3.0T体线圈~1H-MRS诊断前列腺癌和前列腺增生

目的:探讨3.0T体线圈磁共振波谱对前列腺癌和前列腺增生的诊断和鉴别诊断价值。方法:分析经手术或穿刺活检证实的23例前列腺癌和34例前列腺增生的MRI、MRS所见。所有病例均应用3.0T MR体线圈行MR常规检查、扩散加权成像及MRS检查。MRS测量每个体素的枸橼酸盐(Cit)、胆碱(Cho)、肌酸(Cr)的相对值;(胆碱+肌酸)/枸橼酸盐[(Cho+Cr)/Cit]的比值。受试者工作特性曲线(ROC)下的面积值用来评价前列腺癌与前列腺增生鉴别的准确性,P<0.05表明有显著差异。分析病变区域的病理镜下所见。结果:前列腺癌患者癌体素的(Cho+Cr)/Cit平均值为3.49±2.05,增生体素的(Cho+Cr)/Cit平均值为1.19±0.71,两组间差异有显著统计学意义(t=12.755,P<0.01)。前列腺确定癌与增生前列腺组织的差别的ROC曲线下的面积(Az值)为0.863[95%可信区间为(0.818,0.907);P<0.01],当切点值为2.08时,Youden指数为0.547,诊断前列腺癌的敏感度为73.9%,特异度为88.5%。结论:3.0T体线圈MRS对前列腺癌和前列腺增生可以很好地鉴别诊断,可应用于临床诊断,指导临床医师穿刺检查。     

3TMR波谱和扩散加权成像活体评价前列腺癌的侵袭性

目的确定单独或联合应用3TMRS和扩散加权成像活体评价前列腺癌侵袭性的效能,通过组织病理学在前列腺癌根治标本中确定兴趣区内前列腺癌的受累范围。材料与方法此回顾性研究获得单位伦理委员会批准,无需知情同意书。54例经穿刺证实为前列腺癌的病人,在前列腺切除术前进行MRS检查。根据组织病理图,选择包含肿瘤组织的MRS体素,计算(Cho+Cr)/Cit和Cho/Cr的代谢物比率。由于ADC的体素常小于MRS的体素,在每个MRS体素内以该区域25%的表观扩散系数作为该体素的ADC值,代表ADC图中最异常的肿瘤部分。每个肿瘤的最大代谢物比率和25%ADC值与肿瘤的侵袭性相关,用于确定肿瘤的侵袭性分类。综合两种方法,采用逻辑回归模型(LRM)评价所有数据。结果前列腺癌的侵袭性分类与外周带的最大(Cho+Cr)/Cit比率(ρ=0.36)、最大Cho/Cr比率(ρ=0.35)和最小25%ADC值(ρ=-0.63)之间存在显著相关性。在移行带,仅(Cho+Cr)/Cit和Cho/Cr比率存在相关性(ρ=0.58和ρ=0.60)。在鉴别侵袭性分类方面,与其他手段相比,采用LRM方式并未发现鉴别能力有所提高。结论本研究结果证实,MRS和扩散加权成像能够无创性地活体评价前列腺癌的侵袭性,两种检查方法效能相当。联合应用并没有提高诊断效能。虽然如此,移行带中的代谢物比率和外周带的ADC值具有较好的互补应用价值。     

MR波谱分析对前列腺癌诊断效能的研究

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.     

3.0T MRS对前列腺外周带癌的诊断价值及其与PSA相关性研究

目的 探讨3.0T磁共振波谱(MRS)对前列腺外周带癌的诊断价值及其与前列腺特异性抗原(PSA)的相关性研究.资料与方法 对15名正常自愿者和43例经病理证实的前列腺疾病患者行MRI常规平扫及MRS检查,分析各组间[胆碱(Cho)+肌酸(Cr)]/枸橼酸(Cit)比值及其与PSA之间的相关性.结果 前列腺癌肿组PSA值明显高于增生组,前列腺癌肿组的(Cho+Cr)/Ci比值与PSA值呈正相关性(r=0.424,P=0.049);各组间(Cho+Cr)/Ci比值从大到小依次为前列腺癌肿组、增生组、前列腺癌非癌外周带及正常外周带(P=0.000);当(Cho+Cr)/Ci比值为0.85时对前列腺外周带癌诊断的敏感性、特异性及准确性分别为83%、87%和85%.结论 3.0 T体表线圈MRS对前列腺疾病具有较高诊断价值,联合PSA值及MRS可明显提高对前列腺癌的检出率.     

