Dwivedi Durgesh Kumar, Kumar Rajeev, Bora Girdhar S, Thulkar Sanjay, Sharma Sanjay, Gupta Siddhartha Datta, Jagannathan Naranamangalam R
Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
NMR Biomed. 2016 Mar;29(3):232-8. doi: 10.1002/nbm.3452. Epub 2016 Jan 5.
Risk stratification, based on the Gleason score (GS) of a prostate biopsy, is an important decision-making tool in prostate cancer management. As low-grade disease may not need active intervention, the ability to identify aggressive cancers on imaging could limit the need for prostate biopsies. We assessed the ability of multiparametric MRI (mpMRI) in pre-biopsy risk stratification of men with prostate cancer. One hundred and twenty men suspected to have prostate cancer underwent mpMRI (diffusion MRI and MR spectroscopic imaging) prior to biopsy. Twenty-six had cancer and were stratified into three groups based on GS: low grade (GS ≤ 6), intermediate grade (GS = 7) and high grade (GS ≥ 8). A total of 910 regions of interest (ROIs) from the peripheral zone (PZ, range 25-45) were analyzed from these 26 patients. The metabolite ratio [citrate/(choline + creatine)] and apparent diffusion coefficient (ADC) of voxels were calculated for the PZ regions corresponding to the biopsy cores and compared with histology. The median metabolite ratios for low-grade, intermediate-grade and high-grade cancer were 0.29 (range: 0.16, 0.61), 0.17 (range: 0.13, 0.32) and 0.13 (range: 0.05, 0.23), respectively (p = 0.004). The corresponding mean ADCs (×10(-3) mm(2) /s) for low-grade, intermediate-grade and high-grade cancer were 0.99 ± 0.08, 0.86 ± 0.11 and 0.69 ± 0.12, respectively (p < 0.0001). The combined ADC and metabolite ratio model showed strong discriminatory ability to differentiate subjects with GS ≤ 6 from subjects with GS ≥ 7 with an area under the curve of 94%. These data indicate that pre-biopsy mpMRI may stratify PCa aggressiveness noninvasively. As the recent literature data suggest that men with GS ≤ 6 cancer may not need radical therapy, our data may help limit the need for biopsy and allow informed decision making for clinical intervention. Copyright © 2015 John Wiley & Sons, Ltd.
基于前列腺活检的Gleason评分（GS）进行风险分层，是前列腺癌管理中一项重要的决策工具。由于低级别疾病可能无需积极干预，因此在影像学上识别侵袭性癌症的能力可能会减少前列腺活检的必要性。我们评估了多参数磁共振成像（mpMRI）在前列腺癌患者活检前风险分层中的能力。120名疑似患有前列腺癌的男性在活检前接受了mpMRI（扩散加权成像和磁共振波谱成像）检查。其中26人患有癌症，并根据GS分为三组：低级别（GS≤6）、中级别（GS = 7）和高级别（GS≥8）。对这26例患者外周带（PZ，范围25 - 45）共910个感兴趣区域（ROI）进行了分析。计算了与活检核心对应的PZ区域体素的代谢物比率[柠檬酸盐/（胆碱 + 肌酸）]和表观扩散系数（ADC），并与组织学结果进行比较。低级别、中级别和高级别癌症的代谢物比率中位数分别为0.29（范围：0.16，0.61）、0.17（范围：0.13，0.32）和0.13（范围：0.05，0.23）（p = 0.004）。低级别、中级别和高级别癌症对应的平均ADC（×10(-3) mm(2)/s）分别为0.99±0.08、0.86±0.11和0.69±0.12（p < 0.0001）。ADC和代谢物比率联合模型显示出强大的区分能力，能够将GS≤6的受试者与GS≥7的受试者区分开来（曲线下面积为94%）。这些数据表明，活检前mpMRI可能无创地对前列腺癌的侵袭性进行分层。由于最近的文献数据表明，GS≤6的癌症患者可能不需要根治性治疗，我们的数据可能有助于减少活检的必要性，并为临床干预提供明智的决策依据。版权所有© 2015 John Wiley & Sons, Ltd.
