从正常前列腺组织中鉴别前列腺癌：药代动力学 MRI 与组织学评估中的热点作用。

Differentiation of prostate cancer from normal prostate tissue: role of hotspots in pharmacokinetic MRI and histologic evaluation.

机构信息

Department of Radiology, Institut für Radiologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

出版信息

AJR Am J Roentgenol. 2010 Mar;194(3):675-81. doi: 10.2214/AJR.09.3233.

DOI:10.2214/AJR.09.3233

PMID:20173144

Abstract

OBJECTIVE

The purpose of this study was to investigate whether analysis of voxels with the highest perfusion and blood volume (hotspots) within a whole region affected by prostate cancer can improve differentiation of cancerous and normal prostate tissue at pharmacokinetic MRI.

SUBJECTS AND METHODS

Fifty-three patients with biopsy-proven prostate cancer were examined with 1.5-T MRI performed with endorectal and body phased-array coils and a dynamic contrast-enhanced inversion-prepared dual-contrast gradient-echo sequence (temporal resolution, 1.65 seconds). Perfusion and blood volume maps were generated with a sequential three-compartment model. A total of 110 regions (62 prostate cancer, 48 normal prostate tissue) and their MRI perfusion and blood volume hotspots were analyzed and correlated with histologic mean vessel density and mean vessel area.

RESULTS

In patients with prostate cancer, median perfusion in the entire region was 0.71 mL/cm(3)min(-1) (hotspot, 1.53 mL/cm(3)min(-1)) with a median blood volume of 1.06% (hotspot, 2.23%). In the corresponding histologic areas, median mean vessel density was 77 vessels/mm(2) (hotspot, 156 vessels/mm(2)) with a median mean vessel area of 1.61% (hotspot, 2.50%). In normal prostate tissue, median perfusion was 0.33 mL/cm(3)min(-1) (hotspot, 1.38 mL/cm(3)min(-1)) with a median blood volume of 0.62% (hotspot, 2.6%). In the corresponding histologic regions, median mean vessel density in the entire area was 57 vessels/mm(2) with a median mean vessel area of 1.21% (no hotspots). MRI perfusion in the entire region was the most suitable parameter for differentiating prostate cancer and facilitated correct classification in 61.8% of cases (blood volume hotspots, 58.2%; perfusion hotspots, 56.4%).

CONCLUSION

In differentiation of cancerous and normal prostate tissue, use of perfusion in the entire region is superior to use of perfusion and blood volume in MRI hotspots.

摘要

目的

本研究旨在探讨在前列腺癌全区域内分析灌注和血容量最高的体素（热点）是否能改善前列腺磁共振药物动力学成像中癌性和正常前列腺组织的鉴别。

材料和方法

对 53 例经活检证实为前列腺癌的患者进行了 1.5T MRI 检查，采用直肠内和体部相控阵线圈和动态对比增强反转双对比梯度回波序列（时间分辨率 1.65 秒）。灌注和血容量图是用序贯三房室模型生成的。共分析了 110 个区域（62 个前列腺癌，48 个正常前列腺组织）及其 MRI 灌注和血容量热点，并与组织学平均血管密度和平均血管面积相关。

结果

在前列腺癌患者中，整个区域的中位灌注为 0.71mL/cm³min⁻¹（热点为 1.53mL/cm³min⁻¹），中位血容量为 1.06%（热点为 2.23%）。在相应的组织学区域，中位平均血管密度为 77 个/毫米²（热点为 156 个/毫米²），中位平均血管面积为 1.61%（热点为 2.50%）。在正常前列腺组织中，中位灌注为 0.33mL/cm³min⁻¹（热点为 1.38mL/cm³min⁻¹），中位血容量为 0.62%（热点为 2.6%）。在相应的组织学区域，整个区域的中位平均血管密度为 57 个/毫米²，中位平均血管面积为 1.21%（无热点）。整个区域的 MRI 灌注是区分前列腺癌和正常前列腺组织最适宜的参数，能正确分类 61.8%的病例（血容量热点为 58.2%；灌注热点为 56.4%）。