目的:探索表观弥散系数(apparent diffusion coefficient,ADC)在前列腺影像报告和数据系统(pros-tate imaging-reporting and data system,PI-RADS)3 分且前列腺特异性抗原(prostate specific antigen,PSA)灰区患者中对减少非必要前列腺穿刺活检的应用价值.方法:回顾性收集2019年1月-2023年12月在中国科学技术大学附属第一医院(安徽省立医院)泌尿外科接受经会阴前列腺穿刺活检患者的临床资料.对于PI-RADS 3分病灶ADC值的计算,由1位泌尿外科医生只选择病灶上最可疑的区域,即在ADC图像上最可疑区域依次绘制2个圆形感兴趣区(region of interest,ROI)(大小为10～20 mm-2),影像系统将自动计算ADC值,最终的ADC值取2次绘制的ROI所对应ADC值的平均值,记为ADCmin.采用Mann-Whitney U检验比较各临床变量在良、恶性组的组间差异,使用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area un-der curve,AUC)、灵敏度和特异度来评价各临床变量的诊断价值.结果:本研究共纳入121例患者,其中88例患者术后病理为良性、33例患者为前列腺癌(prostate cancer,PCa)(包括16例临床有意义前列腺癌患者).前列腺体积(prostate volume,PV)、前列腺特异性抗原密度(prostate specific antigen density,PSAD)和 ADCmin在组间比较时差异均有统计学意义.在诊断效能方面,ADCmin(AUC=0.810,95％CI:0.729～0.876)明显优于前列腺特异性抗原(PSA)(AUC=0.593,95％CI:0.446～0.630)、PV(AUC=0.691,95％CI:0.600～0.772)、PSAD(AUC=0.683,95％CI:0.592～0.765).当 ADCmin＜600 μm2/s 时,93.33％(14/15)的患者术后病理为 PCa;当 ADCmin＞750 μm2/s时,仅有13.33％(10/75)的患者术后病理为PCa.结论:对于PI-RADS 3分且PSA灰区患者而言,ADCmin在区分前列腺穿刺活检术后病理良恶性中有很好的应用价值,ADCmin越小,患者患PCa的风险就越大.
Application value of apparent diffusion coefficient in patients with PI-RADS score of 3 and PSA gray area
Objective:To explore the value of ADCmin in reducing unnecessary prostate biopsies in patients with PI-RADS score of 3 and PSA gray area.Methods:The clinical data of patients who underwent transperineal prostate biopsy in the Department of Urology of First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2019 to December 2023 were collected retrospectively.For the calculation of the ADC value of PI-RADS 3 lesions,one urologist only selects the most suspicious area on the lesion,that is,two circular regions of interest(ROI)(size of 10-20 mm-2)are drawn in turn on the most suspicious area on the ADC map,and the ima-ging system will automatically calculate the ADC value,and the final ADC value is taken as the average value of the ADC value corresponding to the ROI drawn twice,which is recorded as ADCmin.Mann-Whitney U test was used to compare the differences between benign and malignant groups.ROC curve,AUC,sensitivity and specificity were used to evaluate the diagnostic value of clinical variables.Results:A total of 121 patients were included in this study,including 88 patients with benign pathology,33 patients with prostate cancer and 16 patients with clinically significant prostate cancer.There were significant differences in PV,PSAD and ADCmin between groups.In terms of diagnostic efficacy,ADCmin(AUC=0.810,95％CI:0.729-0.876)was significantly better than PSA(AUC=0.593,95％CI:0.446-0.630),PV(AUC=0.691,95％CI:0.600-0.772)and PSAD(AUC=0.683,95％CI:0.592-0.765).When ADCmin was＜600μm2/s,14/15(93.33％)patients were diagnosed with prostate cancer.When ADCmin was＞750 μm2/s,only 10/75(13.33％)patients were diagnosed with prostate cancer.Conclusion:ADCmin has good application value in distinguishing benign and malignant pathology after prostate biopsy for patients with PI-RADS score of 3 and PSA gray area.The smal-ler the ADCmin,the greater the risk of prostate cancer.
prostate cancerprostate biopsyPI-RADS score 3apparent diffusion coefficientPSA gray zone
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