| Part I The Application Value of MRI Multi-parameter Imaging in The Diagnosis of Prostate Cancer and Prostatic HyperplasiaObjective:Based on the second edition of prostate imaging report and data system?PI-RADS v2?score,the application value of magnetic resonance multi-parameter imaging including conventional T2 weighted imaging?T2WI?dynamic enhancement?DCE-MRI?and diffusion weighted imaging?DWI?in the diagnosis of prostate cancer?PCa?and prostatic hyperplasia?BPH?was studied.Methods:Retrospective analysis was performed on the 3.0T MRI images?including conventional T1WI,T2WI,DWI and DCE-MRI?of 97 cases of prostate disease?41cases of PCa and 56 cases of BPH?confirmed by biopsy or surgery pathology.According to the scores of T2WI,DWI and DCE-MRI,PI-RADS v2 score was obtained.1.Firstly,the results of statistical PI-RADS v2 scores of the two radiologists were tested for consistency.Statistical methods were used to analyze whether there were statistically significant differences in PI-RADS v2 scores between the corresponding groups of PCa and BPH,peripheral band PCa and BPH,transition band PCa and BPH.The ROC curve of PI-RADS v2 score for the diagnosis of prostatic adenopathy was plotted,the area under the curve?AUC?was calculated,and its sensitivity,specificity and optimal diagnostic threshold were analyzed.The ROC curve of PI-RADS v2 score for the diagnosis of prostate cancer in the peripheral band?PZ?and transitional band?TZ?was plotted.The area under the curve was calculated,and its sensitivity,specificity and optimal diagnostic threshold of PI-RADS v2 score for prostate cancer in PZ and TZ were analyzed.2.Statistical methods were used to analyze whether there were statistically significant differences in ADC values between the corresponding groups of PCa and BPH,peripheral band PCa and BPH,transition band PCa and B PH.The ROC curve of PI-RADS v2 score for the diagnosis of prostatic adenopathy was plotted.The area under the curve?AUC?was calculated,and its sensitivity,specificity and optimal diagnostic threshold were analyzed.The ROC curve of ADC value for the diagnosis of prostate cancer in the peripheral band?PZ?and transitional band?TZ?was plotted.The area under the curve was calculated,and its sensitivity specificity and optimal diagnostic threshold of ADC values for prostate cancer in PZ and TZ were analyzed.3.Statistical methods were used to analyze the difference of TIC curve types between PCa and BPH groups.Then the sensitivity,specificity and accuracy of TIC curve type diagnosis of PCa and BPH were analyzed.Results:1.A statistical analysis of PI-RADS v2 of the two radiologists showed that the results had a high consistency,with k value of 0.887?P<0.05?.In 41 cases of PCa,PI-RADS v2 had no 1 point,1 case of 2 points,5 cases of 3 points,21 cases of 4 points,14 cases of 5 points.In 56 cases of BPH,PI-RADS v2 had no 1 score,28 cases of 2 scores,23cases of 3 scores,3 cases of 4 scores,0 cases of 5 scores.There were statistically significant differences between PCa and BPH,peripheral band PCa and BPH,transition band PCa and BPH of PI-RADS v2 evaluation.?t values were-10.57,-5.95,-7.88 respectively,P<0.01?.In this study,the AUC of PI-RADS v2 score in the diagnosis of prostate cancer was 0.928 with the largest youden index.PI-RADS v2 score was the best diagnostic threshold of 3.5 points,and youden index of 0.783,its sensitivity and specificity of 92.8%and 85.4%respectively,P<0.01.The AUC of PI-RADS v2 score in the diagnosis of PZ prostate cancer was 0.915 with the largest youden index.PI-RADS v2 was 3.5 points,which was the best diagnostic threshold for the qualitative diagnosis of PZ prostate cancer.The sensitivity and specificity were88.9%85.7%,P<0.01,and the youden index was 0.783.The AUC of PI-RADS v2score in the diagnosis of TZ prostate cancer was 0.941.According to the maximum value of the youden index,PI-RADS v2 was 3.5 points,which was the best diagnostic threshold for qualitative diagnosis of prostate cancer.The sensitivity and specificity were 94.7%84.6%,P<0.01,and the youden index was 0.793.2.The 95%confidence intervals of ADC values with peripheral PCa and BPH were?0.896±0.017?×10-3mm2,?1.189±0.041?×10-3mm2.The 95%confidence intervals of ADC values of PCa and BPH in the transitional band were?0.923±0.027?