论文部分内容阅读
目的回顾性评价多参数[包括T2加权、扩散加权(DW)和动态对比增强(DCE)MR技术]直肠内MR成像诊断精囊腺受侵(SVI)的能力,并确定DWMR和DCEMR影像的增量值。材料与方法本研究经机构审查委员会批准,符合HIPAA标准,并免除知情同意书。本研究纳入2007年1月—2010年4月131例病人(年龄43～75岁,平均68岁)。所有病人均在接受根治性前列腺切除术前行直肠内MR成像。2名放射科医生(A,经验丰富;B,经验稍欠缺)观察3种影像组合:单一T2加权、T2加权联合DWMR影像和T2加权、DWMR联合DCEMR影像,进行五点顺序量表评估SVI可能性。计算敏感度、特异度、阳性预测值、阴性预测值和受试者操作特征曲线下面积(AUC)。通过bootstrapping估计置信区间,并通过McNemar检验和Fisher精确检验比较计算敏感度、特异度、阳性预测值、阴性预测值。结果手术结果证实131例病人中的23例(17.6%)存在SVI。单一回顾T2加权MR影像,特异度(放射科医生A和B分别为93.1%和93.6%)和阴性预测值(94.8%和94.0%)高,但敏感度(59%和52%)和阳性预测值(52%和50%)中等。联合回顾T2加权和DWMR影像,特异度[96.6%(P=0.02)和98.3%(P=0.003)]和阳性预测值[70%(P<0.05)和79%(P<0.05)]显著提高,但AUC未显著提高。附加回顾DCEMR影像未能获得更进一步的增量提升。结论与单一回顾T2加权影像相比,附加回顾DWMR影像可提高检测SVI的特异性和阳性预测值。然而再附加回顾DCEMR影像并不能提高诊断SVI增量值。
Objective To retrospectively evaluate the ability of multi-parametric [including T2-weighted, diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) MR techniques) for the diagnosis of seminal vesicle invasion (SVI) by intrarectal MR imaging and to determine the increase in DWMR and DCEMR images value. Materials and Methods The study was approved by the Institutional Review Board and conformed to the HIPAA standard and was exempt from informed consent. The study included 131 patients (aged 43-75 years, mean age 68 years) from January 2007 to April 2010. All patients underwent endorectal MR imaging prior to radical prostatectomy. Two radiologists (A, experienced; B, lack of experience) observed three imaging combinations: single T2 weighted, T2 weighted combined with DWMR images and T2 weighted, DWMR combined DCEMR images, five-point order scale assessment SVI may Sex. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. The confidence interval was estimated by bootstrapping and the sensitivity, specificity, positive predictive value and negative predictive value were compared by McNemar test and Fisher exact test. Results Surgical results confirmed the presence of SVI in 23 of 131 patients (17.6%). A single review of T2-weighted MR images showed high specificity (93.1% and 93.6% for radiologist A and B, respectively) and high (94.8% and 94.0%) negative predictive values for sensitivity (59% and 52% Values (52% and 50%) are medium. In the T2-weighted and DWMR images, the specificity of [96.6% (P = 0.02) and 98.3% (P = 0.003)] and the positive predictive value of 70% (P <0.05) and 79% (P <0.05) , But AUC did not increase significantly. Additional Review DCEMR images failed to achieve further incremental improvements. Conclusions Compared with a single review of T2-weighted images, the additional review of DWMR images may improve the specificity and positive predictive value of SVI detection. However, an additional review of DCEMR images does not improve the diagnostic SVI delta value.