Latchamsetty Kalyan C, Borden Lester S, Porter Christopher R, Lacrampe Marc, Vaughan Matthew, Lin Eugene, Conti Neal, Wright Jonathan L, Corman John M
Sections of Urology and Radiology, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
Can J Urol. 2007 Feb;14(1):3429-34.
Accurate clinical staging is critical in guiding treatment for patients with prostate adenocarcinoma. Endorectal magnetic resonance imaging (MRI) has been advocated to improve staging accuracy. In order to assess the learning curve for endorectal MRI interpretation, we compared two cohorts of patients with high-risk prostate who underwent endorectal MRI at a center with limited prior exposure to this imaging modality.
Data for all patients who received a preoperative endorectal MRI followed by radical prostatectomy were prospectively collected. MRI was performed in patients with a high level of suspicion for extracapsular disease based on biopsy Gleason score, prostate specific antigen level, and digital rectal examination or if the Memorial Sloan-Kettering nomogram predicted a greater than 30% likelihood of extracapsular disease. The MRI results of our first 40 patients (group 1) and our second 40 patients (group 2) were compared to assess for improvement.
Between October 2003 and September 2005, 80 patients underwent an endorectal MRI followed by radical prostatectomy. Mean age and median PSA were 58.4 (range 43 - 74) and 6.4 (range 0.048 -115.0), respectively. MRI findings were compared to the pathological findings from the radical prostatectomy specimen. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of extracapsular disease were 31.3% versus 64.7%, 70.8% versus 78.3%, 41.7% versus 68.8%, and 60.7% versus 75.0%, respectively in group 1 versus group 2. The accuracy of MRI for detecting extracapsular extension was 52.5% in group 1 compared to 72.5% in group 2.
In our series, endorectal MRI initially did not accurately predict tumor stage in patients with prostatic adenocarcinoma. With further experience, the accuracy of MRI substantially improved and approached the results from centers with significant experience in the interpretation of endorectal prostate MRI.
准确的临床分期对于指导前列腺腺癌患者的治疗至关重要。直肠内磁共振成像（MRI）已被提倡用于提高分期准确性。为了评估直肠内MRI解读的学习曲线，我们比较了两组高危前列腺癌患者，他们在一个此前对这种成像方式接触有限的中心接受了直肠内MRI检查。
前瞻性收集了所有接受术前直肠内MRI检查并随后接受根治性前列腺切除术患者的数据。基于活检Gleason评分、前列腺特异性抗原水平和直肠指检，对高度怀疑有包膜外病变的患者进行MRI检查，或者如果纪念斯隆凯特琳预后 nomogram预测包膜外病变可能性大于30%，也进行MRI检查。比较了我们的前40例患者（第1组）和后40例患者（第2组）的MRI结果，以评估是否有改善。
在2003年10月至2005年9月期间，80例患者接受了直肠内MRI检查并随后接受了根治性前列腺切除术。平均年龄和中位前列腺特异性抗原分别为58.4（范围43 - 74）和6.4（范围0.048 - 115.0）。将MRI结果与根治性前列腺切除标本的病理结果进行比较。第1组与第2组相比，检测包膜外病变的敏感性、特异性、阳性预测值和阴性预测值分别为31.3%对64.7%、70.8%对78.3%、41.7%对68.8%、60.7%对75.0%。第1组中MRI检测包膜外扩展的准确性为52.5%，而第2组为72.5%。
在我们的系列研究中，直肠内MRI最初不能准确预测前列腺腺癌患者的肿瘤分期。随着经验的积累，MRI的准确性显著提高，并接近在直肠内前列腺MRI解读方面有丰富经验的中心的结果。
