Department of Urology, Canisius-Wilhelmina Hospital, Radboud University Nijmegen Medical Center, The Netherlands.
Invest Radiol. 2013 Mar;48(3):152-7. doi: 10.1097/RLI.0b013e31827b711e.
We aimed to determine whether diffusion-weighted magnetic resonance imaging, by means of the apparent diffusion coefficient (ADC), is able to guide magnetic resonance-guided biopsy in patients fit for active surveillance (AS) and identify patients harboring high-grade Gleason components not suitable for AS.
Our study was approved by the institutional review board of all participating hospitals, and all patients signed informed consent at inclusion. Fifty-four consecutive patients with low-risk prostate cancer (PCa) underwent multiparametric magnetic resonance imaging (MP-MRI) at inclusion for AS. Cancer-suspicious regions (CSRs) upon 3-T MP-MRI were identified in all patients, and magnetic resonance-guided biopsy was performed in all CSRs to obtain histopathological verification. For all CSRs, a median ADC (mADC) was calculated. Wilcoxon signed ranks and Mann-Whitney tests was performed to detect differences between the groups. We used the area under the receiver operating characteristic curve to evaluate the accuracy of mADC to predict the presence of PCa in a CSR. Level of statistical significance was set at P < 0.05.
Mean mADC in the CSRs with PCa was 1.04 × 10⁻³ mm²/s (SD, 0.29), whereas the CSRs with no PCa displayed a mean mADC of 1.26 × 10⁻³ mm²/s (SD, 0.25; P < 0.001). Cancer-suspicious regions with a high-grade Gleason component displayed a mean mADC of 0.84 × 10⁻³ mm²/s (SD, 0.35) vs a mean mADC for the low-grade CSRs of 1.09 × 10⁻³ mm²/s (SD, 0.25; P < 0.05). A diagnostic accuracy of mADC for predicting the presence of PCa in a CSR with an area under the receiver operating characteristic curve of 0.73 was established (95% confidence interval, 0.61-0.84).
Median ADC is able to predict the presence and grade of PCa in CSRs identified by MP-MRI.
本研究旨在评估磁共振弥散加权成像（DWI）通过表观弥散系数（ADC）是否能指导适合主动监测（AS）的患者进行磁共振引导下活检，并识别出不适合 AS 的高分级 Gleason 成分的患者。
本研究经所有参与医院的机构审查委员会批准，所有患者在纳入时均签署了知情同意书。54 例低危前列腺癌（PCa）患者在纳入时接受多参数磁共振成像（MP-MRI）以进行 AS。所有患者的 3T MP-MRI 均识别出可疑癌症区域（CSR），并在所有 CSR 进行磁共振引导下活检以获得组织病理学验证。对所有 CSR 计算中位数 ADC（mADC）。采用 Wilcoxon 符号秩和检验和 Mann-Whitney 检验比较组间差异。我们使用受试者工作特征曲线下面积评估 mADC 预测 CSR 中 PCa 存在的准确性。统计学显著性水平设为 P < 0.05。
有 PCa 的 CSR 中 mADC 的平均值为 1.04×10⁻³mm²/s（标准差，0.29），而无 PCa 的 CSR 中 mADC 的平均值为 1.26×10⁻³mm²/s（标准差，0.25；P < 0.001）。高级别 Gleason 成分的可疑癌症区域的 mADC 平均值为 0.84×10⁻³mm²/s（标准差，0.35），而低级别 CSRs 的 mADC 平均值为 1.09×10⁻³mm²/s（标准差，0.25；P < 0.05）。mADC 预测 CSR 中 PCa 存在的诊断准确性以受试者工作特征曲线下面积为 0.73 建立（95%置信区间，0.61-0.84）。
中位数 ADC 能够预测 MP-MRI 识别的 CSR 中 PCa 的存在和分级。
