Department of Radiology, David Geffen School of Medicine at UCLA, 200 Medical Plaza, #165-43, MC 695224, Los Angeles, CA 90095-6952, USA.
Radiology. 2012 Mar;262(3):874-83. doi: 10.1148/radiol.11103504. Epub 2012 Jan 24.
To determine whether findings at preoperative endorectal coil magnetic resonance (MR) imaging influence the decision to preserve neurovascular bundles and the extent of surgical margins in robotic-assisted laparoscopic prostatectomy (RALP).
This study was approved by the investigational review board and was compliant with the HIPAA; the requirement to obtain informed consent was waived. The authors prospectively evaluated 104 consecutive men with biopsy-proved prostate cancer who underwent preoperative endorectal coil MR imaging of the prostate and subsequent RALP. MR imaging was performed at 1.5 T between January 2004 and April 2008 and included T2-weighted imaging (n = 104), diffusion-weighted imaging (n = 88), dynamic contrast-enhanced imaging (n = 51), and MR spectroscopy (n = 91). One surgeon determined the planned preoperative extent of resection bilaterally on the basis of clinical information and then again after review of the final MR imaging report. The differences in the surgical plan before and after review of the MR imaging report were determined and compared with the actual surgical and pathologic results by using logistic regression analysis. Continuous and ranked variables underwent Pearson and Spearman analysis.
After review of MR imaging results, the initial surgical plan was changed in 28 of the 104 patients (27%); the surgical plan was changed to a nerve-sparing technique in 17 of the 28 patients (61%) and to a non-nerve-sparing technique in 11 (39%). Seven of the 104 patients (6.7%) had positive surgical margins. In patients whose surgical plan was changed to a nerve-sparing technique, there were no positive margins on the side of the prostate with a change in treatment plan.
Preoperative prostate MR imaging data changed the decision to use a nerve-sparing technique during RALP in 27% of patients in this series.
确定术前直肠内线圈磁共振（MR）成像的结果是否影响在机器人辅助腹腔镜前列腺切除术（RALP）中保留神经血管束和手术切缘范围的决策。
本研究经机构审查委员会批准，并符合 HIPAA 规定；豁免了获得知情同意的要求。作者前瞻性评估了 104 例连续接受术前直肠内线圈前列腺 MR 成像和随后 RALP 的经活检证实的前列腺癌男性患者。MR 成像于 2004 年 1 月至 2008 年 4 月在 1.5T 下进行，包括 T2 加权成像（n = 104）、弥散加权成像（n = 88）、动态对比增强成像（n = 51）和磁共振波谱成像（n = 91）。一位外科医生根据临床信息确定双侧术前计划切除范围，然后再根据最终的 MR 成像报告进行评估。通过逻辑回归分析确定术前和回顾 MR 成像报告后手术计划的差异，并与实际手术和病理结果进行比较。连续和等级变量进行了 Pearson 和 Spearman 分析。
在回顾 MR 成像结果后，104 例患者中的 28 例（27%）初始手术计划发生改变；28 例患者中的 17 例（61%）手术计划改为保留神经技术，11 例（39%）改为不保留神经技术。104 例患者中有 7 例（6.7%）有阳性手术切缘。在手术计划改为保留神经技术的患者中，治疗计划改变侧的前列腺没有阳性切缘。
在本系列中，27%的患者术前前列腺 MR 成像数据改变了在 RALP 中使用保留神经技术的决策。
