Evaluation Of High B-value DWI Combined With DKI In The Diagnosis And Grading Of Prostate Cancer

Objective:To explore the value of diffusion weighted imaging（DWI）and diffusion kurtosis imaging（DKI）in the diagnosis and grading of prostate cancer.Materials and methods:A total of 76 patients with suspected Prostate cancer in the Affiliated Hospital of North Sichuan Medical College from June 2021 to December 2021 were collected.Thirty-three patients in the Prostate cancer（PCa）group were selected according to clinicopathological results and inclusion and exclusion criteria.33 cases of Benign prostatic hyperplasia（BPH）were reported.Then,according to Gleason score,33 patients with PCa were divided into 14 cases in low-risk group（Gleason≤3+3,Gleason=3+4）and 19 cases in medium and high-risk group（Gleason=4+3,Gleason≥8）.All subjects underwent 3.0T MRI prostateT1WI,T2WI,DWI（b=2000 s/mm²）and DKI scans.Two experienced radiologists delineated the region of interest（ROI）of benign and malignant lesions of prostate at the post-processing workstation,and recorded the apparent diffusion coefficient（ADC）,mean kurtosis（MK）and mean diffusion coefficient（MD）.The differences of ADC₂₀₀₀,MD,MK and their combined parameters among groups were statistically analyzed;Draw the ROC curve of each parameter and its combination,analyze its diagnostic efficacy,and analyze the correlation between the parameter values ofPCa group and Gleason score.Results:1.The measurement of ADC₂₀₀₀,MD and MK values by two surveyors showed high consistency,with ICC>0.8.2.The average MK value of PCa group was significantly higher than that of BPH group,and the difference was statistically significant（P<0.001）.The average ADC₂₀₀₀ value and MD value in PCa group were significantly lower than those in BPH group,with statistical significance（P<0.001）.The AUC of ADC₂₀₀₀,MD and MK in diagnosing PCa was 0.981,0.969 and 0.925,respectively.There was no significant difference in AUC between ADC₂₀₀₀ and MD（P>0.05）,but there was significant difference between ADC₂₀₀₀ and MK and between MD and MK（P<0.05）.The AUC of ADC₂₀₀₀ combined MD,ADC₂₀₀₀ combined MK and MD combined MK were 0.983,0.979 and 0.969 respectively,and only the difference between ADC₂₀₀₀ combined MK and MK was statistically significant（P<0.05）.3.The average MK value of low-risk PCa group was lower than that of medium-risk PCa group,and the difference was statistically significant（P=0.006）.The average ADC₂₀₀₀ and MD values in the low-risk group were higher than those in the medium-risk group,and the difference was statistically significant（P=0.011）.The AUC of ADC₂₀₀₀,MD and MK in PCa grading assessment was 0.774,0.765 and 0.767,respectively,with no statistical significance between groups（P>0.05）.The AUC of ADC₂₀₀₀ combined MD,ADC₂₀₀₀ combined MK and MD combined MK in PCa grading was 0.774,0.786 and 0.789,respectively,with no statistically significant difference between groups（P>0.05）.4.ADC₂₀₀₀ was highly negatively correlated with MK（r=-0.642,P<0.01）,ADC was highly positively correlated with MD（r=0.815,P<0.01）,MD was highly negatively correlated with MK（r=-0.670,P<0.01）.ADC₂₀₀₀ value was moderately negatively correlated with Gleason score（r=-0.446,P<0.01）,while MK value was moderately positively correlated with Gleason score（r=0.414,P<0.05）.There was a moderate negative correlation between MD and Gleason score（r=-0.539,P<0.01）.Conclusions:1.The clinical application of high b-value DWI and DKI in PCa diagnosis and pathological grading is feasible,and the related quantitative parameters ADC₂₀₀₀,MD and MK have high value in the evaluation of PCa diagnosis and grading.2.High b-value DWI combined with DKI and DKI alone had high evaluation value for PCa diagnosis and pathological grading,but the combined application showed no more significant advantage.