多参数磁共振成像评估前列腺癌体积的准确性如何？
How accurate is multiparametric MR imaging in evaluation of prostate cancer volume?
机构信息
From the Departments of Urinary and Vascular Radiology (F.B., O.R.), Pathology (F.M.), and Urology (S.C., M.C., A.G.), Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 place d'Arsonval, 69437 Lyon Cedex 03, France; Université de Lyon, Lyon, France (F.B., S.C., M.C., O.R.); Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., S.C., M.C., O.R.); Inserm, U1032, LabTau, Lyon, France (F.B., R.S., A.H.D., S.C., A.G., O.R.); Laboratoire d'Ecologie Alpine, Université Joseph Fourier, Grenoble, France (C.M.); and CNRS, UMR 5553, Grenoble, France (C.M.).
出版信息
Radiology. 2015 Apr;275(1):144-54. doi: 10.1148/radiol.14140524. Epub 2014 Nov 21.
PURPOSE
To assess the factors influencing multiparametric (MP) magnetic resonance (MR) imaging accuracy in estimating prostate cancer histologic volume (Vh).
MATERIALS AND METHODS
A prospective database of 202 patients who underwent MP MR imaging before radical prostatectomy was retrospectively used. Institutional review board approval and informed consent were obtained. Two independent radiologists delineated areas suspicious for cancer on images (T2-weighted, diffusion-weighted, dynamic contrast material-enhanced [DCE] pulse sequences) and scored their degree of suspicion of malignancy by using a five-level Likert score. One pathologist delineated cancers on whole-mount prostatectomy sections and calculated their volume by using digitized planimetry. Volumes of MR true-positive lesions were measured on T2-weighted images (VT2), on ADC maps (VADC), and on DCE images [VDCE]). VT2, VADC, VDCE and the greatest volume determined on images from any of the individual MR pulse sequences (Vmax) were compared with Vh (Bland-Altman analysis). Factors influencing MP MR imaging accuracy, or A, calculated as A = Vmax/Vh, were evaluated using generalized linear mixed models.
RESULTS
For both readers, Vh was significantly underestimated with VT2 (P < .0001, both), VADC (P < .0001, both), and VDCE (P = .02 and P = .003, readers 1 and 2, respectively), but not with Vmax (P = .13 and P = .21, readers 1 and 2, respectively). Mean, 25th percentile, and 75th percentile, respectively, for Vmax accuracy were 0.92, 0.54, and 1.85 for reader 1 and 0.95, 0.57, and 1.77 for reader 2. At generalized linear mixed (multivariate) analysis, tumor Likert score (P < .0001), Gleason score (P = .009), and Vh (P < .0001) significantly influenced Vmax accuracy (both readers). This accuracy was good in tumors with a Gleason score of 7 or higher or a Likert score of 5, with a tendency toward underestimation of Vh; accuracy was poor in small (<0.5 cc) or low-grade (Gleason score ≤6) tumors, with a tendency toward overestimation of Vh.
CONCLUSION
Vh can be estimated by using Vmax in aggressive tumors or in tumors with high Likert scores.
目的
评估多参数（MP）磁共振（MR）成像在估计前列腺癌组织学体积（Vh）方面的准确性的影响因素。
材料与方法
本研究回顾性分析了 202 例接受根治性前列腺切除术前行 MP-MR 成像的患者的前瞻性数据库。本研究获得了机构审查委员会的批准和患者的知情同意。两位独立的放射科医生在图像（T2 加权、扩散加权、动态对比增强 [DCE] 脉冲序列）上勾画可疑癌症区域，并使用五级李克特评分评估其恶性程度的可疑程度。一位病理学家在整个前列腺切除术标本上勾画癌症，并使用数字化平面测量计算其体积。在 T2 加权图像（VT2）、ADC 图（VADC）和 DCE 图像 [VDCE] 上测量 MR 真阳性病变的体积。比较 Vh（Bland-Altman 分析）与 VT2（P<0.0001，均）、VADC（P<0.0001，均）和 VDCE（P=0.02 和 P=0.003，读者 1 和 2）、最大体积（Vmax）。使用广义线性混合模型评估影响 MP-MR 成像准确性或 A（定义为 A=Vmax/Vh）的因素。
结果
对于两位读者，与 Vh 相比，VT2（P<0.0001，均）、VADC（P<0.0001，均）和 VDCE（P=0.02 和 P=0.003，读者 1 和 2）均显著低估 Vh，但 Vmax（P=0.13 和 P=0.21，读者 1 和 2）无此差异。读者 1 的 Vmax 准确性的平均值、25%分位数和 75%分位数分别为 0.92、0.54 和 1.85，读者 2 分别为 0.95、0.57 和 1.77。在广义线性混合（多变量）分析中，肿瘤李克特评分（P<0.0001）、Gleason 评分（P=0.009）和 Vh（P<0.0001）显著影响 Vmax 准确性（均为两位读者）。在 Gleason 评分≥7 或李克特评分≥5 的侵袭性肿瘤中，Vh 可以通过 Vmax 来估计，且存在低估 Vh 的趋势；在体积较小（<0.5cc）或分级较低（Gleason 评分≤6）的肿瘤中，Vh 存在高估的趋势，Vmax 准确性较差。
结论
在侵袭性肿瘤或高李克特评分的肿瘤中，Vh 可通过 Vmax 估计。
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