Goris Gbenou Maximilien C, Peltier Alexandre, Addla Sanjai K, Lemort Marc, Bollens Renaud, Larsimont Denis, Roumeguère Thierry, Schulman Claude C, van Velthoven Roland
Department of Urology, Institut Jules Bordet, Brussels, Belgium.
Urol Int. 2012;88(1):12-7. doi: 10.1159/000331909. Epub 2011 Oct 15.
Magnetic resonance imaging (MRI) and MR spectroscopic imaging (MRSI) have been gaining acceptance as tools in the evaluation of prostate cancer. We compared the accuracy of transrectal ultrasound (TRUS)-guided biopsy and dynamic contrast-enhanced MRI combined with three-dimensional (3D) MRSI in locating prostate tumours and determined the influence of prostate weight on MRI accuracy.
Between March 1999 and October 2006, 507 patients with localised prostate cancer underwent radical prostatectomy (RP) at the Jules Bordet Institute. Of these, 220 had undergone endorectal MRI (1.5 T Siemens Quantum Symphony) and 3D-MRSI prior to RP. We retrospectively reviewed data on tumour location and compared the results obtained by MRI and by TRUS-guided biopsy with those obtained on histopathology of the RP specimen.
Patient data were as follows: median age 62.4 years (45-74); median PSA 6.36 ng/ml (0.5-22.6); 73.6% of patients had non-palpable disease (T1c); median biopsy Gleason score 6 (3-9); median RP specimen weight 50 g (12-172); median pathological Gleason score 7 (4-10); 68.64% of patients had organ-confined (pT2) disease. Tumour localisation was correlated with RP data in a significantly higher percentage of patients when using MRI rather than TRUS-guided biopsy (47.4 vs. 36.6%, p < 0.0001). MRI was marginally superior to TRUS-guided biopsy in detecting malignancy at the prostate apex (48.3 vs. 41.9%, p = 0.0687) and somewhat better at the prostate base (46 vs. 39.1%, p = 0.0413). It was highly significantly better at mid-gland (52 vs. 41.1%, p = 0.0015) and in the transition zone (40.1 vs. 24.3%, p < 0.0001). MRI had higher sensitivity in larger (≥50 g) than smaller (<50 g) prostates (50.3 vs. 42.2%, p = 0.0017).
MRI was superior to TRUS-guided biopsy in locating prostate tumours except at the gland apex. MRI was more accurate in larger (≥50 g) than smaller prostates.
磁共振成像（MRI）和磁共振波谱成像（MRSI）作为评估前列腺癌的工具已逐渐被认可。我们比较了经直肠超声（TRUS）引导下活检与动态对比增强MRI联合三维（3D）MRSI在定位前列腺肿瘤方面的准确性，并确定了前列腺重量对MRI准确性的影响。
1999年3月至2006年10月期间，507例局限性前列腺癌患者在朱尔斯·博尔德研究所接受了根治性前列腺切除术（RP）。其中，220例在RP术前接受了直肠内MRI（1.5T西门子量子交响乐）和3D-MRSI检查。我们回顾性分析了肿瘤定位数据，并将MRI和TRUS引导下活检的结果与RP标本组织病理学结果进行了比较。
患者数据如下：年龄中位数62.4岁（45 - 74岁）；前列腺特异性抗原（PSA）中位数6.36 ng/ml（0.5 - 22.6）；73.6%的患者为不可触及病变（T1c）；活检Gleason评分中位数6（3 - 9）；RP标本重量中位数50 g（12 - 172）；病理Gleason评分中位数7（4 - 10）；68.64%的患者为器官局限性（pT2）病变。与TRUS引导下活检相比，使用MRI时肿瘤定位与RP数据相关的患者比例显著更高（47.4%对36.6%，p < 0.0001）。MRI在检测前列腺尖部恶性肿瘤方面略优于TRUS引导下活检（48.3%对41.9%，p = 0.0687），在前列腺底部检测效果稍好（46%对39.1%，p = 0.0413）。在前列腺中叶（52%对41.1%，p = 0.0015）和移行区（40.1%对24.3%，p < 0.0001），MRI的检测效果明显更好。MRI在较大（≥50 g）前列腺中的敏感性高于较小（<50 g）前列腺（50.