MRI和MRS对前列腺疾病的鉴别诊断价值

目的探讨MRI和MRS在前列腺疾病中的鉴别诊断价值。方法回顾分析经病理证实的22例患者的临床资料及MRI和MRS所见,其中包括前列腺良性增生(BPH)16例及前列腺癌(PC)6例。MRI观察前列腺大小、病变位置、信号特点和肿瘤侵犯程度,MRS观察枸橼酸盐(Cit)、胆碱复合物(Cho)和肌酸(Cr)的化学位移及(Cho Cr)/Cit比值。结果16例BPH中,前列腺弥漫性增大,T2W均示前列腺中央叶明显增大,其中13例表现为多个大小不等类圆形高和/或低信号结节,部分低信号结节周围可见低信号假包膜,外围带受压变窄。6例PC中5例均表现为T2W外周带中见低信号区,1例表现为中央叶前部较大低信号结节;2例位于包膜内,4例突破包膜侵犯精囊腺和血管神经束,其中1例伴有盆腔淋巴结肿大和骨盆骨转移。MRS上BPH患者Cit明显升高,Cho略升高,(Cho Cr)/Cit比值不高,平均0.60。PC患者,Cit明显下降,Cho明显升高,(Cho Cr)/Cit比值升高,平均2.51。分别对PC与BPH体素的2组代谢物比值进行比较,二者之间有显著的统计学差异(t=0.353,P<0.05)。结论MRI和MRS有助于PC和BPH的鉴别诊断。     

MRS在鉴别前列腺外周带T2低信号炎症和肿瘤中的作用

目的用磁共振波谱分析方法定量评价造成前列腺外周带T2信号减低的前列腺炎和前列腺癌的代谢变化.方法24例MRI检查示外周带T2信号减低的病人,经超声引导下穿刺活检分为前列腺炎和前列腺癌2组,根据T2低信号区在外周带设定兴趣区后利用三维磁共振波谱测定各兴趣区(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值.计算并比较各组(Cho+Cre)/Cit比值的差异.结果前列腺炎组(Cho+Cre)/Cit平均值为0.98±0.17;前列腺癌组(Cho+Cre)/Cit平均值为1.4l±0.31,2组比值的组间差别具有统计学意义,t=8.89,P＜0.05,但有29%的比值重叠.结论用MRS定量评价造成外周带T2低信号的前列腺炎和前列腺癌的代谢变化是可行的,MRS与其它方法结合提高诊断的准确性是有可能的.     

联合应用MR扩散加权成像和MR波谱成像对前列腺癌的诊断价值

 目的 探讨联合应用MR扩散加权成像(DWI)和MR波谱成像(MRS)对前列腺癌的诊断价值.方法 经病理证实的32例前列腺癌患者,进行常规MRI扫描、DWI和3D1HMRS 成像.在前列腺3个连续层面、中央腺体和外周带左右两边选取兴趣区,以T2WI表现为低信号作为肿瘤活检穿刺区.参照穿刺活检取材位置及手术病理结果,分别测量癌区和非癌区的(Cho+Cre)/Cit比值和表观扩散系数(ADC)值,并进行统计学分析.结果 前列腺ADC值:癌区与非癌区比较差异有统计学意义(P<0.05).前列腺MRS:癌区表现为Cit峰降低, (Cho+Cre)峰显著升高,(Cho+Cre) /Cit的均值为(1.94±1.43);非癌区表现为Cit峰高,(Cho+Cre)峰低,(Cho+Cre) /Cit的均值为(0.93±0.28),两者间差异有统计学意义(P<0.05).常规MRI的敏感性为71.9%,MRI结合MRS的敏感性为87.5%,MRI、MRS、DWI联合应用的敏感性为93.7%.结论 联合应用MR扩散加权像和MR波谱成像,较单独应用能提高前列腺癌检出的敏感性.     

