Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room 1B40, Bethesda, MD 20892-1088, USA.
Radiology. 2010 Apr;255(1):89-99. doi: 10.1148/radiol.09090475.
To determine utility of multiparametric imaging performed at 3 T for detection of prostate cancer by using T2-weighted magnetic resonance (MR) imaging, MR spectroscopy, and dynamic contrast material-enhanced MR imaging, with whole-mount pathologic findings as reference standard.
This prospectively designed, HIPAA-compliant, single-institution study was approved by the local institutional review board. Seventy consecutive patients (mean age, 60.4 years; mean prostate-specific antigen level, 5.47 ng/mL [5.47 microg/L]; range, 1-19.9 ng/mL [1-19.9 microg/L]) were included; informed consent was obtained from each patient. All patients had biopsy-proved prostate cancer, with a median Gleason score of 7 (range, 6-9). Images were obtained by using a combination of six-channel cardiac and endorectal coils. MR imaging and pathologic findings were evaluated independently and blinded and then correlated with histopathologic findings by using side-by-side comparison. Analyses were conducted with a raw stringent approach and an alternative neighboring method, which accounted for surgical deformation, shrinkage, and nonuniform slicing factors in pathologic specimens. Generalized estimating equations (GEEs) were used to estimate the predictive value of region-specific, pathologically determined cancer for all three modalities. This approach accounts for the correlation among multiple regions in the same individual.
For T2-weighted MR imaging, sensitivity and specificity values obtained with stringent approach were 0.42 (95% confidence interval [CI]: 0.36, 0.47) and 0.83 (95% CI: 0.81, 0.86), and for the alternative neighboring approach, sensitivity and specificity values were 0.73 (95% CI: 0.67, 0.78) and 0.89 (95% CI: 0.85, 0.93), respectively. The combined diagnostic accuracy of T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy for peripheral zone tumors was examined by calculating their predictive value with different combinations of techniques; T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy provided significant independent and additive predictive value when GEEs were used (P < .001, P = .02, P = .002, respectively).
Multiparametric MR imaging (T2-weighted MR imaging, MR spectroscopy, dynamic contrast-enhanced MR imaging) of the prostate at 3 T enables tumor detection, with reasonable sensitivity and specificity values.
利用 3T 磁共振（MR）成像的 T2 加权成像、MR 波谱分析和动态对比增强 MR 成像，以全器官病理发现为参考标准，确定多参数成像检测前列腺癌的效用。
本研究为前瞻性设计，符合 HIPAA 规定，经当地机构审查委员会批准。纳入 70 例连续患者（平均年龄 60.4 岁；平均前列腺特异性抗原水平 5.47ng/ml[5.47μg/L]；范围 1-19.9ng/ml[1-19.9μg/L]）；每位患者均获得知情同意。所有患者均经活检证实为前列腺癌，中位 Gleason 评分为 7 分（范围 6-9 分）。采用六通道心脏和直肠内线圈联合采集图像。MR 成像和病理结果独立且盲法评估，然后通过并排比较与组织病理学结果相关联。分析采用原始严格方法和替代邻接方法进行，考虑到了病理标本中的手术变形、收缩和非均匀切片因素。使用广义估计方程（GEE）估计三种模态中特定区域、病理确定的癌症的预测值。这种方法考虑了同一个体中多个区域之间的相关性。
采用严格方法，T2 加权 MR 成像的敏感性和特异性值分别为 0.42（95%置信区间[CI]：0.36，0.47）和 0.83（95% CI：0.81，0.86），采用替代邻接方法，敏感性和特异性值分别为 0.73（95% CI：0.67，0.78）和 0.89（95% CI：0.85，0.93）。通过计算不同技术组合的预测值，研究了 T2 加权 MR 成像、动态对比增强 MR 成像和 MR 波谱成像对周围区肿瘤的联合诊断准确性；当使用广义估计方程（GEE）时，T2 加权 MR 成像、动态对比增强 MR 成像和 MR 波谱成像提供了显著的独立和附加预测值（P<.001，P=.02，P=.002）。
3T 多参数 MR 成像（T2 加权 MR 成像、MR 波谱分析、动态对比增强 MR 成像）可实现肿瘤检测，具有合理的敏感性和特异性。
