Fütterer Jurgen J, Engelbrecht Marc R, Huisman Henkjan J, Jager Gerrit J, Hulsbergen-van De Kaa Christina A, Witjes J Alfred, Barentsz Jelle O
Department of Radiology, University Medical Center Nijmegen, the Netherlands.
Radiology. 2005 Nov;237(2):541-9. doi: 10.1148/radiol.2372041724.
To prospectively determine the accuracy of experienced and less experienced readers in the interpretation of combined T2-weighted fast spin-echo (SE) magnetic resonance (MR) images and dynamic contrast material-enhanced MR images compared with T2-weighted fast SE alone, with respect to differentiation of stage T2 versus stage T3 prostate carcinoma, with histologic analysis serving as the reference standard.
Institutional review board approval and informed consent were obtained, and 124 consecutive men (age range, 42-74 years; median age, 63 years) with biopsy-proved prostate cancer underwent MR imaging and were candidates for radical prostatectomy. T2-weighted fast SE MR images and multisection dynamic contrast-enhanced MR images with a 2-second time resolution for the whole prostate were obtained. The T2-weighted and fused color-coded parametric dynamic contrast-enhanced MR images with T2-weighted images were evaluated prospectively and scored with regard to local extent by one experienced reader and evaluated retrospectively by two less experienced readers working in consensus by using a five-point scale; images with a score greater than or equal to four were considered indicative of T3 disease. Results were correlated with whole-mount section histopathologic findings, and receiver operating characteristics analysis was performed.
Twenty-five patients were excluded because of positive findings in the lymph nodes (n = 16), preoperative biopsy-proved seminal vesicle invasion (n = 5), and an absent dynamic dataset (n = 4). Ninety-nine patients were included in this study. The overall sensitivity, specificity, and accuracy of MR staging performance in prostate cancer with dynamic contrast-enhanced MR imaging was 69% (24 of 35 patients), 97% (62 of 64 patients), and 87% (86 of 99 patients), respectively, for the experienced reader. This difference was not significant (P = .48) when results were compared with results from the T2-weighted images. Staging performance for the less experienced readers with parametric dynamic contrast-enhanced MR imaging, however, resulted in significant improvement of the area under the receiver operating characteristics curve (A(z)) compared with T2-weighted MR imaging alone (A(z) = .66 and .82, respectively; P = .01).
The use of multisection dynamic contrast-enhanced MR imaging in staging prostate cancer showed significant improvement in staging performance for the less experienced readers but had no benefit for the experienced reader.
前瞻性地确定经验丰富和经验较少的阅片者在解读联合T2加权快速自旋回波（SE）磁共振（MR）图像和动态对比增强MR图像时与单独使用T2加权快速SE图像相比，在鉴别T2期与T3期前列腺癌方面的准确性，以组织学分析作为参考标准。
获得机构审查委员会批准并取得知情同意，124例经活检证实患有前列腺癌的连续男性患者（年龄范围42 - 74岁；中位年龄63岁）接受了MR成像检查，且均为前列腺癌根治术的候选者。获取了T2加权快速SE MR图像以及全前列腺时间分辨率为2秒的多层面动态对比增强MR图像。由一位经验丰富的阅片者对T2加权图像以及融合了T2加权图像的彩色编码参数化动态对比增强MR图像进行前瞻性评估，并根据局部范围使用五点量表评分；评分大于或等于四分的图像被认为提示T3期疾病。将结果与全切片组织病理学结果进行关联，并进行受试者操作特征分析。
由于淋巴结阳性发现（n = 16）、术前活检证实精囊侵犯（n = 5）以及缺乏动态数据集（n = 4），25例患者被排除。99例患者纳入本研究。对于经验丰富的阅片者，动态对比增强MR成像在前列腺癌MR分期中的总体敏感性、特异性和准确性分别为69%（35例患者中的24例）、97%（64例患者中的62例）和87%（99例患者中的86例）。与T2加权图像的结果相比，该差异无统计学意义（P = 0.48）。然而，对于经验较少的阅片者，参数化动态对比增强MR成像的分期性能与单独的T2加权MR成像相比，受试者操作特征曲线下面积（A(z)）有显著改善（分别为A(z) = 0.66和0.82；P = 0.01）。
在前列腺癌分期中使用多层面动态对比增强MR成像对经验较少的阅片者的分期性能有显著改善，但对经验丰富的阅片者无益处。
