deSouza N M, Riches S F, Vanas N J, Morgan V A, Ashley S A, Fisher C, Payne G S, Parker C
Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
Clin Radiol. 2008 Jul;63(7):774-82. doi: 10.1016/j.crad.2008.02.001. Epub 2008 Apr 18.
To evaluate diffusion-weighted magnetic resonance imaging (DW-MRI) as a marker for disease aggressiveness by comparing tumour apparent diffusion coefficients (ADCs) between patients with low- versus higher-risk localized prostate cancer.
Forty-four consecutive patients classified as low- [n = 26, stageT1/T2a, Gleason score < or = 6, prostate-specific antigen (PSA)< 10 (group 1)] or intermediate/high- [n = 18, stage > or = T2b and/or Gleason score > or = 7, and/or PSA > 10 (group 2)] risk, who subsequently were monitored with active surveillance or started neoadjuvant hormone and radiotherapy, respectively, underwent endorectal MRI. T2-weighted (T2W) and DW images (5 b values, 0-800 s/mm(2)) were acquired and isotropic ADC maps generated. Regions of interest (ROIs) on T2W axial images [around whole prostate, central gland (CG), and tumour] were transferred to ADC maps. Tumour, CG, and peripheral zone (PZ = whole prostate minus CG and tumour) ADCs (fast component from b = 0-100 s/mm(2), slow component from b = 100-800 s/mm(2)) were compared.
T2W-defined tumour volume medians, and quartiles were 1.2 cm(3), 0.7 and 3.3 cm(3) (group 1); and 6 cm(3), 1.3 and 16.5 cm(3) (group 2). There were significant differences in both ADC(fast) (1778 +/- 264 x 10(-6) versus 1583 +/- 283 x 10(-6) mm(2)/s, p = 0.03) and ADC(slow) (1379 +/- 321 x 10(-6) versus 1196 +/- 158 x 10(-6) mm(2)/s, p = 0.001) between groups. Tumour volume (p = 0.002) and ADC(slow) (p = 0.005) were significant differentiators of risk group.
Significant differences in tumour ADCs exist between patients with low-risk, and those with higher-risk localized prostate cancer. DW-MRI merits further study with respect to clinical outcomes.
通过比较低风险与高风险局限性前列腺癌患者的肿瘤表观扩散系数（ADC），评估磁共振扩散加权成像（DW-MRI）作为疾病侵袭性标志物的价值。
连续纳入44例患者，分为低风险组（n = 26，T1/T2a期，Gleason评分≤6，前列腺特异性抗原（PSA）<10（第1组））和中/高风险组（n = 18，T2b期及以上和/或Gleason评分≥7，和/或PSA>10（第2组）），随后分别接受主动监测或新辅助激素及放疗，所有患者均接受直肠内MRI检查。采集T2加权（T2W）和DW图像（5个b值，0 - 800 s/mm²）并生成各向同性ADC图。将T2W轴位图像上的感兴趣区（ROI）[围绕整个前列腺、中央腺体（CG）和肿瘤]转移至ADC图。比较肿瘤、CG和外周带（PZ = 整个前列腺减去CG和肿瘤）的ADC（b = 0 - 100 s/mm²时的快速成分，b = 100 - 800 s/mm²时的慢速成分）。
T2W定义的肿瘤体积中位数及四分位数在第1组为1.2 cm³、0.7和3.3 cm³；在第2组为6 cm³、1.3和16.5 cm³。两组间ADC（快速）（1778 ± 264×10⁻⁶与1583 ± 283×10⁻⁶ mm²/s，p = 0.03）和ADC（慢速）（1379 ± 321×10⁻⁶与1196 ± 158×10⁻⁶ mm²/s，p = 0.001）均存在显著差异。肿瘤体积（p = 0.002）和ADC（慢速）（p = 0.00）是风险组的显著区分因素。
低风险与高风险局限性前列腺癌患者的肿瘤ADC存在显著差异。DW-MRI在临床结局方面值得进一步研究。
