基于体素内不相干运动的虚拟MR弹性成像鉴别前列腺癌与良性病变的诊断价值
前瞻性纳入120例疑似前列腺病变患者，术前行3.0-T MRI包括IVIM-vMRE序列，比较前列腺癌与良性病变的虚拟硬度值（μdiff）。前列腺癌μdiff显著高于良性病变（9.25±1.06 kPa vs. 7.27±0.53 kPa，P<0.001），最佳截断值7.90 kPa时AUC为0.931（95%CI: 0.886-0.976），且μdiff与Gleason评分正相关（r=0.670，P<0.001）。μdiff联合PI-RADS v2.1的AUC（0.941）显著优于单独PI-RADS v2.1（0.811，P<0.001）。
要点
- IVIM-vMRE生成的虚拟硬度图可定量测量前列腺组织硬度，前列腺癌μdiff高于良性病变。
- μdiff最佳截断值7.90 kPa时鉴别前列腺癌与良性病变的AUC达0.931。
- μdiff联合PI-RADS v2.1可显著提高诊断准确性，并有助于评估肿瘤侵袭性。
核心结论
- IVIM-vMRE提供客观可量化的前列腺组织硬度指标，与肿瘤分级相关，作为bpMRI的无创辅助手段可显著提高PI-RADS v2.1的诊断准确性并有助于肿瘤侵袭性分层。
研究设计与样本
- 前瞻性研究，最终纳入120例疑似前列腺病变患者（70例前列腺癌，50例良性病变），术前行3.0-T MRI包括IVIM-vMRE序列，以病理为参考标准。
- 两位放射科医师在不知病理结果情况下手动勾画感兴趣区并进行PI-RADS v2.1评分，采用ROC分析评估诊断性能，Spearman秩相关评估μdiff与Gleason评分相关性，并通过1000次bootstrap进行内部验证。
关键影像表现/征象
- 前列腺癌病灶的μdiff值显著高于良性前列腺病变（9.25±1.06 kPa vs. 7.27±0.53 kPa，P<0.001）。
诊断标准与关键数值
- μdiff鉴别前列腺癌与良性病变的最佳截断值为7.90 kPa，AUC为0.931（95%CI: 0.886-0.976）。
- μdiff与病理Gleason评分呈显著正相关（r=0.670，P<0.001）。
- μdiff联合PI-RADS v2.1模型的AUC为0.941，显著优于单独PI-RADS v2.1的AUC 0.811（P<0.001），bootstrap验证中乐观校正AUC为0.940。
临床应用与阅片要点
- 在bpMRI阅片中加入IVIM-vMRE生成的μdiff图，可辅助鉴别前列腺癌与良性病变，减少不必要活检。
- μdiff值可与PI-RADS v2.1评分联合使用，提高诊断准确性并提示肿瘤侵袭性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To evaluate the diagnostic efficacy of virtual magnetic resonance elastography (vMRE) derived from intravoxel incoherent motion (IVIM) imaging in distinguishing prostate cancer (PCa) from benign prostate lesion (BPL).
METHODS: In this prospective study, patients with suspected prostate lesions underwent 3.0-T MRI, including an IVIM-vMRE sequence, prior to biopsy or surgery. Virtual stiffness maps (µdiff) were generated using a custom MATLAB algorithm. Two radiologists, blinded to pathology, performed manual region-of-interest segmentation and PI-RADS v2.1 scoring. The protocol focused on comparing µdiff values between malignant and benign lesions. Diagnostic performance was assessed via receiver operating characteristic (ROC) analysis, and the correlation between µdiff and Gleason scores was evaluated using Spearman's rank correlation. Internal validation was performed via 1,000-sample bootstrapping.
RESULTS: The final cohort comprised 120 patients (70 PCa; 50 BPL). PCa lesions exhibited significantly higher µdiff values compared to BPL (9.25 ± 1.06 kPa vs. 7.27 ± 0.53 kPa, P < 0.001). ROC analysis revealed an optimal µdiff cutoff of 7.90 kPa, which yielded an AUC of 0.931 (95% CI: 0.886-0.976). Furthermore, µdiff values were significantly positively correlated with pathological Gleason scores (r = 0.670, P < 0.001). The combined model of µdiff and PI-RADS v2.1 significantly outperformed PI-RADS v2.1 alone (AUC: 0.941 vs. 0.811, P < 0.001), and it achieved an optimism-corrected AUC of 0.940 in bootstrap validation.
CONCLUSION: IVIM-vMRE provides an objective, quantifiable measure of prostate tissue stiffness that correlates with tumor grade. As a non-invasive adjunct to bpMRI, vMRE significantly improves the diagnostic accuracy of PI-RADS v2.1 and facilitates the stratification of tumor aggressiveness.
引用
- Wang Z, Zhang R, Liu J, et al. Diagnostic value of intravoxel incoherent motion-based virtual MR elastography for differentiating prostate cancer from benign prostate lesion. Abdom Radiol (NY). 2026. PMID: 42065784. doi:10.1007/s00261-026-05535-9
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。