| Objective To explore the value of PI-RADS v2 score in differentiating benign and malignant prostate lesions.The application value of the quantitative parameters(Ktrans、Kep、ADC)to identify benign and malignant lesions of the prostate was discussed by dynamic contrast enhanced magnetic resonance and diffusion weighted imaging of the prostate.To explore whether PI-RADS v2 score combined with DWI and DCE quantitative parameters can improve the diagnostic efficiency of benign and malignant prostate lesions.Methods From December 2018 to January 2020,the patients of the second affiliated hospital of Zhejiang Traditional Chinese Medicine University who were clinically diagnosed as prostate diseases were collected,underwent prostate MRI examination,and collected images of all the selected patients,which were scored according to the PI-RADS v2 score standard.DCE-MRI images were imported into Omni-kinetics software for post-processing.The dynamic enhancement quantitative parameters(Ktrans、Kep、ADC)were calculated by pharmacokinetic two-compartment model.The original DWI image data was postprocessed by Siemens syngo workstation,and the ADC value was measured.The t test of two independent samples was used to compare the difference of PI-RADS v2 score and the quantitative parameters(Ktrans、Kep、ADC)in the benign and malignant group.ROC curve was drawn to analyze the differential diagnosis efficacy of PI-RADS v2 score and each quantitative parameter value on benign and malignant prostate lesions.The pairwise combination of PI-RADS score,DWI and DCE quantitative parameters(DCE quantitative parameters adopted the Ktrans value with the highest diagnostic efficiency),as well as the combined combination of the three,was used to compare the diagnostic efficiency differences of each joint index.The research program was approved by the hospital ethics review.Results A total of 43 cases were collected in this study,including 23 cases of prostate cancer in the malignant group and 20 cases of prostate cancer in the benign group（18 cases of prostatic hyperplasia and 2 cases of prostatitis）.（1）The PI-RADS v2 score in the malignant group was（3.87±1.01）,and that of the benign group was（2.45±0.95）.The values of Ktrans、Kep、Ve and ADC in the malignant group were（0.247±0.122）min-1、（1.618±0.802）min-1、（0.165±0.067）、（0.857±0.176）×10-3mm2/s.The values of Ktrans、Kep、Ve and ADC in the benign group were（0.105±0.052）min-1、（0.822±0.429）min-1、（0.143±0.057）、（1.199±0.189）×10-3mm2/s.（2）The area under the ROC curve of PI-RADS v2 score was 0.843,and the sensitivity and specificity were 73.9%and 85.0%.The areas under the ROC curve of Ktrans、Kep,Ve and ADC values were 0.838,0.826,0.573 and 0.890,respectively,and the sensitivity was 82.6%,82.6%,34.8%and 85.0%,respectively.The specificity was 75.0%,70.0%,85.0%and 87.0%,respectively.（3）The differences of PI-RADS v2 score、Ktrans、Kep and ADC in benign and malignant prostate lesions were statistically significant.There was no significant difference in Ve value.（4）The optimal diagnostic threshold of PI-RADS v2 score was 3.5 points,and the optimal diagnostic threshold of Ktrans、Kep and ADC were 0.120 min-1、0.872 min-1、1.107×10-3mm2/s.（5）The diagnostic efficacy of all the combined indicators was significant（AUC>0.9）.Among the combined indicators,the diagnostic efficacy of PI-RADS score+ADC+Ktrans was the highest（AUC=0.970）,with sensitivity of 100%and specificity of 87%.Conclusion The differences of PI-RADS v2 score,Ktrans、Kep and ADC values in benign and malignant prostate lesions are statistically significant,which can be used as a reference index for the differentiation of benign and malignant prostate,among which the ADC diagnosis efficiency is the strongest.Combined application of PI-RADS v2 score,DWI,DCE quantitative parameters is helpful to improve the efficacy of prostate benign and malignant lesions identification,with good clinical application value. |
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