Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer
Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer
复制标题
DOI：
10.2214/ajr.14.14221
复制
发表时间：
2015-08-01
影响因子：
5
通讯作者：
Rosenkrantz, Andrew B.
中科院分区：
文献类型：
--
作者：
Gupta, Rajan T.;Kauffman, Christopher R.;Rosenkrantz, Andrew B.
目标。以前列腺根治术组织病理学结果为参考标准，比较前列腺良性中心区（CZ）与良性外周区（PZ）、良性过渡区（TZ）及前列腺癌的表观弥散系数（ADC）值。材料和方法。该研究纳入了27例前列腺癌患者（平均[+/- SD]年龄，60.0 +/- 7.6岁），这些患者在行前列腺切除术前进行了3-T直肠内圈前列腺MRI检查，并进行了全载组织病理学评估。以组织病理结果为参考标准，记录指数肿瘤内及良性CZ、PZ、TZ内的ROI平均值。采用配对t检验和ROC曲线分析比较各组ADC值。良性CZ右叶(1138 +/- 123 × 10（-6) mm(2)/s）和左叶(1166 +/- 141 × 10（-6) mm(2)/s）的ADC差异无统计学意义（p = 0.217）。然而，良性CZ的ADC (1154 +/- 129 × 10（-6) mm(2)/s）明显低于良性PZ （1579 +/- 197 × 10-6 mm(2)/s）和良性TZ (1429 +/- 180 × 10(-6) mm(2)/s) （p < 0.001）。虽然指数肿瘤的ADC (1042 +/- 134 × 10（-6) mm(2)/s）明显低于良性CZ (p = 0.002)，但良性CZ与Gleason评分为6的肿瘤(1119 +/- 87 × 10（-6) mm(2)/s）之间无显著差异（p = 0.225）。在22.2%（6/27）的患者中，包括5例Gleason评分大于6的肿瘤患者，良性CZ的ADC低于指数肿瘤。ADC鉴别良性CZ与指数肿瘤的AUC为72.4%（敏感性70.4%，特异性51.9%），鉴别Gleason评分大于6的肿瘤的AUC为76.7%（敏感性75.0%，特异性65.0%）。良性CZ的ADC低于前列腺其他区域的ADC，并与前列腺癌组织（包括高级别肿瘤）的ADC重叠。意识到这一潜在的诊断缺陷对于避免将正常的CZ误诊为肿瘤是很重要的。
OBJECTIVE. The apparent diffusion coefficient (ADC) values for benign central zone (CZ) of the prostate were compared with ADC values of benign peripheral zone (PZ), benign transition zone (TZ), and prostate cancer, using histopathologic findings from radical prostatectomy as the reference standard.MATERIALS AND METHODS. The study included 27 patients with prostate cancer (mean [+/- SD] age, 60.0 +/- 7.6 years) who had 3-T endorectal coil MRI of the prostate performed before undergoing prostatectomy with whole-mount histopathologic assessment. Mean ADC values were recorded from the ROI within the index tumor and within benign CZ, PZ, and TZ, with the use of histopathologic findings as the reference standard. ADC values of the groups were compared using paired t tests and ROC curve analysis.RESULTS. The ADC of benign CZ in the right (1138 +/- 123 x 10(-6) mm(2)/s) and left (1166 +/- 141 x 10(-6) mm(2)/s) lobes was not significantly different (p = 0.217). However, the ADC of benign CZ (1154 +/- 129 x 10(-6) mm(2)/s) was significantly lower (p < 0.001) than the ADCs of benign PZ (1579 +/- 197 x 10-6 mm(2)/s) and benign TZ (1429 +/- 180 x 10(-6) mm(2)/s). Although the ADC of index tumors (1042 +/- 134 x 10(-6) mm(2)/s) was significantly lower (p = 0.002) than the ADC of benign CZ there was no significant difference (p = 0.225) between benign CZ and tumors with a Gleason score of 6 (1119 +/- 87 x 10(-6) mm(2)/s). In 22.2% of patients (6/27), including five patients who had tumors with a Gleason score greater than 6, the ADC was lower in benign CZ than in the index tumor. The AUC of ADC for the differentiation of benign CZ from index tumors was 72.4% (sensitivity, 70.4%; specificity, 51.9%), and the AUC of ADC for differentiation from tumors with a Gleason score greater than 6 was 76.7% (sensitivity, 75.0%; specificity, 65.0%).CONCLUSION. The ADC of benign CZ is lower than the ADC of other zones of the prostate and overlaps with the ADC of prostate cancer tissue, including high-grade tumors. Awareness of this potential diagnostic pitfall is important to avoid misinterpreting the normal CZ as suspicious for tumor.