×10-3mm2,?1.185±0.022?×10-3mm2?t values were 11.230,6.252,17.407 respectively P<0.01?.The ADC value was 1.022×10-3mm2 as the optimal diagnostic threshold,the youden index was the maximum,and the sensitivity and specificity were 92.7%and80.4%respectively,P<0.01.The AUC for diagnosing PZ prostate cancer with the youden index of 0.73 ADC value was 0.969.The ADC value of 0.997×10-3mm2 was the optimal diagnostic threshold for qualitative diagnosis of PZ prostate cancer,and the youden index was 0.837,and its sensitivity and specificity were 89.3%and 94.4%respectively,P<0.01.The AUC for diagnosing TZ prostate cancer was 0.919,and the ADC value of 1.107×10-3mm2 was the best diagnostic threshold for qualitative diagnosis of prostate cancer.The sensitivity and specificity were 100%,76.3%respectively,P<0.01,and the youden index was 0.763.3.In 41 cases of PCa,there were 28 cases of TIC type I,3 cases of type II and 10cases of type III.In 56 cases of BPH,there were 18 cases of TIC type I,11 cases of type II and 27 cases of type III.The difference of TIC curve types between PCa group and BPH group was statistically significant?c2=12.536,P<0.05?.When type II is used as the threshold,its sensitivity,specificity and accuracy are 46.1%,81.2%and 51.2%,respectively.When type III is used as the threshold,its sensitivity,specificity and accuracy were 62.5%,71.4%and 68.2%respectively.In this study,type III is selected as the threshold for the diagnosis of benign and malignant prostate.The consistency between TIC curve type in the diagnosis of benign and malignant prostate lesions and pathological results is the general consistency?k value is 0.323?.Conclusions:1.PI-RADS v2 is of high diagnostic performance in prostate disease diagnosis,and the PI-RADS v2 score of TZ the qualitative diagnosis of prostate cancer is more valuable.2.ADC value is of high diagnostic performance in the diagnosis of benign and malignant lesion in prostate,and ADC values of PZ more valuable the qualitative diagnosis of prostate cancer.3.TIC curve type has a certain role in the differentiation of benign and malignant prostate lesions,but the diagnostic efficacy is generally.Part II MR imaging with multiple parameter correlation analysis of serum PSAObjective: The correlation between ADC value of PI-RADS v2 score and serum PSA was analyzed.And the diagnostic efficacy of serum PSA in prostate diseases was analyzed.Methods: Retrospective analysis was performed on 97 cases of prostate lesions?41cases with PCa and 56 cases with BPH?confirmed by biopsy or post-operative pathology after 3.0t MRI scan?T1WI,T2 WI,DWI and DCE-MRI?.The ADC value was measured after processing.PI-RADS v2 score was obtained by combining T2 WI,DWI and DCE-MRI.1.Pearman correlation analysis was conducted between PI-RADS v2 and serum PSA.Then Pearman correlation analysis was conducted between ADC value and serum PSA.2.Statistical methods were used to analyze whether there were statistically significant differences in serum PSA between the groups of PCa and BPH.The ROC curve of serum PSA for the diagnosis of prostate disease was plotted.The area under the curve?AUC?was calculated.And its sensitivity,specificity and optimal diagnostic threshold were analyzed.Results: The serum PSA range of 41 patients with PCa was 3.4123.6 ng/ml whlie that of 56 patients with BPH was 2.167.8 ng/ml.The test result showed that there was a statistical difference between PCa and BPH groups?t=-4.067,P<0.01?.1.In this study,PI-RADS v2 score was positively correlated with serum PSA?r=0.347,P<0.01?,and ADC value was negatively correlated with serum PSA?r=-0.409,P<0.01?.2.In this study,the AUC of serum PSA level in the diagnosis of clinically significant prostate cancer was 0.897.According to the maximum value of the youden index,the serum PSA level of 10.45 ng/ml was the best diagnostic threshold for the qualitative diagnosis of clinically significant prostate cancer.The sensitivity and specificity were87.3% and 89.3%respectively,and the youden index was 0.771.Conclusions:1.PI-RADS v2 score was positively correlated with serum PSA while ADC value was negatively correlated with serum PSA.2.Serum PSA has certain value in the qualitative diagnosis of clinically significant prostate cancer. |
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