Abstract:

Objective　To explore the value of 3.0T multi-parameter magnetic resonance imaging (Mp-MRI), namely T2 weighted imaging (T2WI) combined with diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE) in the diagnosis and differential diagnosis of chronic prostatitis (CP) of peripheral zone. Methods　The Mp-MRI data of 23 patients with CP of peripheral zone and 38 patients with prostate cancer (PCa) of peripheral zone who underwent prostate Mp-MRI examination and were pathologically confirmed in The First Affiliated Hospital of Guangdong Pharmaceutical University from July 2016 to December 2021 were retrospectively analyzed. The age of the CP group was (64.3±7.8) years old, and that of the PCa group was (73.7±8.5) years old. According to the pathological results and the lesion range of peripheral zone of prostate on Mp-MRI, all the selected cases were subdivided into four subgroups: diffuse CP (CP1), focal CP (CP2), diffuse PCa (PCa1), and focal PCa (PCa2). One way ANOVA or independent sample t-test was used to compare the differences of apparent diffusion coefficient (ADC) values among normal tissues, CP, and PCa in the peripheral zone and among subgroups of CP and PCa. Fisher's exact test was used to compare the distribution of signal intensity-time (SI-T) curve types among CP, PCa, and their subgroups. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of ADC value in diagnosing CP of peripheral zone and determine the optimal cut-off value. The sensitivity, specificity, and accuracy of Mp-MRI (T2WI+DWI-ADC+DCE) in the diagnosis of CP were calculated. Results　Among the 23 cases of CP, there were 16 cases in the CP1 subgroup and 7 cases in the CP2 subgroup; among the 38 cases of PCa, there were 21 cases in the PCa1 subgroup and 17 cases in the PCa2 subgroup. There was a statistically significant difference in the ADC value among CP of peripheral zone, PCa, and normal tissues [(1.15±0.23) ×10^-3 mm²/s vs. (0.85±0.28) ×10^-3 mm²/s vs. (1.54±0.19) ×10^-3 mm²/s] (F=14.27, P<0.01). There was a statistically significant difference in the ADC value among CP1, CP2, PCa1, and PCa2 subgroups [(1.17±0.11) ×10^-3 mm²/s vs. (1.10±0.18) ×10^-3 mm²/s vs. (0.81±0.17) ×10^-3 mm²/s vs. (0.89±0.21) ×10^-3 mm²/s] (F=9.76, P<0.01). There were statistically significant differences in the ADC value between the CP group and the PCa group [(1.15±0.23) ×10^-3 mm²/s vs. (0.85±0.28) ×10^-3 mm²/s], between the CP1 subgroup and the PCa1 subgroup [(1.17±0.11) ×10^-3 mm²/s vs. (0.81±0.17) ×10^-3 mm² /s], between the CP2 subgroup and the PCa2 subgroup [(1.10±0.18) ×10^-3 mm²/s vs. (0.89±0.21) ×10^-3 mm²/s] (t=4.23, 7.48, and 2.31; all P<0.05). There were no statistically significant differences in the ADC value between the CP1 subgroup and the CP2 subgroup, between the PCa1 subgroup and the PCa2 subgroup (t=1.16 and 1.30; all P>0.05). Taking ADC value >1.02×10^-3 mm²/s as the diagnostic criteria for CP, the sensitivity, specificity, and accuracy were 86.96%, 89.47%, and 88.52% respectively. There were statistically significant differences in the distribution of DCE SI-T curve types between the CP group and the PCa group, between the CP1 subgroup and the PCa1 subgroup, between the CP2 subgroup and the PCa2 subgroup (all P<0.01). Compared with the surgical pathology, the sensitivity, specificity, and accuracy of Mp-MRI (T2WI+DWI-ADC+DCE) in the diagnosis of CP of peripheral zone were 91.30%, 92.11%, and 91.80%, respectively. Conclusion　Mp-MRI has a high diagnostic efficiency for CP of peripheral zone, and can more accurately distinguish CP from PCa, which can be used as an important method for non-invasive diagnosis of CP of peripheral zone.

Key words: Chronic prostatitis, Multi-parameter magnetic resonance imaging, Quantitative measurement

摘要： 目的　探讨3.0T多参数磁共振成像（Mp-MRI），即T2加权像（T2WI）联合弥散加权成像（DWI）及动态增强（DCE）对外周带慢性前列腺炎（CP）的诊断和鉴别诊断价值。方法　回顾性分析2016年7月至2021年12月在广东药科大学附属第一医院行前列腺Mp-MRI检查并经病理证实的23例外周带CP及38例外周带前列腺癌（PCa）患者Mp-MRI资料。CP组年龄（64.3±7.8）岁，PCa组年龄（73.7±8.5）岁。按病理结果及Mp-MRI上前列腺外周带病变范围，将所有入选病例再分为弥漫性慢性前列腺炎（CP1）、局灶性慢性前列腺炎（CP2）、弥漫性前列腺癌（PCa1）、局灶性前列腺癌（PCa2）4个亚组。采用单因素方差分析或独立样本t检验比较外周带正常组织、CP、PCa及CP、PCa各亚组间表观弥散系数（ADC）值的差异。采用Fisher确切概率法比较CP、PCa及其各亚组间信号强度-时间（SI-T）曲线类型分布的差异。利用受试者工作特征曲线（ROC）评价ADC值诊断外周带CP的诊断效能并确定最佳阈值。计算Mp-MRI（T2WI+DWI-ADC+DCE）诊断CP的灵敏度、特异度和准确度。结果　23例外周带CP中CP1亚组16例、CP2亚组7例，38例外周带PCa中PCa1亚组21例、PCa2亚组17例。外周带CP、PCa、正常组织间ADC值［（1.15±0.23）×10^-3 mm²/s、（0.85±0.28）×10^-3 mm²/s、（1.54±0.19）×10^-3 mm²/s］比较，差异有统计学意义（F=14.27，P<0.01）；CP1、CP2、PCa1、PCa2亚组间ADC值［（1.17±0.11）×10^-3 mm²/s、（1.10±0.18）×10^-3 mm²/s、（0.81±0.17）×10^-3 mm²/s、（0.89±0.21）×10^-3 mm²/s］比较，差异有统计学意义（F=9.76，P<0.01）；CP与PCa组ADC值［（1.15±0.23）×10^-3 mm²/s比（0.85±0.28）×10^-3 mm²/s］、CP1与PCa1亚组ADC值［（1.17±0.11）×10^-3 mm²/s比（0.81±0.17）×10^-3 mm²/s］、CP2与PCa2亚组ADC值［（1.10±0.18）×10^-3 mm²/s比（0.89±0.21）×10^-3 mm²/s］比较，差异均有统计学意义（t=4.23、7.48、2.31，均P<0.05）；CP1与CP2、PCa1与PCa2亚组间ADC值差异均无统计学意义（t=1.16、1.30，均P>0.05）。以ADC值>1.02×10^-3 mm²/s为诊断CP标准，灵敏度为86.96%，特异度为89.47%，准确度为88.52%。DCE SI-T曲线类型在CP组和PCa组、CP1亚组和PCa1亚组、CP2亚组和PCa2亚组间的分布差异均有统计学意义（均P<0.01）。与手术病理对照，Mp‑MRI（T2WI+DWI-ADC+DCE）诊断外周带CP的灵敏度为91.30%、特异度为92.11%、准确度为91.80%。结论　Mp-MRI对外周带CP的诊断效能较高，能较准确区分CP和PCa，可作为无创性诊断外周带CP的一种重要方法。

关键词: 慢性前列腺炎, 多参数磁共振成像, 定量测量