背景:前列腺癌的早期诊断可改善其预后,虽然升级筛选工具是必不可少的。本研究旨在探索一种新的功能磁共振成像(MRI)技术的价值,即酰胺质子转移(APT)加权MRI,结合血清前列腺特异性抗原(PSA)水平来区分恶性前列腺病变和良性前列腺病变。
方法:对2019年7月至2022年3月在重庆大学肿瘤医院行前列腺检查的患者资料进行回顾性分析。所有患者均行T2加权成像(T2WI),APT,弥散加权成像(DWI),和动态对比增强(DCE)MRI。两名放射科医生独立分析了这些图像。通过使用受试者工作特征(ROC)曲线比较了单独或不同组合的定量参数在区分恶性前列腺病变与良性前列腺病变中的能力。根据德隆测试,组合参数与相应的单一参数差异有统计学意义(P<0.05)。
结果:最终纳入了79例患者,其中恶性组52例,良性组27例。对指标的单独评估表明,APTmax,APTmean,平均表观扩散系数(ADCmean),ADCmax,ADCmin,tPAD,游离前列腺特异性抗原(FPSA),FPSA/总前列腺特异性抗原(tPSA),PSA密度(PSAD)在两组间差异有统计学意义(P<0.05),而APTmin在两组间差异无统计学意义(P>0.05)。APTmax和APTmean具有较高的ROC曲线下面积值(AUC),分别为0.780和0.710。APTmax有很高的灵敏度,APTmean有很高的特异性。APTmax的组合,APTmean,ADCmean,和PSAD的AUC值最高(AUC:0.880,敏感性:86.540,特异性:78.260)。
结论:APTmax,APTmean,ADCmean,ADCmin,tPAD,FPSA,和PSAD在单独评估指标中显示出在区分恶性前列腺病变和良性前列腺病变方面具有很高的价值。APTmax的组合,APTmean,ADCmean,PSAD的诊断价值最高。
BACKGROUND: Early diagnosis of prostate cancer improves its prognosis, while it is essential to upgrade screening tools. This study aimed to explore the value of a novel functional magnetic resonance imaging (MRI) technique, namely amide proton transfer (APT)-weighted MRI, combined with serum prostate-specific antigen (PSA) levels to differentiate malignant prostate lesions from benign prostate lesions.
METHODS: Data of patients who underwent prostate examinations at Chongqing University Cancer Hospital between July 2019 and March 2022 were retrospectively analyzed. All patients underwent T2-weighted imaging (T2WI), APT, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) MRI. Two radiologists analyzed the images independently. The ability of the quantitative parameters alone or in different combinations in differentiating malignant prostate lesions from benign prostate lesions were compared by using receiver operating characteristic (ROC) curves. According to the DeLong test, the combined parameters were significantly different from the corresponding single parameter (P < 0.05).
RESULTS: A total of 79 patients were finally enrolled, including 52 patients in the malignant group and 27 patients in the benign group. The separate assessment of indexes revealed that APTmax, APTmean, mean apparent diffusion coefficient (ADCmean), ADCmax, ADCmin, tPAD, free prostate-specific antigen (FPSA), FPSA/total prostate-specific antigen (tPSA), and PSA density (PSAD) were significantly different between the two groups (P < 0.05), while APTmin was not significantly different between the two groups (P > 0.05). APTmax and APTmean had the high values of area under the ROC curve (AUC), which were 0.780 and 0.710, respectively. APTmax had a high sensitivity, and APTmean had a high specificity. The combination of APTmax, APTmean, ADCmean, and PSAD had the highest AUC value (AUC: 0.880, sensitivity: 86.540, specificity: 78.260).
CONCLUSIONS: APTmax, APTmean, ADCmean, ADCmin, tPAD, FPSA, and PSAD showed to have a high value in differentiating malignant prostate lesions from benign prostate lesions in the separate assessment of indexes. The combination of APTmax, APTmean, ADCmean, and PSAD had the highest diagnostic value.