Cancer Research UK Clinical MR Research Group, Institute of Cancer Research, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
AJR Am J Roentgenol. 2011 Mar;196(3):586-91. doi: 10.2214/AJR.10.5016.
The purpose of our study was to investigate whether fast and slow components of the apparent diffusion coefficient (ADC) from diffusion-weighted MR images could predict prostate cancer progression in patients managed by active surveillance.
Eighty-one patients managed by active surveillance underwent diffusion-weighted MRI in addition to T2-weighted MRI using an endorectal technique. ADCs from tumor regions of interest were calculated using all b values (ADC(all)), b = 0-300 s/mm(2) (ADC(fast)), and b = 300-800 s/mm(2) (ADC(slow)). These parameters and tumor volumes were compared in those upgraded at subsequent biopsy (n = 14) versus those histologically stable (n = 41) and in evaluable patients who progressed to radical treatment (n = 16) versus those who did not (n = 64). Cox's regression was used to analyze the effect of parameter mean on time to treatment.
ADC(all), ADC(fast), and ADC(slow) in patients upgraded on repeat biopsy were significantly lower than those who were stable (1,070 ± 110 vs 1,356 ± 357 × 10(-6)mm(2)/s, p < 0.001; 1,283 ± 188 vs 1,526 ± 397 × 10(-6)mm(2)/s, p = 0.004; 843 ± 74 vs 1,105 ± 285 × 10(-6) mm(2)/s, p < 0.001, respectively). Tumor volume was significantly higher in the upgraded group (0.86 ± 0.9 vs 0.26 ± 0.25 cm(3), p = 0.02). The lower ADC(slow) in patients who subsequently progressed to radical treatment approached significance (922 ± 256 vs 1,054 ± 235 × 10(-6) mm(2)/s, p = 0.053; hazard ratio, 0.991 for time to treatment). Tumor volume was significantly higher in the treated group (0.86 ± 0.85 cm(3) vs 0.32 ± 0.33 cm(3), p = 0.02). ADC(slow) and tumor volume were significant but independent predictors of upgrade on biopsy (p = 0.01 and 0.002, respectively).
Both fast and slow diffusion components were significantly lower in tumors that were subsequently upgraded on histology. Both tumor volume and the true diffusion ADC(slow) were significant but independent predictors of histologic progression.
我们研究的目的是探讨磁共振扩散加权成像表观扩散系数（ADC）的快、慢成分是否可以预测主动监测管理的前列腺癌患者的进展情况。
81 例接受主动监测的患者在经直肠技术进行 T2 加权 MRI 检查的同时，还进行了扩散加权 MRI 检查。使用所有 b 值（ADC(all)）、b = 0-300 s/mm(2)（ADC(fast)）和 b = 300-800 s/mm(2)（ADC(slow)）计算肿瘤感兴趣区的 ADC。比较在后续活检中升级（n = 14）与组织学稳定（n = 41）的患者以及进展为根治性治疗（n = 16）与未进展（n = 64）的可评估患者的这些参数和肿瘤体积。Cox 回归用于分析参数平均值对治疗时间的影响。
重复活检升级的患者的 ADC(all)、ADC(fast)和 ADC(slow)均显著低于稳定患者（1,070 ± 110 比 1,356 ± 357×10(-6)mm(2)/s，p<0.001；1,283 ± 188 比 1,526 ± 397×10(-6)mm(2)/s，p = 0.004；843 ± 74 比 1,105 ± 285×10(-6)mm(2)/s，p<0.001）。升级组的肿瘤体积明显更大（0.86 ± 0.9 比 0.26 ± 0.25 cm(3)，p = 0.02）。随后进展为根治性治疗的患者的 ADC(slow)较低具有显著趋势（922 ± 256 比 1,054 ± 235×10(-6)mm(2)/s，p = 0.053；治疗时间的风险比为 0.991）。治疗组的肿瘤体积明显更大（0.86 ± 0.85 cm(3) 比 0.32 ± 0.33 cm(3)，p = 0.02）。ADC(slow)和肿瘤体积是活检升级的显著但独立的预测因子（p = 0.01 和 0.002）。
在随后组织学升级的肿瘤中，快、慢扩散成分均显著降低。肿瘤体积和真正的扩散 ADC(slow)是组织学进展的显著但独立的预测因子。
