Manenti G, Squillaci E, Carlani M, Mancino S, Di Roma M, Simonetti G
Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Università di Roma Tor Vergata", Policlinico, Viale Oxford 81, 1-00133 Rome, Italy.
Radiol Med. 2006 Feb;111(1):22-32. doi: 10.1007/s11547-006-0003-x.
The purpose of this study was to evaluate the diagnostic ability of proton magnetic resonance spectroscopic imaging (MRSI) in the detection and localisation of prostate cancer, prospectively compared with histopathologic findings.
Magnetic resonance imaging (MRI) and MRSI were performed on 39 patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml and suspicious findings at trans-rectal ultrasound (TRUS). All patients underwent a TRUS ten-core biopsy within 30 days according to a subdivision of the prostate into octants. All studies were interpreted by a dedicated radiologist who reported the areas of interest as normal, equivocal or suspicious on MRI. At MRSI, cancer was defined as possible if the ratio of choline plus creatine to citrate exceeded mean normal peripheral zone values by two standard deviations (SD) or as definite if that ratio exceeded the normal value by three SD. MRI and MRSI findings were spatially correlated with findings obtained from individual biopsy sites.
MRI and MRSI alone had sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in the detection of prostate cancer equal to 85%, 75%; 53%, 89%; 65%, 88%; 77%, 74%; and 69%, 79%, respectively. These values were 70%, 89%, 88%, 74% and 79% when MRI and MRSI were combined. Site-by-site analysis of MRI and MRSI findings and biopsy results yielded no significant correlation.
The combination of MRSI and MRI provides a significantly higher specificity in the detection of tumours as compared with MRI alone and can be recommended as a problem-solving modality before biopsy in patients with high PSA levels and suspicious TRUS.
本研究旨在前瞻性地评估质子磁共振波谱成像（MRSI）在前列腺癌检测和定位中的诊断能力，并与组织病理学结果进行比较。
对39例前列腺特异性抗原（PSA）水平大于4 ng/ml且经直肠超声（TRUS）检查有可疑发现的患者进行了磁共振成像（MRI）和MRSI检查。所有患者均在30天内根据前列腺分为八个象限进行了TRUS引导下的十芯活检。所有研究均由一名专业放射科医生解读，该医生将MRI上的感兴趣区域报告为正常、可疑或模棱两可。在MRSI检查中，如果胆碱加肌酸与枸橼酸盐的比值超过正常外周带平均值两个标准差（SD），则癌症定义为可能；如果该比值超过正常值三个SD，则定义为确定。MRI和MRSI结果与从各个活检部位获得的结果在空间上相关。
单独的MRI和MRSI在前列腺癌检测中的敏感性、特异性、阳性和阴性预测值以及诊断准确性分别为85%、75%；53%、89%；65%、88%；77%、74%；以及69%、79%。当MRI和MRSI联合使用时，这些值分别为70%、89%、88%、74%和79%。对MRI和MRSI结果与活检结果进行逐点分析，未发现显著相关性。
与单独的MRI相比，MRSI和MRI联合使用在肿瘤检测中具有显著更高的特异性，对于PSA水平高且TRUS检查可疑的患者，可推荐作为活检前的问题解决方式。
