MR 動態增強、擴散成像和波譜分析在
前列腺癌診斷中的價值
史浩 武樂斌 丁紅宇 趙斌 王濤 楊貞振 邱秀玲 李慧華 曲蕾 魏煜龍
【摘要】 目的 探討MR 動態增強掃描( DCE-MRI) 、擴散加權成像( DWI) 和三維氫質子MR 波
譜分析( 3D 1H-MRS) 在前列腺癌診斷中的價值。方法 經穿刺活檢、手術病理或隨訪證實的32 例前
列腺癌及64 例前列腺增生患者, 以及29 例健康志愿者經MR 常規掃描、DCE-MRI、DWI 和MRS 掃
描, 分別測量前列腺癌、前列腺增生病灶和正常前列腺中央腺區和正常周圍帶強化后的相對信號強度
值、DWI 信號強度值和表觀擴散系數( ADC) 值, 以及膽堿/ 枸櫞酸鹽( Cho/Cit) 和[ Cho + 肌酸( Cr) ] /
Cit 比值, 并經方差分析比較不同組織和病灶間差異。結果 經DCE-MRI 檢查, 22 例前列腺癌患者中
18 例病灶區呈早期明顯強化, 并快速下降; 40 例前列腺增生患者中38 例呈早期明顯強化并逐漸上升
至中晚期達峰值后緩慢下降, 除0 及120 s 兩時間段前列腺癌與前列腺增生組織兩者之間差異無統
計學意義( P > 0. 05) 外, 正常周圍帶、增生與癌三者的相對信號強度在其余每個時段均差異有統計學
意義( P < 0. 05 ) 。經DWI 檢查前列腺癌患者26 例于ADC 圖上病灶呈明顯低信號, ADC 值為
( 104. 23 ±26. 15)× 10 - 5 mm2 / s, 43 例前列腺增生患者病灶區平均ADC 值為( 175. 21 ±64. 86 ) ×
10 - 5mm2 / s, 除正常前列腺周圍帶與前列腺增生之間ADC 值差異無統計學意義( P > 0. 05 ) 外, 前列腺
癌、前列腺增生和正常前列腺中央腺區之間差異均有統計學意義( P < 0. 05 ) 。MRS 檢查前列腺癌
17 例, 其病灶區Cho/Cit 比值為2. 26 ±0. 91, ( Cho + Cr) /Cit 比值為2. 85 ±1. 01, 35 例前列腺增生患
者病灶區平均Cho/Cit 比值為0. 46 ±0. 23, ( Cho + Cr) /Cit 比值為0. 57 ±0. 20。除正常前列腺周圍帶
與正常前列腺中央腺區之間差異無統計學意義( P > 0. 05) 外, 前列腺癌、前列腺增生和正常前列腺組
織其余各組間差異均有統計學意義( P < 0. 05) 。DCE-MRI、DWI 和MRS 3 種檢查方法在前列腺癌診
斷敏感度、特異度和準確度均達70% 以上, 而通過3 種檢查方法的聯合應用, 其敏感度、特異度和準確
度分別達87. 50% 、94. 74%、92. 59% 。結論 DCE-MRI、DWI 和MRS 3 種檢查方法在前列腺癌診斷中具
有特征性表現, 而3 種檢查方法的聯合應用又將極大地提高MRI 診斷前列腺癌的正確診斷率。
【關鍵詞】 磁共振成像; 前列腺腫瘤; 前列腺增生
Pr ostate cancer : diagnost ic value of dynamic cont rast -enhanced MRI, diffusion weighted imaging
a nd 3D 1H-MR spectr oscopy SHI Hao, WU Le-bin, DING Hong-yu, ZHAO Bin, WANG Tao, YANG
Zhen-zhen, QIU Xiu-ling, LI Hui-hua , QU Lei, WEI Yu-long. Department of MR Sha ndong Medical Imaging
Research Institute, Jinan 250021, China
【Abstra ct 】 Objective To explore the applying value of the diagnosis of dynamic contrast-enhanced
MRI ( DCE-MRI) , diffusion weighted imaging ( DWI) and 3D 1 H-MR spectroscopy ( MRS) in prostate
cancer ( PC) . Methods Thirty-two cases with PC and 64 cases with benign prostatic hyperplasia ( BPH)
which were confirmed with biopsy-proven, operation and follow-up, and 29 healthy volunteers underwent the
examinations of DCE-MRI, DWI and MRS. The signal intensity, ADC value, and Cho /Cit ratio and ( Cho +
Cr) /Cit ratio were measured respectively on the lesions of PC and BPH, normal prostatic peripheral zone
( PZ) and normal prostatic central gland ( CG) of DCE-MRI, DWI and MRS. The results were statistically
treated with ANOVA. Result s The lesions showed obvious enhancement in the early phase of DCE-MRI and
washed out in late phase in 18 of 22 cases with PC, who underwent the examination of DCE-MRI. The
enhancement was obvious in early and strengthened gradually, and then went to decrease in late phase after
peak value on the lesions in 38 of 40 cases with BPH. The signal intensities from different time and different
lesions and tissues were treated statistically and the results showed that there were significant differences
( P < 0. 05) between PZ, PC and BPH in different time except 0 s and 120 s between PC and BPH ( P >
0. 05) . The lesions were shown lower signal intensity on ADC map in 26 cases with PC, who were examined
·678· 中華放射學雜志2006 年7 月第40 卷第7 期 Chin J Radiol, July 2006, Vol 40, No. 7
with DWI and the average ADC value was ( 104. 23 ±26. 15)× 10 - 5 mm2 / s. The average ADC value of the
lesions of 43 cases with BPH was ( 175. 21 ±64. 86 ) × 10 - 5 mm2 /s. The statistical analysis showed that
there were significant differences between PC, BPH and CG except between PZ and BPH. Average Cho /Cit
ratio and average ( Cho + Cr) /Cit ratio of the lesions of PC were 2. 26 ±0. 91 and 2. 85 ±1. 01 respectively
in 17 cases with PC, who were performed with MRS. The average Cho /Cit ratio and average ( Cho + Cr) /Cit
ratio were 0. 46 ±0. 23 and 0. 57 ±0. 20 respectively in 35 cases with BPH. After the statistical analyzing,
the results presented that there were significant differences between PC, BPH and normal prostatic tissues
except between PZ and CG. The sensitivity, specificity and accuracy of DCE-MRI, DWI and MRS were all
more than 70% in displaying PC. Furthermore, the sensitivity, specificity and accuracy of DCE-MRI, DWI
and MRS had increased to 87. 50% , 94. 74% and 92. 59% respectively with the combining use of this three
examination methods. Conclusions DCE-MRI, DWI and MRS could present the specific findings in the
diagnosis of PC. The combining application of the three examination methods will further increase the
accurate diagnosis of PC.
【Key wor ds】 Magnetic resonance imaging; Prostatic neoplasms; Prostatic hyperplasia

MR 動態增強、擴散成像和波譜分析在--腹部.rar