慢性前列腺炎的MRS表现

目的 探讨3.0T MR 体外相控阵线圈MRS在慢性前列腺炎的表现及其病理基础.方法 分析经手术或穿刺活检证实的7例表现为MR T2WI低信号的慢性前列腺炎的MRI、MRS所见.所有病例均应用3.0T MR 体外相控阵线圈行MR常规检查、扩散加权成像及MRS检查.MRS测量前列腺T2WI低信号区及对侧正常区域的枸橼酸盐(Cit)、胆碱(Cho)、肌酸(Cr)的相对值及( 胆碱+肌酸) /枸橼酸盐[(Cho+Cr)/Cit]的比值,并计算T2WI低信号病变区与对侧正常区域的胆碱比值及枸橼酸盐比值.分析病变区域的病理镜下所见.结果 慢性前列腺炎病变区域与对侧正常区域的胆碱含量比值为1.05±0.23,病变区域与对侧正常区域的枸橼酸盐含量比值为0.31±0.14,病变区域的(Cho+Cr)/Cit比值(1.77±0.41)明显高于对侧正常区域的(Cho+Cr)/Cit比值(0.58±0.15),两者有明显统计学差异(P＜0.01).病理上,慢性前列腺炎病变区域见淋巴细胞浸润、腺泡及导管不同程度萎缩、闭塞.结论 在常规MR T2WI上表现为低信号的慢性前列腺炎,在MRS上(Cho+Cr)/Cit比值升高,与前列腺癌表现极为相似,但慢性前列腺炎的(Cho+Cr)/Cit比值升高主要是因为病变区域的枸橼酸盐含量降低,而其胆碱含量变化不明显.     

中国健康成人前列腺3.0T体线圈磁共振波谱表现

目的探讨采用体线圈行前列腺3.0T磁共振波谱（MRS）检查的可行性,总结3D1H-MRS在正常前列腺中的表现。方法收集20名中老年健康志愿者行3.0T MRI常规检查、扩散加权成像及MRS检查。年龄为41～80岁,平均年龄（56±11）岁。MRS以体线圈为信号接收线圈,用Proseme序列进行扫描,体素分为正常外腺区、正常内腺区。然后工作软件自动计算每个体素的胆碱（Cho）相对值、（胆碱＋肌酸）/枸橼酸盐[（Cho＋Cr）/Cit]的比值。正常前列腺内、外腺分为左、右两侧,每侧由上到下分为底部、中部和尖部3部分,这样每个志愿者测量12个感兴趣区,每个感兴趣区包括0～3个可用体素平均计算。结果20名健康志愿者获得体素201个,其中可用体素170个（84.6%）,不可用体素为31个（15.4%）。20名中老年健康志愿者前列腺外腺区的（Cho＋Cr）/Cit平均值是0.39±0.21,内腺区的（Cho＋Cr）/Cit平均值是0.50±0.17,2组间比较差异有统计学意义（t=3.219,P〈0.01）。结论①用3.0T体线圈可以顺利完成对前列腺的MRS检查,并可以获得用于分析的体素,其在临床实践中具有可行性。②中老年正常前列腺内腺和外腺的代谢物含量是不同的,差异有统计学意义（t=3.219,P〈0.01）,内腺区（Cho＋Cr）/Cit平均值高于外腺区,进一步对其病变进行MRS定量研究时应根据解剖进行分区研究。     

