Testa Claudia, Schiavina Riccardo, Lodi Raffaele, Salizzoni Eugenio, Corti Barbara, Farsad Mohsen, Kurhanewicz John, Manferrari Fabio, Brunocilla Eugenio, Tonon Caterina, Monetti Nino, Castellucci Paolo, Fanti Stefano, Coe Manuela, Grigioni Walter F, Martorana Giuseppe, Canini Romeo, Barbiroli Bruno
Department of Clinical Medicine and Applied Biotechnology D. Campanacci, Diagnostic Imaging Section V. Bollini, Pathologic Anatomy Unit, Institute of Oncology F. Addarii, P.E.T. Center, Policlinico S. Orsola-Malpighi, University of Bologna, Italy.
Radiology. 2007 Sep;244(3):797-806. doi: 10.1148/radiol.2443061063. Epub 2007 Jul 24.
To retrospectively compare sensitivity and specificity of magnetic resonance (MR) imaging, three-dimensional (3D) MR spectroscopy, combined MR imaging and 3D MR spectroscopy, and carbon 11 (11C)-choline positron emission tomography (PET)/computed tomography (CT) for intraprostatic tumor sextant localization, with histologic findings as reference standard.
The local ethics committee on human research provided approval and a waiver of informed consent for the retrospective study. MR imaging, 3D MR spectroscopy, and 11C-choline PET/CT results were retrospectively reviewed in 26 men with biopsy-proved prostate cancer (mean age, 64 years; range, 51-75 years) who underwent radical prostatectomy. Cancer was identified as areas of nodular low signal intensity on T2-weighted MR images. At 3D MR spectroscopy, choline-plus-creatine-to-citrate and choline-to-creatine ratios were used to distinguish healthy from malignant voxels. At PET/CT, focal uptake was visually assessed, and maximum standardized uptake values (SUVs) were recorded. Agreement between 3D MR spectroscopic and PET/CT results was calculated, and ability of maximum SUV to help localize cancer was assessed with receiver operating characteristic analysis. Significant differences between positive and negative sextants with respect to mean maximum SUV were calculated with a paired t test.
Sensitivity, specificity, and accuracy were, respectively, 55%, 86%, and 67% at PET/CT; 54%, 75%, and 61% at MR imaging; and 81%, 67%, and 76% at 3D MR spectroscopy. The highest sensitivity was obtained when either 3D MR spectroscopic or MR imaging results were positive (88%) at the expense of specificity (53%), while the highest specificity was obtained when results with both techniques were positive (90%) at the expense of sensitivity (48%). Concordance between 3D MR spectroscopic and PET/CT findings was slight (kappa=0.139).
In localizing cancer within the prostate, comparable specificity was obtained with either 3D MR spectroscopy and MR imaging or PET/CT; however, PET/CT had lower sensitivity relative to 3D MR spectroscopy alone or combined with MR imaging.
以组织学结果作为参考标准，回顾性比较磁共振（MR）成像、三维（3D）MR波谱、联合MR成像与3D MR波谱以及碳11（11C）-胆碱正电子发射断层扫描（PET）/计算机断层扫描（CT）对前列腺内肿瘤分区定位的敏感性和特异性。
当地人体研究伦理委员会批准了本回顾性研究并免除了知情同意。对26例经活检证实为前列腺癌（平均年龄64岁；范围51 - 75岁）且接受了根治性前列腺切除术的男性患者的MR成像、3D MR波谱以及11C-胆碱PET/CT结果进行回顾性分析。在T2加权MR图像上，癌症表现为结节状低信号强度区域。在3D MR波谱分析中，使用胆碱加肌酸与枸橼酸盐的比值以及胆碱与肌酸的比值来区分健康组织和恶性组织体素。在PET/CT检查中，通过视觉评估局部摄取情况，并记录最大标准化摄取值（SUV）。计算3D MR波谱分析结果与PET/CT结果之间的一致性，并通过受试者操作特征分析评估最大SUV对癌症定位的能力。使用配对t检验计算阳性和阴性分区之间平均最大SUV的显著差异。
PET/CT的敏感性、特异性和准确性分别为55%、86%和67%；MR成像分别为54%、75%和61%；3D MR波谱分别为81%、67%和76%。当3D MR波谱分析或MR成像结果为阳性时，敏感性最高（88%），但特异性降低（53%）；而当两种技术结果均为阳性时，特异性最高（90%），但敏感性降低（48%）。3D MR波谱分析结果与PET/CT结果之间的一致性较低（kappa = 0.139）。
在前列腺内癌症定位方面，3D MR波谱分析、MR成像以及PET/CT获得的特异性相当；然而，相对于单独的3D MR波谱分析或与MR成像联合使用，PET/CT的敏感性较低。
