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磁共振扩散加权成像鉴别诊断前列腺良恶性增生的效能及影像特点分析

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目的:探讨磁共振扩散加权成像(DWI)对前列腺良恶性增生的鉴别诊断效能和影像特点。方法:回顾性分析2021 年3 月至2023 年3 月于本院行前列腺常规MRI检查和DWI检查患者126例,分析前列腺良恶性增生患者DWI 影像特点,比较常规 MRI 检查、DWI 检查对前列腺良恶性增生诊断情况及诊断效能。以前列腺良、恶性病理检查结果为依据将患者分为恶性组、良性组,比较两组患者DWI的ADC值,受试者工作特征(ROC)曲线分析ADC值对前列腺恶性增生的诊断价值。结果:经前列腺组织病理确诊前列腺恶性病变(前列腺癌)89 例(70。63%),前列腺良性病变(前列腺炎性增生结节)37 例(29。37%)。当扩散敏感因子(b)值分别为0s/mm2、1000s/mm2、2000s/mm2 时,前列腺良性增生患者列腺中央腺体表现为等、稍高、高信号,ADC 图出现稍低信号;而前列腺恶性增生患者前列腺右侧中央腺体及移行区表现为稍低、高、亮信号,ADC 图出现明显低信号。常规 MRI 检出列腺恶性增生 104例、前列腺良性增生22 例,其中准确率为84。92%、阳性预测值为 83。65%、阴性预测值为 90。91%,灵敏度、特异度分别为 97。75%、54。05%,kappa 值为 0。588;DWI 检查前列腺恶性增生 94 例、前列腺良性增生32 例,其中准确率为91。27%、阳性预测值为91。49%、阴性预测值为 90。63%,灵敏度、特异度分别为96。63%、78。38%,kappa值为0。781。恶性组患者的ADC 值为(0。91±0。28)×10-3mm2/s,明显低于良性组患者的ADC值(1。59±0。33)×10-3mm2/s(t=11。769,P<0。001)。ADC值对前列腺恶性增生诊断的曲线下面积为0。895(95%CI:0。836~0。954),最佳临界值为1。20610-3mm2/s,灵敏度为86。52%,特异度为78。38%。结论:前列腺恶性增生组织DWI 信号强度较前列腺良性增生显著增强,但 ADC 图信号明显降低,DWI检查对前列腺恶性增生诊断与病理诊断的一致性较强,ADC值对前列腺恶性增生表现出良好的诊断价值。
Diagnostic Efficacy and Imaging Features of Magnetic Resonance Diffusion-Weighted Imaging in the Differential Diagnosis of Benign and Malignant Prostate Hyperplasia
Objective:To explore the efficiency and imaging characteristics of diffusion-weighted ima-ging(DWI)in the differential diagnosis of benign and malignant prostatic hyperplasia.Methods:A total of 126 patients undergoing routine MRI and DWI examinations in the hospital were retrospectively analyzed be-tween March 2021 and March 2023.DWI characteristics in patients with benign and malignant prostatic hyper-plasia were analyzed.The diagnosis results and diagnostic efficiency of routine MRI and DWI for benign and malignant prostatic hyperplasia were compared.According to results of pathological examination,patients were divided into malignant group and benign group,and ADC values of DWI were compared between the two groups.The diagnostic value of ADC for malignant prostatic hyperplasia was analyzed by receiver operating characteristic(ROC)curves.Results:According to pathological examination,there were 89 cases(70.63%)with malignant prostate lesions(prostate cancer)and 37 cases(29.37%)with benign prostate lesions(prostatitis hyperplasia nodules).When diffusion-sensitivity factor(b)was 0,1000 s/mm2 and 2000 s/mm2,there were equal,slightly high and high signals in central gland,and there were slightly low signals in ADC maps in patients with benign prostatic hyperplasia.In patients with malignant prostatic hyperplasia,there were slightly low,high and bright signals in right central gland and transitional area,and there were signifi-cantly low signals in ADC maps.Routine MRI showed that there were 104 cases with malignant prostatic hy-perplasia and 22 cases with benign prostatic hyperplasia,and its accuracy,positive predictive value,negative predictive value,sensitivity,specificity and kappa value were 84.92%,83.65%,90.91%,97.75%,54.05%and 0.588,respectively.DWI showed that there were 94 cases with malignant prostatic hyperplasia and 32 cases with benign prostatic hyperplasia,and its accuracy,positive predictive value,negative predictive val-ue,sensitivity,specificity and kappa value were 91.27%,91.49%,90.63%,96.63%,78.38%and 0.781,respectively.ADC value in malignant group was significantly lower than that in benign group[(0.91±0.28)×10-3 mm2/s vs(1.59±0.33)×10-3 mm2/s;t=11.769,P<0.001].The area under the curve,opti-mum critical value,sensitivity and specificity of ADC value in the diagnosis of malignant prostatic hyperplasia were 0.895(95%CI:0.836-0.954),1.20610-3 mm2/s,86.52%and 78.38%,respectively.Conclusion:Compared with benign prostatic hyperplasia,signals intensity of DWI is significantly increased,while signals in ADC maps are significantly decreased in malignant prostatic hyperplasia.The consistency between DWI and pathological examination is high in the diagnosis of malignant prostatic hyperplasia.ADC has good diagnostic value for malignant prostatic hyperplasia.

ProstateMalignant hyperplasiaBenign hyperplasiaMagnetic resonance diffusion-weighted imagingDifferential diagnosis efficiencyImaging characteristic

李迁、蒲敬泽、蒋华庭、宋建军

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四川省巴中市中心医院放射科, 四川 巴中 636000

前列腺 恶性增生 良性增生 磁共振扩散加权成像 鉴别诊断效能 影像特点

四川省医学会科研项目

Q15010

2024

河北医学
河北省医学会

河北医学

CSTPCD
影响因子:1.915
ISSN:1006-6233
年,卷(期):2024.30(3)
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