Venkitaraman R, Cook G J R, Dearnaley D P, Parker C C, Huddart R A, Khoo V, Eeles R, Horwich A, Sohaib S A
Academic Uro-oncology Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Clin Oncol (R Coll Radiol). 2009 Feb;21(1):39-42. doi: 10.1016/j.clon.2008.09.006. Epub 2008 Nov 6.
Magnetic resonance imaging (MRI) is an effective method for evaluating the spine in patients with a high risk of metastatic disease. The aim of this study was to compare MRI spine with radionuclide bone scan in detecting spinal metastases for staging prostate cancer patients.
A cohort of 99 patients with locally advanced prostate cancer at high risk of skeletal metastasis (prostate-specific antigen>10 ng/ml, composite Gleason score>or=8) or equivocal findings on bone scan were included in the retrospective study, and their MRI spine and bone scans were analysed.
Ten patients were detected to have definite spinal metastasis by bone scan, whereas 12 patients had definite skeletal metastasis by MRI spine. Compared with the 'gold standard', derived from clinical and radiological follow-up, the sensitivities for radionuclide bone scan and that for MRI spine for detecting skeletal metastasis were 71.4 and 85.7%, respectively (P=0.023), whereas the specificities were 96.5 and 97.7%, respectively (P=0.95). Of the 34 individual metastatic lesions in the spine, 15 were concordantly positive on both scans, whereas five lesions were positive only by bone scan and 11 positive only by MRI. The addition of MRI spine in the staging for prostate cancer resulted in a change of stage and management plan in seven (7%) patients.
MRI spine has comparable specificity and slightly better sensitivity than bone scan to detect spinal metastasis from prostate cancer.
磁共振成像（MRI）是评估转移性疾病高危患者脊柱的有效方法。本研究的目的是比较MRI脊柱成像与放射性核素骨扫描在检测前列腺癌患者脊柱转移灶以进行分期方面的效果。
本回顾性研究纳入了99例局部晚期前列腺癌且有骨骼转移高危风险（前列腺特异性抗原>10 ng/ml，Gleason总分>或=8）或骨扫描结果不明确的患者，并对他们的MRI脊柱成像和骨扫描进行分析。
骨扫描检测到10例患者有明确的脊柱转移，而MRI脊柱成像检测到12例患者有明确的骨骼转移。与临床和影像学随访得出的“金标准”相比，放射性核素骨扫描和MRI脊柱成像检测骨骼转移的敏感性分别为71.4%和85.7%（P=0.023），而特异性分别为96.5%和97.7%（P=0.95）。在脊柱的34个单个转移病灶中，15个在两种扫描中均为阳性，5个病灶仅骨扫描阳性，11个仅MRI阳性。在前列腺癌分期中增加MRI脊柱成像使7例（7%）患者的分期和治疗方案发生了改变。
在检测前列腺癌脊柱转移方面，MRI脊柱成像与骨扫描具有相当的特异性，且敏感性略优于骨扫描。
