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目的对照前列腺癌(Pca)根治术后病理切片,探讨国人Pca磁共振波谱成像(MRS)的诊断标准及其可靠性。方法根据5例行Pca根治术患者的术前MRS的最大横径层面切取前列腺标本兴趣层,依照MRS兴趣层内诸体素将标本层切块,制备成与MRS结果一一对应的病理切片,分析病理结果中全部有癌区及与之对应区域的MRS的(胆碱+肌酐)/枸橼酸盐(CC/C)值,绘制受试者工作特征曲线获得CC/C诊断Pca的最佳诊断阈值。采用SPSS 11.5分析软件,计算本组数据在CC/C值>0.86标准下诊断Pca的敏感性、特异性及准确性,再采用受试者工作特征曲线分析法选择本研究数据诊断Pca最佳CC/C值,并计算在此标准下的敏感性、特异性及准确性。结果本实验共得病理结果 90个,无癌区20个,有癌区70个,得到CC/C值90个,在CC/C值>0.86标准下,MRS诊断无癌区25个,有癌区65个,与病理对照诊断正确区域分别为14个和59个,MRS诊断Pca的准确性为CA=81.1%,敏感性为Se=84.3%、特异性为Sp=70.0%。利用受试者工作特征曲线确定基于本研究CC/C值的诊断阈值(Cut-off值)以0.88最佳,以此标准计算MRS诊断Pca的准确性为CA=80.0%,敏感性为Se=81.4%,特异性为Sp=75.0%。结论 CC/C值>0.88较国际标准的>0.86可能更适合于国人的Pca MRS诊断。
Objective To compare the pathological results of radical prostatectomy (Pca) and evaluate the diagnostic criteria and reliability of Pca magnetic resonance imaging (MRS) in Chinese. Methods According to the maximum horizontal diameter of MRS in 5 patients who underwent radical resection of Pca, the specimens were excised according to the voxels in the interest layer of MRS. The specimens were then cut into sections corresponding to MRS results. The choline + creatinine / citrate (CC / C) values of MRS in all cancers and their corresponding regions were analyzed and the receiver operating characteristic curves were plotted to obtain the best CC / C diagnosis of Pca Diagnostic threshold. Using SPSS 11.5 analysis software to calculate the sensitivity, specificity and accuracy of the diagnosis of Pca under the CC / C value of> 0.86 in this group of data, and then use the working characteristic curve analysis method to select the data of this study to diagnose Pca best CC / C value, and calculate the sensitivity, specificity and accuracy under this standard. Results There were 90 pathological findings, 20 non-cancerous areas and 70 cancerous areas with 90 CC / C values. There were 25 non-cancerous areas in MRS diagnosis with CC / C value> 0.86 The accuracy of MRS in diagnosing Pca was 81.1% for CA, the sensitivity was Se = 84.3% and the specificity was Sp = 70.0%. The accuracy of the diagnosis of Pca was MR = 80.0% and the sensitivity was Se = 0.88. The best cut-off value based on the CC / C value of the study was 0.88. 81.4% with a specificity of Sp = 75.0%. Conclusion The CC / C value> 0.88 may be more suitable for Pca MRS diagnosis in China than the international standard> 0.86.