Department of Radiology, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium.
Eur Urol. 2012 Jul;62(1):68-75. doi: 10.1016/j.eururo.2012.02.020. Epub 2012 Feb 17.
Technetium Tc 99m bone scintigraphy (BS) and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis and abdomen are universally recommended for detecting prostate cancer (PCa) metastases in cancer of all stages. However, this two-step approach has limited sensitivity and specificity.
Evaluate the diagnostic accuracy of whole-body MRI (WBMRI) as a one-step screening test for PCa metastases.
DESIGN, SETTING, AND PARTICIPANTS: One hundred consecutive PCa patients at high risk for metastases prospectively underwent WBMRI, CT, and BS completed with targeted x-rays (BS/TXR) in case of equivocal BS. Four independent reviewers reviewed the images.
This study compares the diagnostic performance of WBMRI, CT, BS, and BS/TXR in detecting PCa metastases using area under the curve (AUC) receiver operator characteristics. A best valuable comparator (BVC) approach was used to adjudicate final metastatic status in the absence of pathologic evaluation.
Based on the BVC, 68 patients had metastases. The sensitivity of BS/TXR and WBMRI for detecting bone metastases was 86% and 98-100%, respectively (p<0.04), and specificity was 98% and 98-100%, respectively. The first and second WBMRI readers respectively identified bone metastases in 7 and 8 of 55 patients with negative BS/TXR. The sensitivity of CT and WBMRI for detecting enlarged lymph nodes was similar, at 77-82% for both; specificity was 95-96% and 96-98%, respectively. The sensitivity of the combination of BS/TXR plus CT and WBMRI for detecting bone metastases and/or enlarged lymph nodes was 84% and 91-94%, respectively (p=0.03-0.10); specificities were 94-97% and 91-96%, respectively. The 95% confidence interval of the difference between the AUC of the worst WBMRI reading and the AUC of any of the BS/TXR plus CT lay within the noninferiority margin of ±10% AUC.
WBMRI outperforms BS/TXR in detecting bone metastases and performs as well as CT for enlarged lymph node evaluation. WBMRI can replace the current multimodality metastatic work-up for the concurrent evaluation of bones and lymph nodes in high-risk PCa patients.
锝 99m 骨闪烁扫描（BS）和骨盆及腹部增强 CT 或磁共振成像（MRI）被广泛推荐用于检测各期癌症的前列腺癌（PCa）转移。然而，这种两步法的敏感性和特异性有限。
评估全身 MRI（WBMRI）作为 PCa 转移一步筛查试验的诊断准确性。
设计、设置和参与者：100 例连续的高危 PCa 患者前瞻性地接受了 WBMRI、CT 和 BS 检查，如果 BS 结果不确定，则进行靶向 X 射线（BS/TXR）检查。4 位独立的审查员对图像进行了审查。
本研究通过曲线下面积（AUC）受试者工作特征比较了 WBMRI、CT、BS 和 BS/TXR 在检测 PCa 转移中的诊断性能。在没有病理评估的情况下，采用最佳有价值比较器（BVC）方法来裁决最终的转移性状态。
根据 BVC，68 例患者存在转移。BS/TXR 和 WBMRI 检测骨转移的敏感性分别为 86%和 98-100%（p<0.04），特异性分别为 98%和 98-100%。第一和第二位 WBMRI 读者分别在 55 例 BS/TXR 阴性患者中发现了 7 例和 8 例骨转移。CT 和 WBMRI 检测肿大淋巴结的敏感性相似，均为 77-82%；特异性分别为 95-96%和 96-98%。BS/TXR 加 CT 和 WBMRI 联合检测骨转移和/或肿大淋巴结的敏感性分别为 84%和 91-94%（p=0.03-0.10）；特异性分别为 94-97%和 91-96%。WBMRI 最差阅读 AUC 与 BS/TXR 加 CT 任何一项 AUC 之间差异的 95%置信区间在±10%AUC 非劣效性边界内。
WBMRI 在检测骨转移方面优于 BS/TXR，在评估肿大淋巴结方面与 CT 相当。WBMRI 可以替代当前用于高危 PCa 患者同时评估骨骼和淋巴结的多模态转移检查。
