Scheenen Tom W J, Heijmink Stijn W T P J, Roell Stefan A, Hulsbergen-Van de Kaa Christina A, Knipscheer Ben C, Witjes J Alfred, Barentsz Jelle O, Heerschap Arend
Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
Radiology. 2007 Nov;245(2):507-16. doi: 10.1148/radiol.2451061444. Epub 2007 Sep 11.
To evaluate sensitivity and specificity of proton magnetic resonance (MR) spectroscopy of the prostate with external surface coil elements at 3 T for differentiation of cancer from healthy tissue within an acceptable measurement time, by using histopathologic findings as the reference standard.
The study was approved by the institutional review board; informed consent was obtained. Forty-five men (age range, 51-70 years) underwent 3-T MR imaging with external radiofrequency surface coils for signal reception. MR spectroscopy was performed with acquisition-weighted three-dimensional water- and lipid-suppressed point-resolved spectroscopy pulse sequence. Voxels were classified into healthy peripheral zone, central gland, and periurethral zone and cancer tissue. Cancer voxels were classified according to cancer size and certainty in matching histopathologic findings with MR images. After visual inspection of automated fitting of classified voxels, the choline plus creatine-to-citrate (Cho + Cr/Cit) ratio was calculated for all tissues. Area under the receiver operating characteristic curves (A(z)) values were used to assess accuracy of discrimination of cancer from healthy tissues. P < .05 indicated a significant difference.
After exclusion of four patients with no voxels that passed visual inspection of the automated fit, a median of 82% of the classified voxels per patient was used in the analysis. Mean Cho + Cr/Cit ratios for healthy tissues were 0.22 +/- 0.12 (standard deviation) for peripheral zone, 0.34 +/- 0.14 for central gland, and 0.36 +/- 0.20 for periurethral area; all were significantly different from that of cancer (P < .001). A(z) for discrimination of probable and definite cancer tissue from healthy tissue for the peripheral zone (0.84) was significantly higher than that for the central gland (0.69) (P < .05).
Three-dimensional proton MR spectroscopy of the prostate, with a combination of only external radiofrequency surface coils at 3 T, can be used to discriminate cancer from healthy tissue.
以组织病理学结果作为参考标准，评估在3T场强下使用外表面线圈元件的前列腺质子磁共振（MR）波谱在可接受的测量时间内区分癌组织与健康组织的敏感性和特异性。
本研究经机构审查委员会批准；获得了知情同意。45名男性（年龄范围51 - 70岁）接受了3T MR成像，使用外部射频表面线圈进行信号接收。采用采集加权三维水脂抑制点分辨波谱脉冲序列进行MR波谱分析。将体素分为健康外周带、中央腺和尿道周围区以及癌组织。根据癌组织大小以及MR图像与组织病理学结果匹配的确定性对癌体素进行分类。在对分类体素的自动拟合进行视觉检查后，计算所有组织的胆碱加肌酸与柠檬酸（Cho + Cr/Cit）比值。采用受试者操作特征曲线下面积（A(z)）值评估区分癌组织与健康组织的准确性。P < 0.05表示有显著差异。
排除4例没有通过自动拟合视觉检查的体素的患者后，每位患者分析中使用的分类体素中位数为82%。健康组织的平均Cho + Cr/Cit比值在外周带为0.22±0.12（标准差），中央腺为0.34±0.14，尿道周围区为0.36±0.20；均与癌组织有显著差异（P < 0.001）。外周带区分可能和确定癌组织与健康组织的A(z)（0.84）显著高于中央腺（0.69）（P < 0.05）。
在3T场强下，仅结合外部射频表面线圈的前列腺三维质子MR波谱可用于区分癌组织与健康组织。
