Department of Urology, University of Iowa, Iowa City, IA 52242, USA.
Urol Oncol. 2013 Jul;31(5):601-6. doi: 10.1016/j.urolonc.2011.05.004. Epub 2011 Jun 12.
Endorectal MRI (ER-MRI) may identify areas suspicious for prostate cancer. We evaluated the accuracy of ER-MRI compared with subsequent pathology specimen from prostatectomy.
We reviewed 309 open radical retropubic prostatectomy cases (RRP) from 2003 to 2008 to identify 94 men with a preoperative ER-MRI, which was obtained in patients with high-risk factors suspicious for local extension (Gleason grade ≥ 4+3, PSA ≥ 10 ng/ml, abnormal rectal exam, or extensive biopsy core involvement). Findings of extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymphadenopathy (LAD) on ER-MRI were compared with subsequent findings on pathology specimens.
Ninety-four men underwent preoperative ER-MRI. No tumor was seen on ER-MRI in 9 men (10%). Of 94 ER-MRIs, 4% showed SVI, and 12% had ECE. At prostatectomy, lymph nodes were pathologically positive in 10 men, none of which were enlarged on ER-MRI. RRP was aborted in 3 of these 10 patients due to positive nodes confirmed on frozen section. Comparing ER-MRI results to subsequent prostatectomy specimen the results for accuracy, positive predictive value, negative predictive value, sensitivity, specificity were 70%, 27%, 76%, 14%, 88% for ECE and 93%, 75%, 94%, 38%, 99% for SVI. The accuracy of ECE prediction was 86% in abnormal rectal exam vs. 66% in normal exam (P < 0.05).
Endorectal MRI in the evaluation of high-risk prostate cancer was moderately accurate for SV involvement but inaccurate for ECE and insensitive for metastatic lymph node involvement. The predictive accuracy of ER-MRI improved in patients with an abnormal rectal exam.
直肠内磁共振成像（ER-MRI）可识别前列腺癌可疑部位。我们评估了 ER-MRI 与随后的前列腺切除术标本相比的准确性。
我们回顾了 2003 年至 2008 年 309 例开放性经直肠前列腺根治性切除术（RRP）病例，以确定 94 例术前接受过 ER-MRI 检查的患者，这些患者具有局部扩展的高危因素（Gleason 分级≥4+3、PSA≥10ng/ml、直肠检查异常或广泛活检核心受累）。将 ER-MRI 上的包膜外延伸（ECE）、精囊侵犯（SVI）和淋巴结病（LAD）的发现与随后的病理标本进行比较。
94 名男性接受了术前 ER-MRI 检查。9 名男性（10%）的 ER-MRI 未见肿瘤。在 94 例 ER-MRI 中，4%的患者出现 SVI，12%的患者出现 ECE。在前列腺切除术时，10 名患者的淋巴结在病理上呈阳性，而这些患者中没有一个在 ER-MRI 上肿大。由于冷冻切片证实淋巴结阳性，这 10 名患者中有 3 名的 RRP 被中止。将 ER-MRI 结果与随后的前列腺切除术标本进行比较，ECE 的准确性、阳性预测值、阴性预测值、敏感性、特异性分别为 70%、27%、76%、14%、88%，SVI 分别为 93%、75%、94%、38%、99%。在直肠检查异常的患者中，ECE 预测的准确性为 86%，而在直肠检查正常的患者中为 66%（P<0.05）。
在高危前列腺癌的评估中，直肠内磁共振成像对 SV 受累具有中等准确性，但对 ECE 不准确，对转移性淋巴结受累不敏感。在直肠检查异常的患者中，ER-MRI 的预测准确性提高。
