| The first part:Evaluation of single-shot echo-planar imaging?SS-EPI?and readout segmentation of long variable echo—trains?RESLOVE?with diffusion kurtosis imaging in the diagnosis of prostate disease at 1.5T MRI.Abstract Objective The clinical application value of 1.5T MR RESOLVE-DKI in the diagnosis of prostate disease was evaluated by comparing the quality and quantitative parameters of the SS-EPI-DKI and RESOLVE-DKI images of 1.5T MR prostate.Methods A total of 71 patients with prostate disease confirmed by pathology were included in this study.29 cases had prostate malignant tumors?39 malignant lesions?,42 cases had BPH.All patients underwent SS-EPI-DKI and RESOLVE-DKI with a 1.5T MRI scanner.Four groups of DKI sequences were set up.Two radiologists,unaware of the clinical date and sequences,retrospectively and independently interpreted four groups of DKI images which consisted of anatomical structure and geometric distortion of prostate and lesion conspicuity and diagnostic confidence of prostate cancer using a 5-point Likert scale.Inter-observer agreement was assessed with the Kappa statistics.ROI was drawn on the map of DKI parameters to measure the D,and K value corresponding to different sets of DKI.Parameters of prostate cancer zone,non-cancerous peripheral zone and non-cancerous transition zone were compared by using Kruskal-Wallis test.Using the receiver operating characteristic?ROC?curve,the quantitative parameters of DKI were calculated to compare the diagnostic efficacy between prostate cancer and non-cancer.Results Good agreement was achieved in image quality of all four groups,Kappa value is 0.690.80.Four points or more accounted for 83.09%in the RESOLVE group,while most of them were less than four points in SS-EPI group which four points accounted for 14.08%?12.67%?32.39%,respectively.In the evaluation index for the clarity of the prostate cancer and the diagnosis of confidence in the image,four points or more accounted for 92.31%in the RESOLVE-DKI group,while SS-EPI-DKI group accounted for 28.21%,35.89%and43.59%,respectively.One points accounted for 83.09%in the RESOLVE-DKI group,while SS-EPI-DKI group accounted for 7.6%?7.6%?5.1%,respectively.Group?1?:the DKI parameters?K?D?obtained in prostate cancer area were?1.00±0.17???1.19±0.24?×10-3mm2/s,?0.75±0.08???1.74±0.13?×10-3mm2/s in non-cancerous transition zone and?0.68±0.05???2.32±0.19?×10-3mm2/s in non-cancerous peripheral zone;Group?2?:the DKI parameters?K?D?obtained in prostate cancer area were?1.05±0.09???1.24±0.18?×10-3mm2/s,?0.82±0.06???1.70±0.13?×10-3mm2/s in non-cancerous transition zone and?0.71±0.04???2.28±0.16?×10-3mm2/s in non-cancerous peripheral zone;Group?3?:the DKI parameters?K?D?obtained in prostate cancer area were?1.11±0.14???1.16±0.22?×10-3mm2/s,?0.84±0.07???1.73±0.15?×10-3mm2/s in non-cancerous transition zone and?0.72±0.04???2.41±0.19?×10-3mm2/s in non-cancerous peripheral zone;Group?4?:the DKI parameters?K?D?obtained in prostate cancer area were?0.96±0.13???1.23±0.20?×10-3mm2/s,?0.68±0.08???1.70±0.11?×10-3mm2/s in non-cancerous transition zone and?0.60±0.06???2.34±0.16?×10-3mm2/s in non-cancerous peripheral zone.K value was was significantly higher in prostate cancer area compared to non-cancerous areas?P<0.001?.K value of non-cancerous transition zone was more than that of the non-cancerous peripheral areas,and the difference was statistically significance?P<0.001?.D value was was significantly lower in prostate cancer area compared to non-cancerous areas?P<0.001?.D value of non-cancerous transition zone was less than that of the non-cancerous peripheral areas,and the difference was statistically significance?P<0.001?.The area under the ROC curve of K value in four groups were 0.959?0.976?0.977?0.986,respectively.The area under the ROC curve of D value in four groups were 0.981?0.987?0.978?0.988,respectively.Conclusion K and D value of RESOLVE-DKI and SS-EPI-DKI all showed higher diagnostic performance between prostate cancer and non-cancer;compared with SS-EPI-DKI,RESLOVE-DKI can provide higher quality image