3D 1 HMRSI对外周带前列腺癌鉴别诊断价值的初步研究

目的:探讨3D1HMRSI(three dimensional proton MR spectroscopic imaging)研究外周带前列腺癌(PCa)的代谢特点,及对外周带PCa的鉴别诊断价值。方法:分析18例良性前列腺增生(BPH)和21例PCa的3D MRSI表现。测量外周带PCa体素及BPH外周带体素的(Cho Cre)/Cit及Cho/Cre,并比较它们之间的差异。结果:BPH的外周带波谱主要表现为Cit高耸,Cho次之,Cre最低;PCa波谱主要表现为Cit峰明显下降甚至消失,Cho显著升高,两者波峰可呈现倒置,(Cho Cre)/Cit>0.86。PCa体素的(Cho Cre)/Cit显著高于BPH体素,且两者仅存在小部分重叠,PCa体素的Cho/Cre也显著高于BPH体素,但两者存在较大部分重叠;经ROC曲线分析得出(Cho Cre)/Cit对外周带PCa的鉴别诊断效能高于Cho/Cre,(Cho Cre)/Cit对外周带PCa的最佳诊断阈值为1.16。结论:外周带PCa的3D MRSI表现具有特征性,(Cho Cre)/Cit为诊断外周带PCa的有效指标,以(Cho Cre)/Cit>1.16作为诊断标准,可获得较高的敏感度、特异度和准确度(分别为99.3%、99.2%、99.3%)。     

Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging--initial results

PURPOSE: To determine whether cancers of the prostate transition zone (TZ) possess a unique metabolic pattern by which they may be identified at proton magnetic resonance (MR) spectroscopic imaging. MATERIALS AND METHODS: Findings in 40 patients who underwent combined endorectal MR imaging and hydrogen 1 MR spectroscopic imaging before radical prostatectomy and who had TZ tumor identified subsequently at step-section pathologic analysis were retrospectively reviewed. Within this population, a subset of 16 patients whose TZ tumor had a largest diameter of 1 cm or greater and was included in the MR spectroscopic imaging excitation volume was identified. In these 16 patients, the ratios of choline-containing compounds (Cho) and creatine/phosphocreatine (Cr) to citrate (Cit) (ie, [Cho + Cr]/Cit), Cho/Cr, and Cho/Cit were compared in tumor and control tissues. The presence of only Cho and the absence of all metabolites were also assessed. RESULTS: The mean values of (Cho + Cr)/Cit, Cho/Cr, and Cho/Cit were different between TZ cancer and control tissues (P =.001, P =.003, and P =.001, respectively; Wilcoxon signed rank test). Nine (56%) of 16 patients had at least one tumor voxel in which Cho comprised the only detectable peak, while no control voxels showed only Cho (P =.008, McNemar test). The percentage of voxels in which no metabolites were detected did not differ between tumor and control tissues (P =.134, McNemar test). CONCLUSION: TZ cancer has a metabolic profile that is different from that of benign TZ tissue; however, the broad range of metabolite ratios observed in TZ cancer precludes the use of a single ratio to differentiate TZ cancer from benign TZ tissue.     

Detection of prostate cancer with MR spectroscopic imaging: an expanded paradigm incorporating polyamines

PURPOSE: To characterize benign and malignant prostate peripheral zone (PZ) tissue retrospectively by using a commercial magnetic resonance (MR) spectroscopic imaging package and incorporating the choline plus creatine-to-citrate ratio ([Cho + Cr]/Cit) and polyamine (PA) information into a statistically based voxel classification procedure. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and waived the requirement for informed consent. Fifty men (median age, 60 years; range, 44-69 years) with untreated biopsy-proved prostate cancer underwent combined endorectal MR imaging and MR spectroscopic imaging. Commercial software was used to acquire and process MR spectroscopic imaging data. The (Cho + Cr)/Cit and the PA level were tabulated for each voxel. The PA level was scored on a scale of 0 (PA undetectable) to 2 (PA peak as high as or higher than Cho peak). Whole-mount step-section histopathologic analysis constituted the reference standard. Classification and regression tree analysis in a training set generated a decision-making tree (rule) for classifying voxels as malignant or benign, which was validated in a test set. Receiver operating characteristic and generalized estimating equation regression analyses were used to assess accuracy and sensitivity, respectively. RESULTS: The median (Cho + Cr)/Cit was 0.55 (mean +/- standard deviation, 0.59 +/- 0.03) in benign and 0.77 (mean, 1.08 +/- 0.20) in malignant PZ voxels (P = .027). A significantly higher percentage of benign (compared with malignant) voxels had higher PA than choline peaks (P < .001). In the 24-patient training set (584 voxels), the rule yielded 54% sensitivity and 91% specificity for cancer detection; in the 26-patient test set (667 voxels), it yielded 42% sensitivity and 85% specificity. The percentage of cancer in the voxel at histopathologic analysis correlated positively (P < .001) with the sensitivity of the classification and regression tree rule, which was 75% in voxels with more than 90% malignancy. CONCLUSION: The statistically based classification rule developed indicated that PAs have an important role in the detection of PZ prostate cancer. With commercial software, this method can be applied in clinical settings.     

