Correlation Between Quantitative MRI Apparent Diffusion Coefficient Combined With Gleason Score And Prostate Cancer Metastasis

Background and purposeMRI has been widely used in the detection,localization and staging of prostate cancer.The nature of the disease determines the choice of clinical scheme,and whether prostate cancer was accompanied by metastasis was directly related to the clinical prognosis of patients.The apparent diffusion coefficient（ADC）of MRI has a good correlation with the diagnosis,pathological grade and metastasis of prostate cancer,and there was also a certain relationship between tumor pathological grade and lesion metastasis.Therefore,the purpose of this study is to clarify the apparent diffusion coefficient of MRI and prostate cancer（PCA）the relationship between pathological grade and tumor metastasis.The metastatic sites mainly involve bone and lymph nodes.MethodsA total of 73 patients with PCa confirmed by pathology in our hospital from April 2017 to October 2020 were selected.In the past,prostate 3.0T magnetic resonance scanning was performed.The DWI image was post processed by Philips diffusion software.The b value was 1400s/mm²to obtain the ADC value and EADC value of the lesion.According to the pathological results,the patients were divided into low-risk group（Gleason score≤7）and high-risk group（Gleason score≥8）54cases.According to whether prostate cancer patients have bone metastasis,they were divided into 14 cases of bone metastasis group and 59 cases of no bone metastasis group.According to whether prostate cancer patients have lymph node metastasis,they were divided into 19 cases of lymph node metastasis group and 54 cases of no lymph node metastasis group.ResultsThe ADC value of low-risk group was 1.17±0.368×10^-3mm²/s,ADC value of high-risk group was 0.77±0.249×10^-3mm²/s,the area under ROC curve（AUC）between the two groups was 0.821,and when ADC=0.97×10^-3mm²/s,the sensitivity of graded diagnosis was the highest.The ADC value of bone metastasis group was0.74±0.270×10^-3mm²/s,the ADC value of the group without bone metastasis was0.95±0.359×10^-3mm²/s.When ADC truncation value was 0.835×10^-3mm²/s,the AUC of ADC for predicting bone metastasis was 0.666 and the sensitivity was 0.576,The specificity was 0.778（P=0.048）;when the cut-off value of GS was 8.5,the AUC of GS for predicting bone metastasis was 0.656,the sensitivity was 0.733 and the specificity was 0.458（P=0.043）.Using binary logistic regression analysis,ADC combined with Gleason score to predict the AUC of this group was 0.714,the sensitivity was 0.857 and the specificity was 0.542（P=0.013）,the sensitivity of combined prediction of bone metastasis of prostate cancer was 28%and 12%higher than that relying solely on ADC value and GS,respectively;the most common sites of bone metastasis were right iliac bone（20.8%）and left acetabulum（16.7%）.When ADC truncation value was 0.755×10^-3mm²/s,the AUC of ADC for predicting lymph node metastasis was 0.700 and the sensitivity was 0.710,The specificity was 0.727（P=0.006）;when the cut-off value of GS was 8.5,the AUC of GS for predicting lymph node metastasis was 0.738,the sensitivity was 0.750 and the specificity was0.407（P=0.002）.Using binary logistic regression analysis,ADC combined with Gleason score predicted that the AUC of this group was 0.787,the sensitivity was0.929 and the specificity was 0.441（P=0.000）,the sensitivity of combined prediction of lymph node metastasis of prostate cancer was 22%and 18%higher than that of ADC and GS.There was no significant difference in EADC value among groups（P>0.05）.ConclusionsADC value of prostate cancer was negatively correlated with Gleason score.when ADC=0.97×10^-3mm²/s,the sensitivity of grading diagnosis was the highest.Quantitative ADC provides a possibility for noninvasive assessment of risk grading of prostate cancer.ADC value and Gleason score had good correlation with bone metastasis and lymph node metastasis of prostate cancer,and when ADC≤0.835×10^-3mm²/s or GS≥8.5,we should be alert to the occurrence of bone metastasis of prostate cancer.The most common sites of bone metastasis were the right iliac bone and the left acetabulum.When ADC≤0.755×10^-3mm²/s or GS≥8.5,we should be alert to the occurrence of lymph node metastasis of prostate cancer.In addition,quantitative ADC combined with Gleason score can improve the sensitivity of predicting PCA metastasis.Quantitative ADC combined with Gleason score plays an important role in judging the pathological grade,preoperative evaluation and predicting metastasis of prostate cancer.