多参数磁共振成像联合血清ALP、D-二聚体、FIB对前列腺癌骨转移的诊断效能分析
Analysis of the Diagnostic Efficacy of Multi-Parameter Magnetic Resonance Imaging Combined with Serum ALP, D-Dimer, and FIB for Prostate Cancer Bone Metastasis

目的：多参数磁共振成像(multiparametric magnetic resonance imaging, mpMRI)联合血清碱性磷酸酶(alkaline phosphatase, ALP)、D-二聚体(D-dimer, DD2)、纤维蛋白原(fibrinogen, FIB)诊断前列腺癌骨转移的效能分析。方法：对169例前列腺癌患者的临床资料进行回顾性收集和分析，根据骨扫描的检查结果辅以核磁共振，将盆腔有无骨转移的病人分为前列腺癌骨转移组80例和非骨转移组89例。所有患者在手术前都接受了MRI检查，对血清PSA、ALP、D-二聚体、FIB水平进行定量检测。对不同影像指标与前列腺癌骨转移结果之间的一致性采用Kappa一致性检验；利用单因素和多因素Logistic回归分析，评估mpMRI、ALP、D-二聚体、FIB及其他临床指标在前列腺癌骨转移诊断中的价值。利用受试者工作特征(receiver operating characteristic, ROC)曲线对前列腺癌骨转移中纳入的mpMRI、ALP、D-二聚体、FIB及其联合指标的临床应用价值进行评价。结果：T1WI、T2WI压脂、DWI及mpMRI与前列腺癌骨转移结果比较的Kappa值分别为0.536、0.470、0.629、0.691 (P < 0.001)。与前列腺癌非骨转移组相比，骨转移组患者的血清ALP、D-二聚体、FIB水平更高(P < 0.001)。多因素Logistic回归分析表明，mpMRI、ALP、D-二聚体、FIB均是前列腺癌骨转移的独立危险因素(P < 0.05)。联合指标水平最佳，其次为单一指标D-二聚体、mpMRI、ALP、FIB，均体现了较好的诊断价值(P < 0.05)。结论：mpMRI、ALP、D-二聚体、FIB均对前列腺癌骨转移有一定诊断效能，将这些指标联合后能进一步提升诊断价值，在临床实践考虑推广使用。
Objective: To analyze the efficacy of multiparametric MRI (mpMRI) combined with serum ALP, D-dimer, and FIB in the diagnosis of bone metastasis in prostate cancer. Methods: A retrospective collection and analysis of clinical data from 169 prostate cancer patients were conducted. Based on the results of bone scans supplemented by MRI, patients with or without pelvic bone metastasis were divided into the prostate cancer bone metastasis group (80 cases) and the non-bone metastasis group (89 cases). All patients underwent MRI examination prior to surgery, and serum levels of PSA, ALP, D-dimer, and FIB were quantitatively measured. Kappa consistency tests were used to analyze the agreement between different imaging indicators and the results of prostate cancer bone metastasis. Uni- and multivariable logistic regression analyses were performed to evaluate the value of mpMRI, ALP, D-dimer, FIB, and other clinical indicators in the diagnosis of prostate cancer bone metastasis. The clinical application value of mpMRI, ALP, D-dimer, FIB, and their combined indicators in diagnosing prostate cancer bone metastasis was assessed using receiver operating characteristic (ROC) curves. Results: The Kappa values comparing T1WI, T2WI fat suppression, DWI, and mpMRI with the results of prostate cancer bone metastasis were 0.536, 0.470, 0.629, and 0.691, respectively (P < 0.001). Compared to the non-bone metastasis group, the serum levels of ALP, D-dimer, and FIB in the bone metastasis group were significantly higher (P < 0.001). Multivariable logistic regression analysis indicated that mpMRI, ALP, D-dimer, and FIB are independent risk factors for prostate