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目的比较扩散加权成像(DWI)单指数模型ADCtotal及双指数模型ADCslow、ADCfast、f值在中央叶前列腺癌、腺体型前列腺增生、基质型前列腺增生诊断及鉴别诊断中的应用价值。方法回顾性分析经磁共振超声融合靶向穿刺证实的中央叶前列腺癌患者23例、腺体型前列腺增生患者19例、基质型前列腺增生患者24例的临床资料。所有病例均于穿刺前行包括T2WI、T1WI及多b值DWI在内的MRI检查。DWI的b值设置为0、50、100、150、200、500、800、1 000、1 500和2 000s/mm2。根据病理结果将靶向穿刺区病灶同DWI图像进行匹配。分别测定各病理类型的ADCtotal、ADCslow、ADCfast、f值。采用Kruskal-Wallis检验进行差异性比较,受试者工作特征(ROC)曲线分析各参数诊断及鉴别诊断中央叶前列腺癌、腺体型前列腺增生、基质型前列腺增生的诊断效能。结果中央叶前列腺癌、腺体型前列腺增生、基质型前列腺增生的ADCtotal值分别为(0.46±0.06)、(0.87±0.19)、(0.68±0.09)×10-3 mm2/s,ADCslow分别(0.39±0.13)、(0.57±0.15)、(0.49±0.13)×10-3 mm2/s,ADCfast分别为(4.8±2.5)、(3.6±0.76)、(4.5±1.8)×10-3 mm2/s,f值分别为0.43±0.10、0.68±0.09、0.58±0.08。ADCtotal、ADCslow、f值在各组之间差异有统计学意义(P=0.000、0.001和0.000),ADCfast在各组间差异无统计学意义(P=0.489)。ADCtotal、ADCslow、f值在鉴别中央叶前列腺癌和腺体型前列腺增生时曲线下面积(AUC)分别为1、0.828、0.971,在鉴别中央叶前列腺癌和间质性前列腺增生时AUC分别为0.991、0.719、0.861,在鉴别中央叶腺体型前列腺增生和间质性前列腺增生时AUC分别为0.876、0.650、0.831。结论在b值位于0~2 000s/mm2时单指数模型的ADCtotal较双指数模型的ADCslow和f值在诊断及鉴别诊断中央叶前列腺癌、腺体型前列腺增生、基质型前列腺增生时具有更佳的诊断效能。
Objective To compare the diagnostic value of ADCtotal and ADCslow, ADCfast, f values of diffusion-weighted imaging (DWI) single exponential model in the diagnosis and differential diagnosis of central lobe prostate cancer, glandular hyperplasia, and benign prostatic hyperplasia. Methods The clinical data of 23 patients with central lobe prostate cancer confirmed by magnetic resonance ultrasound fusion and targeted puncture were retrospectively analyzed. The clinical data of 24 patients with benign prostatic hyperplasia and 19 patients with benign prostatic hyperplasia were retrospectively analyzed. All cases underwent MRI before the procedure including T2WI, T1WI and multiple b-value DWI. The b values for DWI are set to 0, 50, 100, 150, 200, 500, 800, 1000, 1500 and 2000s / mm2. According to the pathological results, the lesions in the targeted puncture area were matched with the DWI images. ADCtotal, ADCslow, ADCfast, f values were determined for each pathological type. The Kruskal-Wallis test was used to compare the differences, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each parameter in the diagnosis and differential diagnosis of central prostate cancer, glandular prostate hyperplasia and stromal prostatic hyperplasia. Results The ADCtotal values of prostate, glandular hyperplasia and stromal hyperplasia were (0.46 ± 0.06), (0.87 ± 0.19) and (0.68 ± 0.09) × 10-3 mm2 / s, respectively ± 0.13), (0.57 ± 0.15), (0.49 ± 0.13) × 10-3 mm2 / s, ADCfast were (4.8 ± 2.5), (3.6 ± 0.76), (4.5 ± 1.8) × 10-3 mm2 / s , f values were 0.43 ± 0.10,0.68 ± 0.09,0.58 ± 0.08. ADCtotal, ADCslow and f values were significantly different between the groups (P = 0.000, 0.001 and 0.000), and there was no significant difference in ADCfast among the groups (P = 0.489). ADCtotal, ADCslow, f values in the identification of central lobular prostate cancer and glandular prostate hyperplasia area under the curve (AUC) were 1,0.828,0.971, in the identification of central prostate cancer and interstitial prostatic hyperplasia AUC were 0.991 , 0.719,0.861, AUC of 0.876, 0.650, 0.831 respectively in distinguishing central leaf gland type benign prostatic hyperplasia and interstitial benign prostatic hyperplasia. Conclusions ADCtotal of single exponential model with b value of 0 ~ 2000s / mm2 is better than ADCslow and f value of double exponential model in the diagnosis and differential diagnosis of central lobe of prostate, glandular hyperplasia of prostate and benign prostatic hyperplasia. The diagnostic efficacy.