Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK.
Br J Radiol. 2011 Jan;84(997):31-7. doi: 10.1259/bjr/14556365.
We studied patients managed by active surveillance to determine whether there was a difference over time in apparent diffusion coefficients (ADCs) derived from diffusion-weighted MRI in those who progressed to radical treatment (progressors, n = 17) compared with those who did not (non-progressors, n = 33).
50 consecutive patients (Stage T1/2a, Gleason grade ≤ 3+4, prostate-specific antigen (PSA) <15 ng ml⁻¹, <50% cores positive) were imaged endorectally (baseline and 1-3 years follow-up) with T₂ weighted (T₂W) and echo-planar diffusion-weighted MRI sequences. Regions of interest drawn on ADC maps with reference to the T₂W images yielded ADC(all) (b = 0-800), ADC(fast) (b = 0-300) and ADC(slow) (b = 300-800) for whole prostate (minus tumour) and tumour (low signal-intensity peripheral zone lesion in biopsy-positive octant).
Tumour and whole prostate ADC(all) and ADC(fast) were significantly reduced over time in progressors (p = 0.03 and 0.03 for tumours, respectively; p = 0.02 and 0.007 for the whole prostate, respectively). There were no significant changes in ADC over time in non-progressors. A 10% reduction in tumour ADC(all) indicated progression with a 93% sensitivity and 40% specificity (A(z) of receiver operating characteristic (ROC) curve = 0.68). Percentage reductions in whole prostate ADC(all), ADC(fast) and ADC(slow) were also significantly greater in progressors than in non-progressors (p = 0.01, 0.03 and 0.008, respectively).
This pilot study shows that DW-MRI has potential for monitoring patients with early prostate cancer who opt for active surveillance.
我们研究了接受主动监测的患者，以确定在进展为根治性治疗的患者（进展者，n = 17）与未进展的患者（非进展者，n = 33）中，源自扩散加权 MRI 的表观扩散系数（ADC）随时间的变化是否存在差异。
50 例连续患者（T1/T2a 期，Gleason 评分≤3+4，前列腺特异性抗原（PSA）<15ng/ml-1，<50%核心阳性）接受直肠内 MRI 成像（基线和 1-3 年随访），包括 T₂加权（T₂W）和回波平面扩散加权 MRI 序列。在 ADC 图上参考 T₂W 图像绘制感兴趣区，得出整个前列腺（减去肿瘤）和肿瘤（活检阳性八区中的低信号强度外周区病变）的 ADC(all)（b = 0-800）、ADC(fast)（b = 0-300）和 ADC(slow)（b = 300-800）。
进展者的肿瘤和整个前列腺 ADC(all)和 ADC(fast)随时间显著降低（肿瘤分别为 p = 0.03 和 0.03；整个前列腺分别为 p = 0.02 和 0.007）。非进展者的 ADC 随时间没有显著变化。肿瘤 ADC(all)降低 10%提示进展，其敏感性为 93%，特异性为 40%（ROC 曲线的 A(z)为 0.68）。进展者的整个前列腺 ADC(all)、ADC(fast)和 ADC(slow)的百分比降低也显著大于非进展者（分别为 p = 0.01、0.03 和 0.008）。
这项初步研究表明，DW-MRI 具有监测选择主动监测的早期前列腺癌患者的潜力。
