| 周 洁,邓 婕,樊 化,许艳蕾,孙美荣.多模态磁共振成像结合前列腺健康指数对前列腺癌Gleason分级的鉴别诊断价值[J].,2024,(8):1589-1593 |
| 多模态磁共振成像结合前列腺健康指数对前列腺癌Gleason分级的鉴别诊断价值 |
| Value of Multimodal Magnetic Resonance Imaging Combined with Prostate Health Index in the Differential Diagnosis of Gleason Grade of Prostate Cancer |
| 投稿时间：2023-11-06 修订日期：2023-11-30 |
| DOI：10.13241/j.cnki.pmb.2024.08.037 |
| 中文关键词: 前列腺癌 多模态磁共振成像 前列腺健康指数 Gleason分级 鉴别诊断 |
| 英文关键词: Prostatic cancer Multimodal magnetic resonance imaging Prostate health index Gleason grade Differential diagnosis |
| 基金项目:江苏省重点研发计划(社会发展)项目（BE2017772） |
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| 中文摘要: |
| 摘要 目的：探讨多模态磁共振成像（MRI）结合前列腺健康指数（PHI）对前列腺癌（PCa）Gleason分级的鉴别诊断价值。方法：选择2020年5月-2023年1月在我院经手术或穿刺活检证实为PCa的150例患者作为研究对象，根据患者病理结果并参照2019年国际泌尿病理学会（ISUP）PCa分级共识会议，将纳入研究病例分为低级别PCa组81例（Gleason 评分≤3+4）和高级别PCa组69例（Gleason 评分≥4+3）。另选取同时期内经病理学证实为前列腺良性增生的80例患者作为对照组。所有患者均完善多模态MRI、前列腺特异性抗原（PSA）等检查，并计算出前列腺健康指数（PHI）。采用Spearman秩相关分析多模态MRI参数和PHI水平与PCa患者Gleason分级的相关性。采用ROC曲线分析多模态MRI参数及PHI水平鉴别PCa患者Gleason分级的诊断效能。结果：对照组、低级别PCa组和高级别PCa组的ADC值和Tmax逐渐减小，而SImax和Rmax逐渐升高，差异均有统计学意义（P＜0.05）。对照组、低级别PCa组和高级别PCa组PHI水平逐渐升高，差异有统计学意义（P＜0.05）。多模态MRI参数ADC值和Tmax与PCa患者Gleason分级呈负相关（r＝0.536、0.540，均P＜0.001）；多模态MRI参数SImax和Rmax与PCa患者Gleason分级呈正相关（r＝0.495、0.507，均P＜0.001）。PHI水平与PCa患者Gleason分级呈正相关（r＝0.514，P＜0.001）。以PCa患者Gleason分级作为状态变量，将多模态MRI参数和PHI水平联合分别作为检验变量，进行ROC曲线分析；结果显示，多模态MRI参数（ADC值、Tmax、SImax、Rmax）和PHI水平联合鉴别低级别PCa组和高级别PCa组的AUC为0.875（95%CI：0.775-0.976，P＜0.001），敏感度和特异度分别为81.0%和83.7%，优于多模态MRI参数或PHI水平的单独应用。结论：多模态MRI参数联合PHI水平可作为区分低级别和高级别PCa的重要诊断依据，在术前Gleason分级的临床应用中具有一定参考价值。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the value of multimodal magnetic resonance imaging (MRI) combined with prostate health index (PHI) in the differential diagnosis of Gleason grade of prostate cancer (PCa). Methods: A total of 150 patients with PCa confirmed by surgery or biopsy in our hospital from May 2020 to January 2023 were selected as the research objects. According to the pathological results of the patients and referring to the 2019 International Society of Urology (ISUP) PCa grading consensus meeting, the included cases were divided into 81 cases of low-grade PCa group ( Gleason score≤3+4 ) and 69 cases of high-grade PCa group (Gleason score≥4+3). Another 80 patients with benign prostatic hyperplasia confirmed by pathology during the same period were selected as the control group. All patients underwent multimodal MRI, prostate specific antigen (PSA) and other examinations, and the prostate health index (PHI) was calculated. Spearman rank correlation was used to analyze the correlation between multimodal MRI parameters and PHI levels with Gleason grade in PCa patients. ROC curve was used to analyze the diagnostic efficacy of multimodal MRI parameters and PHI level in differentiating Gleason grade of PCa patients. Results: The ADC value and Tmax of the control group, the low-grade PCa group and the high-grade PCa group gradually decreased, while the SImax and Rmax gradually increased, and the differences were statistically significant (P<0.05). The PHI level of the control group, the low-grade PCa group and the high-grade PCa group gradually increased, and the difference was statistically significant (P<0.05). The ADC value and Tmax of multimodal MRI parameters were negatively correlated with Gleason grade in PCa patients (r=0.536, 0.540, all P<0.001). The multimodal MRI parameters SImax and Rmax were positively correlated with Gleason grade in PCa patients (r=0.495, 0.507, all P<0.001). PHI level was positively correlated with Gleason grade in PCa patients (r=0.514, P<0.001). The Gleason grade of PCa patients was used as the state variable, and the combination of multimodal MRI parameters and PHI level was used as the test variable to analyze the ROC curve. The results showed that the AUC of multimodal MRI parameters (ADC value, Tmax, SImax, Rmax) and PHI levels in the differential diagnosis of low-grade PCa group and high-grade PCa group was 0.875 (95%CI: 0.775-0.976, P<0.001).The sensitivity and specificity were 81.0% and 83.7%, respectively, which were better than the single application of multimodal MRI parameters or PHI levels. Conclusion: Multimodal MRI parameters combined with PHI level can be used as an important diagnostic basis for distinguishing low-grade and high-grade PCa, and has certain reference value in the clinical application of preoperative Gleason grading. |
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