中央腺体内前列腺癌3D 1 H-MRSI的初步研究

目的 应用3D氢质子磁共振波谱成像（3D ^1H-MRSI）研究中央腺体（CG）前列腺癌（PC）的代谢特点，并初步探讨3D ^1H-MRSI对CG内PC的鉴别诊断价值。资料与方法 分析18例良性前列腺增生（BPH）和16例PC的3D ^1H-MRSI表现，16例PC中2例源于CG，14例肿块较大同时累及外周带和CG。测量CG内PC及BPH的CG体素（Cho＋Cre）／Cit比值及Cho／Cre比值，并分别对PC与BPH体素的两组代谢物比值进行比较。结果 CG内PC波谱主要表现为Cit峰明显下降甚至消失，Cho峰显著升高，两者波峰可呈现倒置。CG的腺体增生组织主要表现为Cit峰高耸，Cho峰次之，Cre峰最低，基质增生者Cit、Cho峰均降低；CG内PC体素（Cho＋Cre）／Cit比值显著高于BPH的CG（P〈0．001），但两组体素存在部分重叠（29／133，21．8％）。CG内PC体素的Cho／Cre比值明显高于BPH的CG（P〈0．001），但两组之间重叠较多（105／133，78．9％）。结论 CG内PC的诊断存在一定困难，其（Cho＋Cre）／Cit明显高于BPH的CG，但与BPH有部分重叠，综合Cit峰降低、Cho峰升高、Cho／Cre增大有助于CG内PC的检出。     

Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy

PURPOSE: To determine whether hydrogen 1 magnetic resonance (MR) spectroscopic imaging can be used to predict aggressiveness of prostate cancer. MATERIALS AND METHODS: All patients gave informed consent according to an institutionally approved research protocol. A total of 123 patients (median age, 58 years; age range, 40-74 years) who underwent endorectal MR imaging and MR spectroscopic imaging between January 2000 and December 2002 were included. MR imaging and spectroscopy were performed by using combined pelvic phased-array and endorectal probe. Water and lipids were suppressed, and phase-encoded data were acquired with 6.2-mm resolution. Voxels in the peripheral zone were considered suspicious for cancer if (Cho + Cr)/Cit was at least two standard deviations above the normal level, where Cho represents choline-containing compounds, Cr represents creatine and phosphocreatine, and Cit represents citrate. Correlation between metabolite ratio and four Gleason score groups identified at step-section pathologic evaluation (3 + 3, 3 + 4, 4 + 3, and > or =4 + 4) was assessed with generalized estimating equations. RESULTS: Data from 94 patients were included. Pathologic evaluation was used to identify 239 lesions. Overall sensitivity of MR spectroscopic imaging was 56% for tumor detection, increasing from 44% in lesions with Gleason score of 3 + 3 to 89% in lesions with Gleason score greater than or equal to 4 + 4. There was a trend toward increasing (Cho + Cr)/Cit with increasing Gleason score in lesions identified correctly with MR spectroscopic imaging. Tumor volume assessed with MR spectroscopic imaging increased with increasing Gleason score. CONCLUSION: MR spectroscopic imaging measurement of prostate tumor (Cho + Cr)/Cit and tumor volume correlate with pathologic Gleason score. There is overlap between MR spectroscopic imaging parameters at various Gleason score levels, which may reflect methodologic and physiologic variations. MR spectroscopic imaging has potential in noninvasive assessment of prostate cancer aggressiveness.     

