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目的:分析前列腺外周带的MRS特征,探讨MRS技术及其在外周带前列腺癌诊断中的价值。方法:24例临床及常规MRI检查拟诊局限性前列腺外周带前列腺癌患者均成功行前列腺MRS检查,所有患者均经病理证实为前列腺癌,其中19例行穿刺活检,5例经手术证实。回顾性分析患者的临床资料、病变部位、大小、常规MRI特征、MRS检查结果,计算(胆碱+肌酸)/枸橼酸盐(CC/C)。采用重复测量方差分析比较正常外周带与前列腺癌组织CC/C值差异。采用操作者工作特征曲线(ROC)分析CC/C值诊断前列腺癌的价值。结果:早期外周带前列腺癌T2WI表现为在外周带高信号内有局灶性低信号区。MRS示前列腺外周带肿瘤组织枸橼酸盐(Cit)峰明显下降,胆碱(Cho)峰升高,CC/C值为1.40±0.33,正常外周带为0.51±0.12,两者差异有统计学意义(F=95.189,P<0.001)。CC/C值的ROC曲线下面积为0.994,这一指标可用于判断前列腺癌(P=0.002);以0.85为阈值时,诊断前列腺癌的敏感度为95%,特异度为100%。结论:前列腺MRS检查能反映早期外周带前列腺癌的代谢变化,对常规MRI无法明确诊断的前列腺癌具有重要诊断价值。
Objective: To analyze the characteristics of MRS in the peripheral zone of prostate and to explore the value of MRS in the diagnosis of peripheral zone prostate cancer. Methods: Twenty-four cases of clinically and routinely diagnosed prostate cancer with peripheral prostate cancer were examined by MRS. All patients were pathologically confirmed as prostate cancer. Twenty-nine of them were biopsy and 5 were confirmed by surgery. The clinical data of the patients were retrospectively analyzed. The lesion location, size, MRI features and MRS results were calculated and calculated for choline + creatine / citrate (CC / C). Repeated measures analysis of variance was used to compare CC / C values between normal peripheral zone and prostate cancer. The value of CC / C in the diagnosis of prostate cancer was analyzed using the operator’s working characteristic curve (ROC). Results: T2WI in early stage of peripheral prostate cancer showed focal low signal area in peripheral zone with high signal. MRS showed that the citrate peak of the peripheral prostate tumor tissue was significantly decreased and the peak of choline (Cho) peak was increased. The CC / C value was 1.40 ± 0.33 and the normal peripheral zone was 0.51 ± 0.12, with statistical difference Significance (F = 95.189, P <0.001). The area under the ROC curve of CC / C value was 0.994, which could be used to judge the prostate cancer (P = 0.002). When the threshold value was 0.85, the sensitivity and specificity of the diagnosis of prostate cancer were 95% and 100% respectively. Conclusion: The MRS of prostate can reflect the metabolic changes of prostate cancer in early peripheral zone, and it is of great diagnostic value for prostate cancer which can not be diagnosed by conventional MRI.