Tan Nelly, Margolis Daniel J, Lu David Y, King Kevin G, Huang Jiaoti, Reiter Robert E, Raman Steven S
1 Department of Radiology, David Geffen School of Medicine at UCLA, Box 957437, RRUMC 1621, Los Angeles, CA 90095.
2 Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
AJR Am J Roentgenol. 2015 Jul;205(1):W87-92. doi: 10.2214/AJR.14.13285.
The objective of this study was to determine the characteristics of prostate cancer foci missed on 3-T multiparametric MRI performed with an endorectal coil.
The MRI examinations of 122 patients who underwent 3-T multiparametric MRI of the prostate with an endorectal coil were compared with whole-mount histopathology obtained after radical prostatectomy. The mean age of the patients was 60.6 years (SD, 7.6 years), and the mean prostate-specific antigen value was 7.2 ng/mL (SD, 5.9 ng/mL). The clinical, multiparametric MRI (i.e., T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging), and histopathologic features were obtained. After an independent review, two blinded genitourinary radiologists matched each case with a genitourinary pathologist. A structured reporting system was used to classify the multiparametric MRI features of each MRI-detected lesion. A chi-square analysis was performed for categoric variables, and the t test was performed for continuous variables.
On whole-mount histopathology, 285 prostate cancer foci were detected in 122 patients. Of the 285 cancer foci detected at histopathology, 153 (53.3%) were missed on MRI and 132 (46.7%) were detected on MRI. Of the missed lesions, 75.2% were low-grade prostate cancer. Multiparametric MRI had a significantly higher sensitivity for prostate cancer foci 1 cm or larger than for subcentimeter foci (81.1% vs 18.9%, respectively; p < 0.001), for lesions with a Gleason score of 7 or greater than for lesions with a Gleason score of 6 (72.7% vs 27.3%; p < 0.01), and for index lesions than for satellite lesions (80.3% vs 20.8%; p < 0.01). The 3-T multiparametric MRI examinations showed a higher detection rate for lesions in the midgland or base of the gland compared with lesions in the apex (52.3% vs 22.0%, respectively; p < 0.01).
Compared with the prostate cancer lesions that were detected on multiparametric MRI, the prostate cancer lesions that were missed were significantly smaller, were more likely to be low-grade lesions (i.e., Gleason score of 6), were more commonly satellite lesions, and were more likely to be located in the prostatic apex.
本研究的目的是确定使用直肠内线圈进行的3-T多参数磁共振成像（MRI）遗漏的前列腺癌病灶的特征。
将122例行3-T前列腺多参数MRI检查（使用直肠内线圈）的患者的MRI检查结果与根治性前列腺切除术后获得的全层组织病理学结果进行比较。患者的平均年龄为60.6岁（标准差为7.6岁），平均前列腺特异性抗原值为7.2 ng/mL（标准差为5.9 ng/mL）。记录临床、多参数MRI（即T2加权成像、扩散加权成像和动态对比增强成像）及组织病理学特征。经过独立评估后，两名不知情的泌尿生殖放射科医生将每个病例与一名泌尿生殖病理科医生进行匹配。使用结构化报告系统对每个MRI检测到的病变的多参数MRI特征进行分类。对分类变量进行卡方分析，对连续变量进行t检验。
在全层组织病理学检查中，122例患者共检测到285个前列腺癌病灶。在组织病理学检测到的285个癌灶中，153个（53.3%）在MRI上被遗漏，132个（46.7%）在MRI上被检测到。在遗漏的病灶中，75.2%为低级别前列腺癌。多参数MRI对直径1 cm或更大的前列腺癌病灶的敏感性显著高于对亚厘米病灶的敏感性（分别为81.1%和18.9%；p<0.001），对Gleason评分为7或更高的病灶的敏感性高于对Gleason评分为6的病灶（72.7%对27.3%；p<0.01），对主要病灶的敏感性高于对卫星病灶的敏感性（80.3%对20.8%；p<0.01）。与前列腺尖部的病灶相比，3-T多参数MRI检查对前列腺中叶或基底部的病灶显示出更高的检出率（分别为52.3%和22.0%；p<0.01）。
与多参数MRI检测到的前列腺癌病灶相比，遗漏的前列腺癌病灶明显更小，更可能是低级别病灶（即Gleason评分为6），更常见为卫星病灶，且更可能位于前列腺尖部。
