|摘要||目的 以前列腺六分区法为基础,评价MRS对前列腺痛的诊断效能.方法 110例行MR前列腺检查的患者中前列腺癌54例,非前列腺癌56例,以经直肠穿刺活检病理结果作为金标准,计算前列腺MRS各体素内的(且H碱+肌酸)/枸橼酸盐(CC/C)的比值并采用秩和检验进行比较,计算六分区内阳性体素所占的比例(阳性体素比,PVR),采用ROC分析判断单个体素代谢物比值及分区内阳性体素比的诊断效能.结果 来源于癌区的体素1673个,非癌区体素2426个.癌区和非癌区体素的CC/C中位数分别为2.137和0.600,差异有统计学意义(Z-41.7,P<0.01).以单个体素CC/C比值0.911为临界点,诊断前列腺癌的敏感度为81.4%(1362/1673),特异度为83.1%(2018/2426),准确度为82.4%[(1362+2018)/4099].癌区和非癌区的PVR中位数分别为1和0,差异有统计学意义(Z=-11.7,P<0.01).以分区内PVR值0.519为临界点时,诊断前列腺癌的敏感度77.5%(148/191),特异度76.9%(247/321),准确度为77.1%[(148+247)/512].结论 通过确定单个体素CC/C比值及六分区内PVR的临界值,MRS有助于前列腺癌的量化诊断.
Objective To evaluate the diagnostic efficacy of MRS in prostate cancer based on sextant localization. Methods There were 110 patients, 54 patients with pathologically confirmed prostate cancer and 56 patients confirmed non-prostate cancer proved by ultrasound guided systemic biopsy. The (choline + creatine)/citrate (CC/C) value in each voxel and ratio of positive voxel (PVR) in sextant localization were measured. The ROC analysis was used to evaluate the diagnostic efficacy of CC/C in single voxel and PVR in sextant localization. Results There are 1673 and 2426 voxel in prostate cancer and non-prostate cancer respectively. The median of CC/C in cancer sextants was 2. 137; the median of CC/C in noncancer sextants was 0. 600. The difference of these two groups was statistically significant (Z = -41.7, P < 0. 01 ). The diagnostic sensitivity was 81.4% ( 1362/1673 ), the specificity was 83.1% (2018/2426), and the accuracy was 82.4% [ (1362+2018)/4099] for prostatic cancer with the cutoff point 0. 911 of the CC/C value. The median of PVR in cancer sextants and noncancer sextants were 1 and 0 respectively, the difference of PVR was statistically significant (Z = -11.7,P < 0.01 ). The diagnostic sensitivity was 77. 5% (148/191), the specificity was 76. 9% (247/321), and the accuracy was 77. 1% [ ( 148 + 247 )/ 512] for prostatic cancer with the cutoff point 0. 519 of the PVR. Conclusion Detecting the cutoff point of the CC/C value in single voxel and the PVR in sextant localization may be valuable in the diagnosis of prostate cancer.|