Weinreb Jeffrey C, Blume Jeffrey D, Coakley Fergus V, Wheeler Thomas M, Cormack Jean B, Sotto Christopher K, Cho Haesun, Kawashima Akira, Tempany-Afdhal Clare M, Macura Katarzyna J, Rosen Mark, Gerst Scott R, Kurhanewicz John
Department of Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520, USA.
Radiology. 2009 Apr;251(1):122-33. doi: 10.1148/radiol.2511080409.
To determine the incremental benefit of combined endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging, as compared with endorectal MR imaging alone, for sextant localization of peripheral zone (PZ) prostate cancer.
This prospective multicenter study, conducted by the American College of Radiology Imaging Network (ACRIN) from February 2004 to June 2005, was institutional review board approved and HIPAA compliant. Research associates were required to follow consent guidelines approved by the Office for Human Research Protection and established by the institutional review boards. One hundred thirty-four patients with biopsy-proved prostate adenocarcinoma and scheduled to undergo radical prostatectomy were recruited at seven institutions. T1-weighted, T2-weighted, and spectroscopic MR sequences were performed at 1.5 T by using a pelvic phased-array coil in combination with an endorectal coil. Eight readers independently rated the likelihood of the presence of PZ cancer in each sextant by using a five-point scale-first on MR images alone and later on combined MR-MR spectroscopic images. Areas under the receiver operating characteristic curve (AUCs) were calculated with sextant as the unit of analysis. The presence or absence of cancer at centralized histopathologic evaluation of prostate specimens was the reference standard. Reader-specific receiver operating characteristic curves for values obtained with MR imaging alone and with combined MR imaging-MR spectroscopic imaging were developed. The AUCs were estimated by using Mann-Whitney statistics and appropriate 95% confidence intervals.
Complete data were available for 110 patients (mean age, 58 years; range, 45-72 years). MR imaging alone and combined MR imaging-MR spectroscopic imaging had similar accuracy in PZ cancer localization (AUC, 0.60 vs 0.58, respectively; P > .05). AUCs for individual readers were 0.57-0.63 for MR imaging alone and 0.54-0.61 for combined MR imaging-MR spectroscopic imaging.
In patients who undergo radical prostatectomy, the accuracy of combined 1.5-T endorectal MR imaging-MR spectroscopic imaging for sextant localization of PZ prostate cancer is equal to that of MR imaging alone.
确定与单纯直肠内磁共振成像（MR）相比，联合直肠内磁共振成像和磁共振波谱成像在外周带（PZ）前列腺癌六分区定位中的增量效益。
本前瞻性多中心研究由美国放射学会成像网络（ACRIN）于2004年2月至2005年6月进行，经机构审查委员会批准并符合健康保险流通与责任法案（HIPAA）。研究人员需遵循人类研究保护办公室批准并由机构审查委员会制定的同意指南。在7家机构招募了134例经活检证实为前列腺腺癌且计划接受根治性前列腺切除术的患者。使用盆腔相控阵线圈结合直肠内线圈在1.5T下进行T1加权、T2加权和波谱MR序列检查。8名阅片者先仅根据MR图像，然后根据联合MR-磁共振波谱图像，使用五点量表独立评估每个六分区中PZ癌存在的可能性。以六分区作为分析单位计算受试者操作特征曲线（AUC）下的面积。前列腺标本集中组织病理学评估中癌的存在与否为参考标准。绘制了单独MR成像和联合MR成像-磁共振波谱成像获得的值的阅片者特异性受试者操作特征曲线。使用曼-惠特尼统计和适当的95%置信区间估计AUC。
110例患者（平均年龄58岁；范围45 - 72岁）有完整数据。单纯MR成像和联合MR成像-磁共振波谱成像在PZ癌定位方面具有相似的准确性（AUC分别为0.60和0.58；P >.05）。单独MR成像时各阅片者的AUC为0.57 - 0.63，联合MR成像-磁共振波谱成像时为0.54 - 0.61。
在接受根治性前列腺切除术的患者中，联合1.5T直肠内MR成像-磁共振波谱成像用于PZ前列腺癌六分区定位的准确性与单纯MR成像相同。
