Akin Oguz, Sala Evis, Moskowitz Chaya S, Kuroiwa Kentaro, Ishill Nicole M, Pucar Darko, Scardino Peter T, Hricak Hedvig
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Radiology. 2006 Jun;239(3):784-92. doi: 10.1148/radiol.2392050949. Epub 2006 Mar 28.
To retrospectively evaluate the accuracy of endorectal magnetic resonance (MR) imaging in the detection and local staging of transition zone prostate cancers, with pathologic analysis serving as the reference standard, and to assess MR imaging features of these cancers.
The institutional review board approved this HIPAA-compliant retrospective study and waived the informed consent requirement. An institutional database of 986 patients who underwent MR imaging before radical prostatectomy yielded 148 consecutive patients with at least one transition zone cancer at step-section pathologic analysis. An additional 46 patients without transition zone cancer were randomly selected as a control group. Two readers independently reviewed MR studies to identify patients with transition zone cancers and determine the location and local extent of these cancers. Imaging features that helped in the identification of transition zone cancers were recorded. Descriptive and kappa statistics, as well as receiver operating characteristic and multivariate logistic regression analyses, were used.
For identification of patients with transition zone cancers, sensitivity and specificity were 75% and 87%, respectively, for reader 1 and 80% and 78%, respectively, for reader 2. Interreader agreement was fair. For detection of the location of transition zone cancer, the area under the receiver operating characteristic curve was 0.75 for reader 1 and 0.73 for reader 2. Interreader agreement was fair. The readers' accuracy in detecting transition zone cancer foci increased significantly (P=.001) as tumor volume increased. In the detection of extraprostatic extension of transition zone cancers, sensitivity and specificity were 56% and 94%, respectively, for reader 1 and 28% and 93%, respectively, for reader 2. Homogeneous low T2 signal intensity (P=.001 for reader 1, P<.001 for reader 2) and lenticular shape (P=.017 for reader 1) were significantly associated with the presence of transition zone cancer.
MR imaging can be used to detect, localize, and stage transition zone prostate cancers.
以病理分析作为参考标准，回顾性评估直肠内磁共振（MR）成像在检测移行区前列腺癌及进行局部分期方面的准确性，并评估这些癌症的MR成像特征。
机构审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的回顾性研究，并免除了知情同意要求。一个包含986例在前列腺癌根治术前接受MR成像检查患者的机构数据库，经病理切片分析发现有148例连续患者至少患有一处移行区癌。另外随机选择46例无移行区癌的患者作为对照组。两名阅片者独立审查MR研究，以识别患有移行区癌的患者，并确定这些癌症的位置和局部范围。记录有助于识别移行区癌的成像特征。使用描述性统计、kappa统计以及受试者操作特征曲线和多变量逻辑回归分析。
对于识别移行区癌患者，阅片者1的敏感度和特异度分别为75%和87%，阅片者2分别为80%和78%。阅片者间一致性为中等。对于检测移行区癌的位置，阅片者1的受试者操作特征曲线下面积为0.75，阅片者2为0.73。阅片者间一致性为中等。随着肿瘤体积增大，阅片者检测移行区癌灶的准确性显著提高（P = 0.001）。在检测移行区癌的前列腺外侵犯方面，阅片者1的敏感度和特异度分别为56%和94%，阅片者2分别为28%和93%。均匀低T2信号强度（阅片者1为P = 0.001，阅片者2为P < 0.001）和透镜状形态（阅片者1为P = 0.017）与移行区癌的存在显著相关。
MR成像可用于检测、定位和分期移行区前列腺癌。