to detect prostate focus,which may potentially provide more help for clinical diagnosis.The second part: A preliminary study on the correlation between quantitative parameters of 1.5T RESOLVE-DKI and Gleason score of prostate cancerObjective To explore the difference and correlation of 1.5T RESOLVE-DKI quantitative parameters in different Gleason scores of prostate cancer.Methods A total of 35 patients?48 lesions?with prostate cancer confirmed by pathology were included in this study.All patients underwent pelvis 1.5-T magnetic resonance imaging,including conventional DWI?b=800s/mm2?and RESOLVE-DKI with three b values used?from 0 to 1600s/mm2?.Apparent diffusion coefficient?ADC?was derived using a monoexponential model,while diffusion coefficient?D?and kurtosis?K?were determined using a DKI model.Cancerous focus were classified into well differentiated group?GS?6??moderately differentiated group?GS=7?and poorly differentiated group?GS ? 8?.ROI was drawn on the ADC map and DKI map to measure the ADC ?D and K value.Parameters of prostate cancer zone were compared with ANOVA and LSD-t test,Pearson test was used to evaluate the association among different Gleason scores.The receiver operating characteristic?ROC?curve was used to compare the diagnostic efficiency of the above parameters among the distinction of well-differentiated group?GS?6?and moderately and poorly differentiation group?GS?7?.Results 35 cases had prostate malignant tumors?48 malignant lesions?.Highly differentiated group?GS ? 6?: 6,medium differentiation?GS=7?: 12,poorly differentiated?GS ? 8?: 20.The K value,D value and ADC value of the foci in the high differentiation group?GS?6?:0.84±0.08??1.36±0.25?×10-3mm2/s??0.83±0.09?×10-3mm2/s;The K value,D value and ADC value of the foci in the Medium differentiated group?GS=7?:0.92±0.05 ??1.20±0.27?×10-3mm2/s ??0.74±0.13?×10-3mm2/s;The K value,D value and ADC value of the foci in the Medium differentiated group?GS=7?in the Poorly differentiated group?GS ? 8?:1.07±0.12 ??1.13±0.17?×10-3mm2/s??0.68±0.07?×10-3mm2/s.K value and D value and ADC value in different GS?6,7 and GS ? 8?lesions were statistically significant?P<0.05?which K value difference was statistically significant?P<0.001?.Highly differentiated group?GS ? 6?and moderately differentiated group?GS=7?were significantly lower than those in poorly differentiated group?GS ? 8??P<0.001?;However,there was no significant difference in K value between well-differentiated group?GS?6?and moderately differentiated group?GS=7??P> 0.05?.D value in the well differentiated group?GS ? 6?and poorly differentiated group?GS ? 8?foci of the D value was statistically significant?P <0.05?;the ADC value in the well differentiated group?GS ? 6?and poorly differentiated group?GS ? 8?were significantly different between the two groups?P <0.001?.However,the difference between D value and ADC value in the differentiated group?GS=7?and the poorly differentiated group?GS ? 8??the well differentiated group?GS ? 6?and the moderately differentiated group?GS = 7?were no statistical significance?P> 0.05?.The higher the Gleason score,the higher the K value,the correlation between the two was positive?r 0.778 P<0.001?;The higher the Gleason score,the lower the D and ADC values,correlation between the two was negative?r 0.384 P<0.05,r 0.579 P <0.001?.The area under the ROC curve?AUC?of K value,and D value and ADC value in the distinction of well-differentiated group?GS ? 6?and moderately and poorly differentiation group?GS?7?were 0.905?P <0.001??0.732?P <0.05?and 0.831?P=0.002?.The K value shows the largest area under the curve.Conclusion The ADC value,K and D value of RESOLVE-DKI were statistically different in Gleason scores of prostate cancer,while difference in K value was statistically significant?P<0.001?.K value was positively correlated with the Gleason score.K value has higher diagnostic performance than ADC and D value between well-differentiated?GS ? 6?group and moderately and poorly differentiated?GS?7?group. |
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