Study On Diagnosis And Differential Diagnosis Of Prostatic Carcinoma With Magnetic Resonance Spectroscopy

Objective Analysis metabolic characteristic of normal prostate,benign prostate hyperplasia(BPH)and prostate cancer(PCa)with MR spectroscopic(MRS),to evaluate MRS combine MRI in the diagnosis and differential diagnosis of PCa.Materials and Methods Compile clinical date,information of MRS and MRI of 87 patients(52 of BPH,33 ofPCa,2 of prostatic Leiomyosarcoma)and 10 cases of normal prostate.Most hyperplasia in 52 BPH are glandular organ mix to muscle fiber,3 in muscle fiber and 6 in glandular organ;All cases have patho-confirmed.33 PCa(9 of PZ,2 of CZ)and large tumor involve PZ and CZ meanwhile of 22;Patho-confirm 26 cases and clinical confirm 7 cases.2 cases of prostatic Leiomyosarcoma all have confirmed of operative verification.MR imaging/MR spectroscopic imaging studies were performed with a 1.5T SIEMENS sonata Medical System before operation and biopsy-pricking.The sequences included axial T1WI,axial T2WI,fs T2WI and coronal,anteroposterior axes of T1WI,T2WI,3D MRSI by PRESS and multi voxel spectroscopy.While we use software to postprocessing,measure and calculus.MRI observation was focused on the size of the gland,the location of the lesion,the signal features and the extent of the tumor.MRS observation included the chemical shift of citrate(Cit),choline(Cho)and creatine(Cr)spectra,and the ratio of Cho+Cr/Cit. There are 4 voxels in a matter that 388 voxels are analyzed altogether.Statistics analysis of normal,BPH and PCa are K-S test and case drawing,while validated gaussian distribution.Compare with interclass by One-way ANOVA and LSD,P＜0.05 discrepancy have statistical significance.ROC curve to select best diagnosis region and calculation sensitivity and specificity.Eventually,Contrast MRI,MRS,ultrasound and PSA with pathology to compare sensitivity,specificity,accracy,positive predictive value and negative predictive value of them.Results Most BPH are in central zone,6 of intrude bladder,PZ have been compressed;5 of hyperplasia in PZ,CZ without augmentation.On MRI,27 cases have apparent signal of PCa,in these the affected structures included seminal vesicle(n=21),bladder (n=14),bone of pelvic(n=15),rectum(n=5)and pelvic lymph nodes fused in mass(n=6);While having apparent sign of PCa was not found in 6 cases. Leiomyosarcoma of prostate is mingle signal and uneven strengthening.On MRS,Cit peak is most high in normal prostate.The average ratio of(Cho+Cr)/Cit is 0.4168±0.15365;In BPH,Cho peak steps up the ratio is 0.4578±0.17357;Cho peak is most of high,two peaks inversion,the ratio is 2.2605±2.47032.Leiomyosarcoma of prostate's Cho steps up and Cit doesn't descend.The ratio of(Cho+Cr)/Cit in normal,BPH and PCa have discrepancy in statistics.PCa's ratio is most of high.Best diagnose region is 0.785,sensitivity is 89.4%and specificity is 99.2%.Conclusion (1)MRI can well display localization of tumor,detection of circum-organization and assessment if have metastases.MRI is base of imaging diagnose,but have limitations of pathological changes in CZ;(2)Spectra shape in normal and BPH don't have discrepancy.Spectra shape in normal,BPH all have discrepancy with PCa;(3)On these grounds we can draw qualitative diagnose.Best diagnose region is 0.785, sensitivity is 89.4%and specificity is 99.2%;(4)Sensitiveness,degree of accuracy and specificity are the highest in MRS;(5)Connect MRS with MRI can raise diagnose and differential diagnosis of PCa.①Raise differential diagnosis of PCa;②Judge the degree of tumor;③Evaluate bionomics of PCa;④Judeg the prognosis of PCa;(6)Due to multiple factors,we wish to move forward a single step to elevate and improve time and space resolution.