The Application Of Quantitative Dynamic Contrast-Enhanced MRI In Differential Diagnosis Of Prostate Cancer Of Different Anatomical Regions And Assessing The Effects Of Androgen Deprivation Therapy For Prostate Cancer

Part ?:The application of quantitative dynamic contrast-enhanced MRI in differential diagnosis of prostate cancer of different anatomical regions.Objective:To investigate the value of quantitative dynamic contrast-enhanced MRI(DCE-MRI)in differential diagnosis of prostate cancer in different anatomical regions.Materials and Methods:Ninety-three cases(mean age,67.1 years;range,49-87 years)with prostate diseases confirmed pathologically were retrospectively analyzed,including 43 cases of prostate cancer,28 cases of benign prostatic hyperplasia and 22 cases of chronic prostatitis.All cases underwent conventional MRI and DCE-MRI before biopsy or surgery.The DCE-MRI data were imported into the Omni Kinetics Manual software to measure the values of volume transfer contant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve),blood flow(BF).blood volume(BV)using Extended Tofts two compartment Model.ROIs were drawn on areas of cancerous regions,hyperplastic regions and prostatitic regions in peripheral zone,and cancerous regions,hyperplastic nodules in central gland.All the values of quantitative parameters of different tissues were analyzed statistically.Results:1.The differences of values of Ktrans.Kep.BF and BV among the three groups in peripheral zone were statistically significant(P<0.05),while the differences of Ve were not statistically significant(P>0.05).According to the ROC curve analysis of prostate cancer and prostatitis,the sensitivity and specificity of the combined Ktrans-Kep parameters for the diagnosis of prostate cancer and prostatitis were 78.4%and 89.2%,respectively.While the sensitivity and specificity of the combined Ktrans-BF parameters were 81.1%and 94.6%.According to the ROC curve analysis of prostate cancer and hyperplasia in peripheral region,the sensitivity and specificity of the combined Ktrans-Kep parameters for detection of prostate cancer and hyperplasia were 94.6%and 89.8%,respectively.While the sensitivity and specificity of the combined Ktrans-BF parameters were 91.9%and 93.9%,respectively.2.The differences of values of Ktrans,Kep,Ve,BF and BV between prostate cancer and hyperplasia in central gland were statistically significant(P<0.05).The areas of Ktrans,Ve under the ROC curve were larger than that of Kep.The sensitivity and specificity of the combined Ktrans-Ve parameters for the detection of cancer were 88%and 90.6%,respectively.While the sensitivity and specificity of the combined Ktrans-BF parameters were 88%and 90.6%,respectively.Conclusion:The diagnostic value of the combined Ktrans-BF parameters is higher than that of combined Ktrans-Kep parameters and Ktrans-Ve parameters in diagnosis and deferential diagnosis of prostate diseases in peripheral and central regions.Therefore,DCE-MRI quantitative analysis combined with perfusion parameters plays a significant role in the differential diagnosis of prostate cancer.Part ?:Assessing the effects of androgen deprivation therapy for prostate cancer using quantitative DCE-MRIObjective:To investigate the value of quantitative dynamic contrast-enhanced MRI(DCE-MRI)in monitoring response to androgen deprivation therapy(ADT)for patients with prostate cancer.Materials and Methods:Fifteen patients(mean age,70.8 years;range,57-86 years)with prostate cancer pathologically confirmed who received ADT treatment were studied.Date of routine MRI and DCE-MRI of pre-and post-ADT were retrospectively analyzed.Seven patients had been treated for one cycle(3 months)and eight patients for three cycles,and all patients underwent the second DCE-MRI within a week after ADT treatment.The volume of the lesions pre-and post-ADT was measured.The DCE-MRI data were imported into the Omni Kinetics Manual software to measure the values of volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve),blood flow(BF)and blood volume(BV)using the Extended Tofts two-compartment Model,and these values were statistically analyzed.Results:1.The volume of prostate cancer of all cases was reduced remarkably after treatment(p<0.001).2.The values of Ktrans,Kep,BF and BV of tumor tissues were decreased with statistically significant differences after treatment(p<0.05),while the differences of Ve were not statistically significant(P=0.989).3.Pearson correlation analysis showed that the d-value of Ktrans(pre-Ktrans minus post-Ktrans)was highly correlated with the value of pre-Krans(r=0.878).the d-value of Kep highly correlated with the value of pre-Kep(r=0.942),the d-value of BF highly correlated with the value of pre-BF(r=0.856),and the d-value of BV moderately correlated with the value of pre-BV(r=0.776);P<0.001.The changes of MRI parameters and volume in tumor pre-and post-ADT were not correlated(p>0.05).4.The reduction rate of each parameter in the treatment of three cycles was higher than that of the patients with one cycle.Conclusion:The values of Ktrans,Kep,BF and BV of prostate cancer reduced remarkably after ADT,and the changes of Ktrans,Kep and BF pre-and post-ADT were highly correlated with the values of Ktrans,Kep,and BF before,respectively.Therefore,the quantitative parameters Ktrans,Kep and BF in DCE-MRI can be used to assess treatment efficacy of prostate cancer after ADT,providing the basis for individualized treatment and adjustment of treatment plans.