目的 探讨基于前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)V2.1版的动态对比增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量值对外周带前列腺癌(prostate cancer,PCa)和局灶性慢性前列腺炎(chronic prostatitis,CP)的鉴别价值.材料与方法 回顾性分析2022年1月至2023年4月期间芜湖市第二人民医院收治的57例外周带PCa患者(研究组)和21例局灶性CP患者(对照组),所有患者接受T2WI、扩散加权成像(diffusion weighted imaging,DWI)、DCE-MRI检查,比较两组双参数(bi-parameter,bp)-MRI(T2WI+DWI)、多参数(multi-parameter,mp)-MRI(T2WI+DWI+DCE-MRI)扫描方案的PI-RADS V2.1评分、DCE-MRI扫描定量值,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各诊断方案对外周带PCa的诊断价值.结果 研究组bp-MRI、mp-MRI扫描方案PI-RADS V2.1评分分别为(4.12±0.88)、(4.31±0.70)分,分别高于对照组的(2.42±1.14)、(2.52±1.22)分,P<0.05.研究组DCE-MRI定量值容积转运常数(volume transport constant,Ktrans)、速率常数(rate constant,Kep)均高于对照组(P<0.001),两组血管外细胞外间隙容积分数(extravascular extracellular volume fraction,Ve)比较差异无统计学意义(P>0.05).ROC分析显示,bp-MRI、mp-MRI、Ktrans、Kep诊断外周带PCa的ROC曲线下面积(area under the curve,AUC)[95％置信区间(confidence interval,CI)]分别为0.780(0.672～0.866)、0.857(0.759～0.926)、0.734(0.622～0.828)、0.818(0.716～0.896),mp-MRI诊断效能较bp-MRI稍高(P<0.05),其余各项比较差异无统计学意义(P>0.05).采用logit(p)法建立ROC拟合诊断模型,结果显示Kep+Ktrans、mp-MRI+Ktrans、mp-MRI+Kep对外周带PCa诊断效能差异均无统计学意义(P>0.05);Kep+Ktrans的诊断效能与bp-MRI、mp-MRI、Ktrans、Kep比较差异均无统计学意义(P>0.05);mp-MRI+Ktrans的诊断效能分别高于bp-MRI、mp-MRI、Kep、Ktrans(P<0.05);mp-MRI+Kep的诊断效能分别高于bp-MRI、Ktrans(P<0.05).结论 基于PI-RADS V2.1 mp-MRI、bp-MRI与DCE-MRI定量值Ktrans、Kep对外周带PCa与局灶性CP的鉴别诊断效能相当,且两定量参数联合,或分别与mp-MRI联合能有效提高诊断效能,能够为临床不同适应症患者的诊断提供更多选择.
Differentiation between peripheral zone prostate cancer and focal chronic prostatitis based on PI-RADS V2.1 assessment of quantitative DCE-MRI values
Objective:To investigate the differential value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative values based on the Prostate Imaging Reporting and Data System (PI-RADS) version V2.1 between peripheral zone prostate cancer (PCa) and focal chronic prostatitis (CP). Materials and Methods:We reviewed 57 patients with peripheral zone PCa (study group) and 21 patients with CP (control group) admitted to the Second Peoples Hospital of Wuhu between January 2022 and April 2023,and all patients underwent T2WI,diffusion weighted imaging (DWI),and DCE-MRI. The PI-RADS V2.1 scores,quantitative values of DCE-MRI scans,were compared between the two groups for the bi-parameter (bp)-MRI (T2WI+DWI) and multi-parameter (mp)-MRI (T2WI+DWI+DCE-MRI) scanning protocols. The diagnostic value of each diagnostic protocol for peripheral zone PCa was assessed using receiver operating characteristic (ROC) curves. Results:The PI-RADS V2.1 scores of the bp-MRI and mp-MRI scan protocols in the study group were (4.12±0.88) and (4.31±0.70),respectively,which were higher than those of the control group (2.42±1.14) and (2.52±1.22),respectively (P<0.05). The volume transport constant (Ktrans) and rate constant (Kep) of DCE-MRI quantitative values in the study group were higher than those in the control group (P<0.001). There was no statistical difference between the two groups in terms of extravascular extracellular volume fraction (Ve) (P>0.05). ROC analysis showed that the AUC (95％ CI) for bp-MRI,mp-MRI,Ktrans and Kep for the diagnosis of PCa in the peripheral zone were 0.780 (0.672-0.866),0.857 (0.759-0.926),0.734 (0.622-0.828) and 0.818 (0.716-0.896),respectively. The diagnostic efficacy of mp-MRI was slightly higher than that of bp-MRI (P<0.05),and the differences among the remaining items were not statistically significant (P>0.05). The ROC fitted diagnostic model using the logit(p) method showed no statistically significant differences in the diagnostic efficacy of Kep+Ktrans,mp-MRI+Ktrans and mp-MRI+Kep when compared to PCa in the peripheral zone (P>0.05). The diagnostic efficacy of Kep+Ktrans was not statistically significant when compared with bp-MRI,mp-MRI,Ktrans and Kep (P>0.05). The diagnostic efficacy of mp-MRI+Ktrans was higher than that of bp-MRI,mp-MRI,Kep and Ktrans,respectively (P<0.05). The diagnostic efficacy of mp-MRI+Kep was higher than that of bp-MRI and Ktrans,respectively (P<0.05). Conclusions:Based on PI-RADS V2.1 mp-MRI,bp-MRI and DCE-MRI quantitative values of Ktrans and Kep,the differential diagnostic efficacy of peripheral PCa and CP is comparable,and the combination of the two quantitative parameters,or respectively with mp-MRI,can effectively improve the diagnostic efficacy and can provide more options for the diagnosis of patients with different clinical indications.
peripheral zone prostate cancerfocal chronic prostatitisdynamic contrast-enhanced magnetic resonance imagingmagnetic resonance imagingtransit constantrate constant
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