摘要： 目的 探讨磁共振成像（MRI）多b值弥散加权成像（DWI）及表观弥散系数（ADC）联合血清前列腺特异性抗原（PSA）相关参数对PSA灰区的移行区前列腺癌（TZ-PCa）的诊断效能。方法 回顾性分析2018年1月至2019年10月我院诊治的血清总PSA （tPSA） 4~10 ng/mL、采用前列腺常规MRI及多b值DWI检查的80例前列腺疾病患者的临床资料。其中37例为TZ-PCa （TZ-PCa组），43例为移行区良性前列腺增生（TZ-BPH组）。检测tPSA、游离PSA （fPSA），计算fPSA/tPSA、前列腺特异性抗原密度（PSAD）。采用受试者操作特征（ROC）曲线分析标准化ADC （ADCstand）、快速ADC （ADCfast）、慢速ADC （ADCslow）及快速扩散所占比例（ffast）在前列腺良恶性病变中的水平变化，并建立4种模型分析MRI多b值DWI及血清PSA相关参数对TZ-PCa的诊断效能。4种模型包括：ffast+PSAD （A）、ffast+fPSA/tPSA （B）、ADCslow+PSAD （C）、ADCslow+fPSA/tPSA （D）。对4种模型进行logistic多因素回归分析，建立回归预测模型。利用4种模型ROC曲线的曲线下面积（AUC）来评价诊断效能。结果 TZ-PCa组ADCstand、ADCfast、ADCslow、ffast均显著低于TZ-BPH组（均P < 0.01）。MRI多b值DWI各参数诊断TZ-PCa的AUC中ffast最高，为0.858，且特异度最高；其次是ADCslow，AUC为0.821，且灵敏度最高。与TZ-BPH组比较，TZ-PCa组PSAD显著增高，fPSA/tPSA显著降低（均P < 0.01）。A模型的AUC为0.927，对TZ-PCa的诊断效能最高。结论 ffast联合PSAD对PSA灰区TZ-PCa的诊断效能最高，对PSA灰区TZ-PCa和TZ-BPH的鉴别诊断具有较大价值。

MRI多b值DWI联合血清PSA相关参数对PSA灰区移行区前列腺癌的诊断效能

刘娜, 王聪, 李玉泽, 卑贵光

北部战区总医院放射诊断科, 沈阳 110812

收稿日期:2022-05-12出版日期:2023-08-30发布日期:2023-08-07
通讯作者:卑贵光E-mail:2023477349@qq.com
作者简介:刘娜(1987-),女,主治医师,硕士.
基金资助:辽宁省自然科学基金（20170540916）


关键词: 移行区前列腺癌, 磁共振弥散加权成像, 表观弥散系数, 诊断效能, 前列腺特异性抗原
Abstract: Objective To investigate the diagnostic efficacy of magnetic resonance imaging (MRI) multi-b-value diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) combined with serum prostate-specific antigen (PSA) -related parameters for prostate cancer in the gray zone of the PSA transition zone (TZ-PCa). Methods A retrospective analysis was conducted on the clinical data obtained from 80 patients diagnosed and treated for prostate cancer at our hospital between January 2018 and October 2019. The study included patients with a serum total PSA (tPSA) level of 4-10 ng/mL who underwent conventional prostate MRI and multi-b value DWI. They were divided into two groups:37 patients diagnosed with TZ-PCa (TZ-PCa group),and 43 patients diagnosed with benign prostatic hyperplasia (TZ-BPH group). Serum tPSA and free PSA (fPSA) were measured,and fPSA/tPSA and PSA density (PSAD) were calculated. The receiver operating characteristic (ROC) curve was used to analyze standardized ADC (ADCstand),fast ADC (ADCfast),slow ADC (ADCslow),and fraction of ADC fast (ffast) in benign and malignant prostate lesions. Four diagnostic models were established to analyze the efficacy of MRI multi-B value DWI and serum PSA related parameters for TZ-PCa. The model includes four modes:ffast+PSAD (A),ffast+fPSA/tPSA (B),ADCslow+PSAD (C),ADCslow+fPSA/tPSA (D). Logistic multivariate regression analysis was performed and regression prediction models were established. The diagnostic efficiency of the four models were evaluated by calculating the area under the curve (AUC) of the ROC curve. Results The ADCstand,ADCfast,ADCslow and ffast in the TZ-PCa group were significantly lower than those in the TZ-BPH group (all P < 0.01). The highest ffast value (0.858) yielded the highest specificity in diagnosing TZ-PCa using MRI multi-b-value DWI parameters. The highest sensitivity was observed with ADCslow (AUC=0.821). PSAD values were significantly increased,and fPSA/tPSA were significantly decreased (all P < 0.01) in the TZ-PCa group than those in the TZ-BPH group. The AUC of model A was 0.927,which demonstrated the highest diagnostic efficiency for TZ-PCa. Conclusion The combination of ffast and PSAD demonstrated the highest diagnostic efficiency for TZ-PCa in the PSA gray zone and exhibited a significant value in the differential diagnosis of TZ-PCa and TZ-BPH in this zone.
Key words: transitional zone prostate cancer, magnetic resonance diffusion-weighted imaging, apparent dispersion coefficient, diagnostic effectiveness, prostate-specific antigen
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