Linder Brian J, Kawashima Akira, Woodrum David A, Tollefson Matthew K, Karnes Jeffrey, Davis Brian J, Rangel Laureano J, King Bernard F, Mynderse Lance A
Mayo Clinic, Rochester, Minnesota, USA.
Can J Urol. 2014 Jun;21(3):7283-9.
To evaluate the ability of endorectal coil (e-coil) magnetic resonance imaging (MRI) to identify early prostatic fossa recurrence after radical prostatectomy.
We identified 187 patients from 2005-2011 who underwent e-coil MRI with dynamic gadolinium-contrast enhancement followed by transrectal ultrasound (TRUS) guided prostatic fossa biopsy for possible local prostate cancer recurrence. For analysis, local recurrence was defined as a negative evaluation for distant metastatic disease with a positive prostatic fossa biopsy, decreased prostate-specific antigen (PSA) following salvage radiation therapy, or increased lesion size on serial imaging.
Local recurrence was identified in 132 patients, with 124 (94%) detected on e-coil MRI. The median PSA was 0.59 ng/mL (range < 0.1-13.1), and median lesion size on MRI was 1 cm. The sensitivity of MRI was 91%, with a specificity of 45%. The positive predictive value was 85%, with a negative predictive value of 60%. For patients with a PSA < 0.4 ng/mL the sensitivity of e-coil MRI was 86%. When a lesion was identified on MRI, the positive biopsy rate was 65% and lesion size was a significant predictor of positive biopsies. The positive biopsy rates were 51%, 74%, and 88% when the lesion was < 1 cm, 1 cm-2 cm, or > 2 cm, respectively (p = 0.0006).
E-coil MRI has a high level of sensitivity in identifying local recurrence of prostate cancer following radical prostatectomy, even at low PSA levels. E-coil MRI should be considered as the first imaging evaluation for biochemical recurrence for identifying patients suitable for localized salvage therapy.
评估直肠内线圈（e线圈）磁共振成像（MRI）识别前列腺癌根治术后早期前列腺窝复发的能力。
我们确定了2005年至2011年间接受e线圈MRI检查并进行动态钆对比增强，随后接受经直肠超声（TRUS）引导的前列腺窝活检以排查局部前列腺癌复发的187例患者。为进行分析，局部复发定义为远处转移性疾病评估为阴性，前列腺窝活检阳性，挽救性放射治疗后前列腺特异性抗原（PSA）降低，或系列成像中病变大小增加。
132例患者被确定为局部复发，其中124例（94%）通过e线圈MRI检测到。PSA中位数为0.59 ng/mL（范围<0.1 - 13.1），MRI上病变大小中位数为1 cm。MRI的敏感性为91%，特异性为45%。阳性预测值为85%，阴性预测值为60%。对于PSA<0.4 ng/mL的患者，e线圈MRI的敏感性为86%。当MRI上发现病变时，阳性活检率为65%，病变大小是阳性活检的重要预测因素。当病变<1 cm、1 cm - 2 cm或>2 cm时，阳性活检率分别为51%、74%和88%（p = 0.0006）。
e线圈MRI在识别前列腺癌根治术后局部复发方面具有较高的敏感性，即使在低PSA水平时也是如此。对于生化复发，e线圈MRI应被视为识别适合局部挽救性治疗患者的首选影像学评估方法。
