MR 动态增强、扩散成像和波谱分析在前列腺癌诊断中的价值

MR 动态增强、扩散成像和波谱分析在
前列腺癌诊断中的价值
史浩 武乐斌 丁红宇 赵斌 王涛 杨贞振 邱秀玲 李慧华 曲蕾 魏煜龙
【摘要】 目的 探讨MR 动态增强扫描( DCE-MRI) 、扩散加权成像( DWI) 和三维氢质子MR 波
谱分析( 3D 1H-MRS) 在前列腺癌诊断中的价值。方法 经穿刺活检、手术病理或随访证实的32 例前
列腺癌及64 例前列腺增生患者, 以及29 例健康志愿者经MR 常规扫描、DCE-MRI、DWI 和MRS 扫
描, 分别测量前列腺癌、前列腺增生病灶和正常前列腺中央腺区和正常周围带强化后的相对信号强度
值、DWI 信号强度值和表观扩散系数( ADC) 值, 以及胆碱/ 枸橼酸盐( Cho/Cit) 和[ Cho + 肌酸( Cr) ] /
Cit 比值, 并经方差分析比较不同组织和病灶间差异。结果 经DCE-MRI 检查, 22 例前列腺癌患者中
18 例病灶区呈早期明显强化, 并快速下降; 40 例前列腺增生患者中38 例呈早期明显强化并逐渐上升
至中晚期达峰值后缓慢下降, 除0 及120 s 两时间段前列腺癌与前列腺增生组织两者之间差异无统
计学意义( P > 0. 05) 外, 正常周围带、增生与癌三者的相对信号强度在其余每个时段均差异有统计学
意义( P < 0. 05 ) 。经DWI 检查前列腺癌患者26 例于ADC 图上病灶呈明显低信号, ADC 值为
( 104. 23 ±26. 15)× 10 - 5 mm2 / s, 43 例前列腺增生患者病灶区平均ADC 值为( 175. 21 ±64. 86 ) ×
10 - 5mm2 / s, 除正常前列腺周围带与前列腺增生之间ADC 值差异无统计学意义( P > 0. 05 ) 外, 前列腺
癌、前列腺增生和正常前列腺中央腺区之间差异均有统计学意义( P < 0. 05 ) 。MRS 检查前列腺癌
17 例, 其病灶区Cho/Cit 比值为2. 26 ±0. 91, ( Cho + Cr) /Cit 比值为2. 85 ±1. 01, 35 例前列腺增生患
者病灶区平均Cho/Cit 比值为0. 46 ±0. 23, ( Cho + Cr) /Cit 比值为0. 57 ±0. 20。除正常前列腺周围带
与正常前列腺中央腺区之间差异无统计学意义( P > 0. 05) 外, 前列腺癌、前列腺增生和正常前列腺组
织其余各组间差异均有统计学意义( P < 0. 05) 。DCE-MRI、DWI 和MRS 3 种检查方法在前列腺癌诊
断敏感度、特异度和准确度均达70% 以上, 而通过3 种检查方法的联合应用, 其敏感度、特异度和准确
度分别达87. 50% 、94. 74%、92. 59% 。结论 DCE-MRI、DWI 和MRS 3 种检查方法在前列腺癌诊断中具
有特征性表现, 而3 种检查方法的联合应用又将极大地提高MRI 诊断前列腺癌的正确诊断率。
【关键词】 磁共振成像; 前列腺肿瘤; 前列腺增生
Pr ostate cancer : diagnost ic value of dynamic cont rast -enhanced MRI, diffusion weighted imaging
a nd 3D 1H-MR spectr oscopy SHI Hao, WU Le-bin, DING Hong-yu, ZHAO Bin, WANG Tao, YANG
Zhen-zhen, QIU Xiu-ling, LI Hui-hua , QU Lei, WEI Yu-long. Department of MR Sha ndong Medical Imaging
Research Institute, Jinan 250021, China
【Abstra ct 】 Objective To explore the applying value of the diagnosis of dynamic contrast-enhanced
MRI ( DCE-MRI) , diffusion weighted imaging ( DWI) and 3D 1 H-MR spectroscopy ( MRS) in prostate
cancer ( PC) . Methods Thirty-two cases with PC and 64 cases with benign prostatic hyperplasia ( BPH)
which were confirmed with biopsy-proven, operation and follow-up, and 29 healthy volunteers underwent the
examinations of DCE-MRI, DWI and MRS. The signal intensity, ADC value, and Cho /Cit ratio and ( Cho +
Cr) /Cit ratio were measured respectively on the lesions of PC and BPH, normal prostatic peripheral zone
( PZ) and normal prostatic central gland ( CG) of DCE-MRI, DWI and MRS. The results were statistically
treated with ANOVA. Result s The lesions showed obvious enhancement in the early phase of DCE-MRI and
washed out in late phase in 18 of 22 cases with PC, who underwent the examination of DCE-MRI. The
enhancement was obvious in early and strengthened gradually, and then went to decrease in late phase after
peak value on the lesions in 38 of 40 cases with BPH. The signal intensities from different time and different
lesions and tissues were treated statistically and the results showed that there were significant differences
( P < 0. 05) between PZ, PC and BPH in different time except 0 s and 120 s between PC and BPH ( P >
0. 05) . The lesions were shown lower signal intensity on ADC map in 26 cases with PC, who were examined
·678· 中华放射学杂志2006 年7 月第40 卷第7 期 Chin J Radiol, July 2006, Vol 40, No. 7
with DWI and the average ADC value was ( 104. 23 ±26. 15)× 10 - 5 mm2 / s. The average ADC value of the
lesions of 43 cases with BPH was ( 175. 21 ±64. 86 ) × 10 - 5 mm2 /s. The statistical analysis showed that
there were significant differences between PC, BPH and CG except between PZ and BPH. Average Cho /Cit
ratio and average ( Cho + Cr) /Cit ratio of the lesions of PC were 2. 26 ±0. 91 and 2. 85 ±1. 01 respectively
in 17 cases with PC, who were performed with MRS. The average Cho /Cit ratio and average ( Cho + Cr) /Cit
ratio were 0. 46 ±0. 23 and 0. 57 ±0. 20 respectively in 35 cases with BPH. After the statistical analyzing,
the results presented that there were significant differences between PC, BPH and normal prostatic tissues
except between PZ and CG. The sensitivity, specificity and accuracy of DCE-MRI, DWI and MRS were all
more than 70% in displaying PC. Furthermore, the sensitivity, specificity and accuracy of DCE-MRI, DWI
and MRS had increased to 87. 50% , 94. 74% and 92. 59% respectively with the combining use of this three
examination methods. Conclusions DCE-MRI, DWI and MRS could present the specific findings in the
diagnosis of PC. The combining application of the three examination methods will further increase the
accurate diagnosis of PC.
【Key wor ds】 Magnetic resonance imaging; Prostatic neoplasms; Prostatic hyperplasia

MR 动态增强、扩散成像和波谱分析在--腹部.rar