Fütterer Jurgen J, Heijmink Stijn W T P J, Scheenen Tom W J, Jager Gerrit J, Hulsbergen-Van de Kaa Christina A, Witjes J Alfred, Barentsz Jelle O
Department of Radiology, University Medical Center Nijmegen, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, The Netherlands.
Radiology. 2006 Jan;238(1):184-91. doi: 10.1148/radiol.2381041832. Epub 2005 Nov 22.
To prospectively investigate the local staging accuracy of 3-T endorectal magnetic resonance (MR) imaging for prostate cancer by using whole-mount-section histopathologic analysis as the standard of reference.
This study was approved by the institutional review board, and informed consent was obtained from all patients. In 35 consecutive patients (median age, 62.3 years) with biopsy-proved prostate cancer, 3-T endorectal MR imaging was performed. High-spatial-resolution endorectal T2-weighted fast spin-echo images of the prostate were obtained in three planes. MR images were prospectively evaluated by two experienced radiologists and a third radiologist who was less experienced with regard to local disease extent by using five established extracapsular criteria. Whole-mount-section histopathologic analysis was the standard of reference. Evaluation was performed according to octant and patient. Sensitivity, specificity, positive and negative predictive values, overall accuracy, and interobserver agreement were calculated.
Thirty-two patients who underwent radical prostatectomy were enrolled in this study. Accuracy, sensitivity, and specificity of local staging were 94% (30 of 32), 88% (seven of eight), and 96% (23 of 24), respectively, for both experienced radiologists, and these values were 81% (26 of 32), 50% (four of eight), and 92% (22 of 24), respectively, for the less experienced radiologist. There was substantial agreement between both experienced readers (kappa = 0.42-0.79) and moderate agreement between the less experienced reader and the experienced readers with respect to all extracapsular criteria. In regard to the three cases of minimal capsular invasion, two were detected by both experienced radiologists.
In this study, high accuracy for staging of prostate cancer at 3-T endorectal MR imaging, with moderate to substantial observer agreement, was demonstrated. In addition, minimal capsular invasion could be detected.
以前瞻性方式，采用全层切片组织病理学分析作为参考标准，研究3-T腔内磁共振（MR）成像对前列腺癌的局部分期准确性。
本研究经机构审查委员会批准，并获得所有患者的知情同意。对35例经活检证实为前列腺癌的连续患者（中位年龄62.3岁）进行3-T腔内MR成像检查。在三个平面上获取前列腺的高空间分辨率腔内T2加权快速自旋回波图像。由两名经验丰富的放射科医生和一名对局部疾病范围经验较少的第三放射科医生，使用五项既定的包膜外标准对MR图像进行前瞻性评估。全层切片组织病理学分析为参考标准。根据八分法和患者进行评估。计算敏感性、特异性、阳性和阴性预测值、总体准确性以及观察者间一致性。
本研究纳入了32例行根治性前列腺切除术的患者。两名经验丰富的放射科医生对局部分期的准确性、敏感性和特异性分别为94%（32例中的30例）、88%（8例中的7例）和96%（24例中的23例），而经验较少的放射科医生的这些值分别为81%（32例中的26例）、50%（8例中的4例）和92%（24例中的22例）。两名经验丰富的阅片者之间在所有包膜外标准方面存在高度一致性（kappa = 0.42 - 0.79），经验较少的阅片者与经验丰富的阅片者之间存在中度一致性。对于三例微小包膜侵犯病例，两名经验丰富的放射科医生均检测出两例。
在本研究中，3-T腔内MR成像对前列腺癌分期具有较高准确性，观察者间一致性为中度至高度。此外，能够检测出微小包膜侵犯。