MR波谱在预测前列腺癌转移中的作用

目的 探讨MR波谱(MRS)在预测前列腺癌转移中的价值.方法 65例超声引导下穿刺活检证实的前列腺癌患者,根据临床分期分为未发生转移组(B期和C期)31例和发生骨和(或)淋巴结转移组(D期)34例,通过MRS测定2组患者癌病灶区(胆碱+肌酸)/枸橼酸盐[(Cho +Cre)/Cit]的比值,并比较其差异.同时利用描绘受试者工作特征(ROC)曲线来初步评价MRS在预测前列腺癌发生转移中的效能.结果 未发生转移组和发生转移组患者的前列腺癌区(Cho+Cre)/Cit比值分别为1.3±0.5和2.2±0.6,差异有统计学意义(t=6.38,P＜0.05).利用癌病灶区(Cho+Cre)/Cit的平均比值对肿瘤是否发生转移进行诊断试验,ROC曲线下面积(Az)值为0.87,最佳临界点为1.53,此时诊断的敏感性为94.12%(32/34),特异性为67.74%(21/31),准确性为81.54%(53/65).结论 MRS作为一种无创的MRS检查方法 ,有可能对肿瘤是否发生转移作出预测.     

MR spectroscopic imaging and diffusion-weighted imaging of prostate cancer with Gleason scores

Purpose:

To investigate functional changes in prostate cancer patients with three pathologically proven different Gleason scores (GS) (3+3, 3+4, and 4+3) using magnetic resonance spectroscopic imaging (MRSI) and diffusion‐weighted imaging (DWI).

Materials and Methods:

In this study MRSI and DWI data were acquired in 41 prostate cancer patients using a 1.5T MRI scanner with a body matrix combined with an endorectal coil. The metabolite ratios of (Cho+Cr)/Cit were calculated from the peak integrals of total choline (Cho), creatine (Cr), and citrate (Cit) in MRSI. Apparent diffusion coefficient (ADC) values were derived from DWI for three groups of Gleason scores. The sensitivity and specificity of MRSI and DWI in patients were calculated using receiver operating characteristic curve (ROC) analysis.

Results:

The mean and standard deviation of (Cho+Cr)/Cit ratios of GS 3+3, GS 3+4, and GS 4+3 were: 0.44 ± 0.02, 0.56 ± 0.06, and 0.88 ± 0.11, respectively. For the DWI, the mean and standard deviation of ADC values in GS 3+3, GS 3+4, and GS 4+3 were: 1.13 ± 0.11, 0.97 ± 0.10, and 0.83 ± 0.08 mm²/sec, respectively. Statistical significances were observed between the GS and metabolite ratio as well as ADC values and GS.

Conclusion:

Combined MRSI and DWI helps identify the presence and the proportion of aggressive cancer (ie, Gleason grade 4) that might not be apparent on biopsy sampling. This information can guide subsequent rebiopsy management, especially for active surveillance programs. J. Magn. Reson. Imaging 2012;36:697–703. © 2012 Wiley Periodicals, Inc.     

