Department of Urology, University Sapienza, and Department of Urology, University of Rome, Rome, Italy.
Clin Cancer Res. 2010 Mar 15;16(6):1875-83. doi: 10.1158/1078-0432.CCR-09-2195. Epub 2010 Mar 2.
This study aimed to prospectively analyze the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the range of >or=4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided biopsy.
This was a prospective randomized single-center study. One hundred and eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a (1)H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy.
At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90 cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7% negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate cancer detection.
The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure.
本研究旨在前瞻性分析磁共振波谱成像（MRSI）和动态对比增强磁共振（DCEMR）在检测前列腺特异性抗原（PSA）水平持续升高（范围为>或=4ng/ml 至 <10ng/ml）且先前经直肠超声（TRUS）引导下前列腺活检阴性的患者中前列腺肿瘤病灶的作用。
这是一项前瞻性随机单中心研究。共纳入 180 例符合条件的病例。A 组患者接受第二次随机前列腺活检，B 组患者接受（1）H-MRSI-DCEMR 检查，并对可疑区域进行靶向取样，与随机活检相结合。
在第二次活检中，A 组 90 例中有 22 例（24.4%）和 B 组 90 例中有 41 例（45.5%）发现前列腺腺癌组织学诊断（P=0.01）。以患者为基础，MRSI 的敏感性为 92.3%，特异性为 88.2%，阳性预测值（PPV）为 85.7%，阴性预测值（NPV）为 93.7%，准确性为 90%；DCEMR 的敏感性为 84.6%，特异性为 82.3%，PPV 为 78.5%，NPV 为 87.5%，准确性为 83.3%；MRSI 联合 DCEMR 的敏感性为 92.6%，特异性为 88.8%，PPV 为 88.7%，NPV 为 92.7%，准确性为 90.7%，用于预测前列腺癌的检测。
MRSI 和 DCEMR 的联合应用有可能指导先前经 TRUS 活检阴性的患者进行活检以检测肿瘤病灶。为了避免潜在的偏倚，即在 B 组（平均活检针数为 12.17 针）比 A 组（10 针）中取更多的样本，在未来，MRSI/DCEMR 引导的活检可以与饱和活检程序进行前瞻性比较。
