合成MRI对前列腺癌分级的诊断价值

Diagnostic Value of Synthetic MRI for Prostate Cancer Grade

摘要: 目的：研究合成MRI定量参数对前列腺癌(PCa)分级的诊断价值。方法：回顾性地分析了2020~2022年扬州大学附属医院112例经病理大切片诊断为前列腺癌(PCa)的患者。所有患者术前进行前列腺MRI检查，扫描序列包括DWI和合成MRI。根据ISUP (国际泌尿外科病理学会)分级将病灶分为低危组(ISUP ≤ 2)和高危组(ISUP ≥ 3)。对照大病理切片最大层面，在DWI和合成MRI上分别勾画ROI，得到并记录ADC值、T1值、T2值、PD值。采用独立样本t检验或Mann Whitney U检验分析比较两组数据之间的差异，并应用受试者工作特征(ROC)曲线评估不同参数对前列腺癌侵袭性的诊断效能，同时采用DeLonng检验比较曲线下的面积(AUC)，运用Spearman相关分析评估各定量参数与ISUP分级的相关性。结果：高危组PCa的T1值、T2值及ADC值均低于低危组[1144 (1040, 1308.75) ms比1223.5 (1124.0, 1402.0) ms；(70.91 ± 7.9) ms比(81.27 ± 8.6) ms；(519.59 ± 100.59) ms比(728.36 ± 120.13) ms]，(均P < 0.05)。在鉴别高危组与低危组前列腺癌上，T1、T2值的AUC均低于ADC值，两两之间差异均P值 < 0.05。另外T1值、T2值及ADC值与ISUP分级均呈负相关(r = −2.03、−0.521、−0.682，均P < 0.05)。结论：合成MRI定量参数可以区分高危PCa和低危PCa，并与ISUP分级呈负相关，有助于术前无创鉴别PCa的侵袭性。

Abstract: Objective: To investigate the diagnostic value of synthetic MRI quantitative parameters for prostate cancer (PCa) grading. Methods: A retrospective analysis was performed for 112 patients diagnosed with prostate cancer by pathological large sections in the Affiliated Hospital of Yangzhou University from 2020 to 2022. All patients had a preoperative MRI of the prostate with scan sequences in-cluding DWI and synthetic MRI. Lesions were classified according to the ISUP (International Society of Urological Pathology) classification into low-risk group (ISUP ≤ 2) and high-risk group (ISUP ≥ 3). According to the maximum level of large pathological sections, the ADC value, T1 value, T2 value, PD value, R1 value and R2 value can be obtained by delineating the ROI on DWI and synthetic MRI, and the ADC value, T1 value, T2 value and PD value can be recorded. Independent sample t-test or Mann Whitney U test analysis was used to compare the differences between the two groups of data, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of dif-ferent parameters on prostate cancer aggressiveness, and the area under the DeLonng test com-parison curve (AUC) was used to evaluate the correlation between each quantitative parameter and ISUP grade. Results: The T1 value, T2 value and ADC value of PCa in the high-risk group were lower than those in the low-risk group [1144 (1040, 1308.75) ms ratio was 1223.5 (1124.0, 1402.0) ms; (70.91 ± 7.9) MS ratio (81.27 ± 8.6) ms; (519.59 ± 100.59) ms ratio (728.36 ± 120.13) ms], (all P < 0.01). In the identification of prostate cancer in the high-risk group and the low-risk group, the AUC of T1 and T2 values was lower than that of ADC, and the difference between the two was < 0.05. In addition, T1 value, T2 value and ADC value were negatively correlated with ISUP classification (r = −2.03, −0.521, −0.682, all P < 0.05). Conclusion: The quantitative parameters of synthetic MRI can distinguish between high-risk PCa and low-risk PCa, and are negatively correlated with ISUP grade, which is helpful to identify the aggressiveness of PCa non-invasively before surgery.