,P＜0.01),两两比较差异也均有统计学意义(P值均＜0.05).结论 DWI有助于早期PCa的检出,但同时也存在一定的漏诊和误诊,联合使用T2 WI和DWI可提高早期PCa诊断的敏感度和准确度.ADC值的定量测量有助于疾病的鉴别诊断.
목적 평개DWI재조기전렬선암(PCa)진단화감별진단중적응용개치.방법 회고성분석경병리증실차동시행T2WI、DWI검사적106례전렬선질병환자자료,기중조기전렬선암(PCa)35례、량성전렬선증생(BPH) 55례、전렬선염16례.대T2WI、DWI화T2WI+ DWI공3충방법소득적도상진행평분종이진행진단,병여조직병리결과상대조.채용ROC곡선진행분석,병채용Z검험비교곡선하면적(Az),계산3충검사방법진단전렬선암적민감도、특이도화준학도.측량불동전렬선질병환자적ADC치,병채용방차분석진행비교.결과 35례조기PCa중DWI루진7례,55례BPH중2례DWI장기오진위PCa,16례전렬선염중11례DWI장기오진위PCa.T2WI、DWI、T2WI+ DWI진단조기PCa적Az치분별위0.846、0.874화0.947,T2WI화DWI적Az치분별여T2WI+ DWI비교,차이균유통계학의의(Z치분별위3.262화2.402,P치분별위0.001화0.016),T2 WI화DWI적Az치차이무통계학의의(Z =0.630,P=0.528).T2WI、DWI、T2WI+ DWI진단조기PCa적민감도분별위51.43％(18/35)、80.00％(28/35)화85.71％ (30/35),특이도분별위90.14％(64/71)、81.69％(58/71)화88.73％(63/71),준학도분별위77.36％(82/106)、81.13％(86/106)화87.74％(93/106).조기PCa、BPH화전렬선염3조병조적ADC치분별위(723±183)×10-3、(1 381±117)×10-3화(957±175)×10-3mm2/s,차이유통계학의의(F=131.94,P＜0.01),량량비교차이야균유통계학의의(P치균＜0.05).결론 DWI유조우조기PCa적검출,단동시야존재일정적루진화오진,연합사용T2 WI화DWI가제고조기PCa진단적민감도화준학도.ADC치적정량측량유조우질병적감별진단.
Objective To evaluate the value of diffusion weighted imaging (DWI) in the diagnosis and differential diagnosis of early prostate cancer.Methods The data of 106 patients [35 with early prostate cancer (PCa),55 with benign prostatic hyperplasia (BPH) and 16 with prostatitis] were retrospectively analyzed,who underwent T2WI,DWI,and T2WI + DWI examination and all patients were confirmed by pathology.The data obtained from T2WI,DWI,and a combination of T2WI and DWI were scored and compared with pathological findings.The receiver operating characteristic (ROC) curves were analyzed for the area under the curve (Az) using Z test.Specificities,sensitivities and accuracies of the three protocols to diagnose PCa were evaluated.The ADC values of each prostate lesion were measured and compared with ANOVA test.Results DWI missed 7 in 35 early prostate cancer,misdiagnosed 2 in 55 BPH,and 11 in 16 prostatitis.The Az values of T2WI,DWI,and T2 WI + DWI for the detection of early prostate cancer were 0.846,0.874,and 0.947,respectively.There was significant differences between T2WI + DWI and T2WI alone (Z =3.262,P =0.001),and between T2WI + DWI and DWI alone (Z =2.402,P =0.016).There was no significant difference between T2WI alone and DWI alone (Z =0.630,P =0.528).The sensitivities,specificities,and accuracies of T2WI,DWI,and a combination of T2WI and DWI for the detection of early prostate cancer were 51.43 ％ (18/35),80.00％ (28/35),and 85.71％ (30/35) ;90.14％ (64/71),81.69％ (58/71),and 88.73％ (63/71) ;77.36％ (82/106),81.13％ (86/106),and 87.74％ (93/106) respectively.The ADC values for detecting early PCa,BPH,and prostatitis were (723 ± 183) ×10-3,(1 381 ± 117) × 10 3,and (957 ± 175) × 10-3 mm2/s.These ADC values showed statistical significance(F =131.94,P ＜ 0.01) among the three groups and also reached statistical significance between each two groups.Conclusions DWI is valuable in detecting early prostate cancer,but there are some misdiagnosis and false negatives.The combination of T2WI and DWI can improve the sensitivity and accuracy of early prostate cancer detection.The quantitative measurement of ADC value can differentiate early prostate cancer from benign prostatic hyperplasia and prostatitis.