前列腺癌的MR波谱成像中体线圈与直肠内线圈的比较

目的 比较体线圈(BODY)与直肠内线圈(ERC)MRS对前列腺癌的定性诊断效能,探讨BODY MRS临床应用的可行性.方法 12例取得穿刺病理结果的前列腺外周带癌患者,其中6例为前列腺癌,6例除外了前列腺癌.12例全部完成BODY MRS检查,其中7例同时完成ERC MRS检查.以六分区法对照穿刺结果进行MRS定量分析,分别测量每个区域内癌与非癌区(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值,并采用Wilcoxon符号等级检验进行比较,计算BODY MRS对前列腺癌的诊断准确性.结果 (1)癌区与非癌区体素(Cho+Cre)/Cit比较:BODY组(7例)癌区体素比值中位数1.744(0.295～7.998),非癌区中位数0.412(0.112～2.113),两者差异有统计学意义(Z=-9.159,P＜0.01).ERC组(7例)癌区体素比值中位数为1.975(0.479～7.998),非癌区中位数为0.400(0.104～2.232),两者差异有统计学意义(Z=-9.200,P＜0.01).BODY与ERC组间比较:癌区体素组间比较差异无统计学意义(Z=-0.105,P＞0.05),非癌区体素组间比较差异无统计学意义(Z=-0.692,P＞0.05).(2)ROC分析:7例BODY与ERC组曲线下面积(Az值)分别为0.931、0.935,两者比较差异无统计学意义(P=0.851);应用BODY MRS 12例患者组Az值为0.935,敏感度、特异度分别为82.2%和88.2%.结论 BODY与ERC的MRS对前列腺外周带癌定性诊断效能接近,临床应用具有可行性.     

前列腺癌血清PSA与磁共振波谱变化的相关性研究

目的：探讨前列腺癌患者磁共振波谱（MRS）改变与血清中总前列腺特异抗原（TPSA）、游离前列腺特异抗原（fPSA）及两者比值（f/T）的相关性。方法：30例经活检证实为前列腺癌患者TPSA、fPSA及f/T值为参数,将3组数据分别与前列腺癌兴趣区所得（Cho＋Cr）/Cit值的平均数进行相关性分析。结果：CC/C比值与血清总PSA浓度平均值呈正相关关系（相关系数r=0.750）,差异具有显著性意义（P〈0.01）;与血清游离PSA浓度呈正相关关系（相关系数r=0.814）,差异具有显著性意义（P〈0.05）;与f/T值呈正相关关系（相关系数r=0.189）,差异无显著性意义（P=0.318〉0.05）。结论：CC/C值与血清总PSA浓度及游离PSA浓度呈正相关,而CC/C值较高患者更易于发现和确定前列腺内发生代谢改变的区域,因此PSA值较高患者行MRS更具临床意义。     

Metabolite ratios in 1H MR spectroscopic imaging of the prostate

In ¹H MR spectroscopic imaging (¹H‐MRSI) of the prostate the spatial distribution of the signal levels of the metabolites choline, creatine, polyamines, and citrate are assessed. The ratio of choline (plus spermine as the main polyamine) plus creatine over citrate [(Cho+(Spm+)Cr)/Cit] is derived from these metabolites and is used as a marker for the presence of prostate cancer. In this review, the factors that are of importance for the metabolite ratio are discussed. This is relevant, because the appearance of the metabolites in the spectrum depends not only on the underlying anatomy, metabolism, and physiology of the tissue, but also on acquisition parameters. These parameters influence especially the spectral shapes of citrate and spermine resonances, and consequently, the (Cho+(Spm+)Cr)/Cit ratio. Both qualitative and quantitative approaches can be used for the evaluation of ¹H‐MRSI spectra of the prostate. For the quantitative approach, the (Cho+(Spm+)Cr)/Cit ratio can be determined by integration or by a fit based on model signals. Using the latter, the influence of the acquisition parameters on citrate can be taken into account. The strong overlap between the choline, creatine, and spermine resonances complicates fitting of the individual metabolites. This overlap and (unknown, possibly tissue‐related) variations in T1, T2, and J‐modulation hamper the application of corrections needed for a “normalized” (Cho+(Spm+)Cr)/Cit ratio that would enable comparison of spectra measured with different prostate MR spectroscopy protocols. Quantitative (Cho+(Spm+)Cr)/Cit thresholds for the evaluation of prostate cancer are therefore commonly established per institution or per protocol. However, if the same acquisition and postprocessing protocol were used, the ratio and the thresholds would be institution‐independent, promoting the clinical usability of prostate ¹H‐MRSI. Magn Reson Med 73:1–12, 2015. © 2014 Wiley Periodicals, Inc.