在初次经直肠超声引导活检前前列腺特异抗原（PSA）升高的患者中，采用三种功能技术进行前列腺多参数磁共振成像。
Multiparametric MRI of the prostate with three functional techniques in patients with PSA elevation before initial TRUS-guided biopsy.
作者信息
Hauth Elke, Hohmuth Horst, Cozub-Poetica Corina, Bernand Stefan, Beer Meinrad, Jaeger Horst
机构信息
1 Radiologische Praxis, Ulm, Germany.
2 Uropraxis, Ulm, Germany.
出版信息
Br J Radiol. 2015 Oct;88(1054):20150422. doi: 10.1259/bjr.20150422. Epub 2015 Aug 13.
OBJECTIVE
Multiparametric MRI (mp-MRI) of the prostate is increasingly being used for local staging and detection of recurrence of prostate cancer (PCA). In patients with elevated prostate-specific antigen (PSA), mp-MRI could provide information on the position of the cancer, allowing adjustments to be made to the needle depth and direction before repeat transrectal ultrasound (TRUS)-guided biopsy to ensure accurate sampling of lesions. The purpose of the prospective study was to evaluate mp-MRI of the prostate in patients with PSA elevation before initial TRUS-guided biopsy.
METHODS
mp-MRI was performed in 94 patients using a 1.5-T scanner (MAGNETOM Aera(®); Siemens Healthcare, Erlangen, Germany) and 16-channel phased-array body coil (Siemens Healthcare). T2 weighted images (T2WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI and MR spectroscopy were obtained. TRUS-guided random biopsies and additional targeted biopsies of suspicious MRI areas were performed.
RESULTS
Additional targeted biopsies were obtained in 17 of 43 (40%) patients with PCA. 11 of 17 targeted biopsies contained PCA. 5 of 11 PCAs were diagnosed only by additional targeted biopsies. Sensitivity of mp-MRI in patients was 97.7% and specificity was 11.8%. mp-MRI was false negative in one patient. Sensitivity of mp-MRI in 207 lesions was 80.9% and specificity was 44.7%. In a logistic regression model, the apparent diffusion coefficient value was the only significant parameter to differentiate malignant and benign lesions.
CONCLUSION
mp-MRI should be performed in patients with PSA elevation before initial TRUS-guided biopsy to allow additional targeted biopsies from suspicious areas of MRI. We recommend mp-MRI with T2WI, DWI, DCE MRI and MR spectroscopy. DWI as the most reliable technique should be used in every mp-MRI.
ADVANCES IN KNOWLEDGE
DWI is the most reliable technique in mp-MRI of the prostate.
目的
前列腺多参数磁共振成像（mp-MRI）越来越多地用于前列腺癌（PCA）的局部分期和复发检测。在前列腺特异性抗原（PSA）升高的患者中，mp-MRI可以提供有关癌症位置的信息，从而在重复经直肠超声（TRUS）引导活检前调整穿刺针的深度和方向，以确保对病变进行准确采样。这项前瞻性研究的目的是评估初次TRUS引导活检前PSA升高患者的前列腺mp-MRI。
方法
使用1.5-T扫描仪（MAGNETOM Aera(®)；西门子医疗，德国埃尔朗根）和16通道相控阵体部线圈（西门子医疗）对94例患者进行mp-MRI检查。获取了T2加权图像（T2WI）、扩散加权成像（DWI）、动态对比增强（DCE）MRI和磁共振波谱。进行了TRUS引导的随机活检以及对可疑MRI区域的额外靶向活检。
结果
43例PCA患者中有17例（40%）进行了额外的靶向活检。17例靶向活检中有11例含有PCA。11例PCA中有5例仅通过额外的靶向活检确诊。mp-MRI在患者中的敏感性为97.7%，特异性为11.8%。1例患者mp-MRI为假阴性。mp-MRI在207个病变中的敏感性为80.9%，特异性为44.7%。在逻辑回归模型中，表观扩散系数值是区分恶性和良性病变的唯一重要参数。
结论
初次TRUS引导活检前PSA升高的患者应进行mp-MRI检查，以便从MRI可疑区域进行额外的靶向活检。我们推荐联合T2WI、DWI、DCE MRI和磁共振波谱的mp-MRI检查。在每次mp-MRI检查中都应使用DWI作为最可靠的技术。
知识进展
DWI是前列腺mp-MRI中最可靠的技术。
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