双参数磁共振成像与多参数磁共振成像在前列腺癌诊断中的应用
Biparametric versus multiparametric MRI in the diagnosis of prostate cancer.
作者信息
Thestrup Karen Cecilie Duus, Logager Vibeke, Baslev Ingerd, Møller Jakob M, Hansen Rasmus Hvass, Thomsen Henrik S
机构信息
Department of Radiology, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, DK-2730 Herlev, Denmark.
Department of Pathology, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, DK-2730 Herlev, Denmark.
出版信息
Acta Radiol Open. 2016 Aug 17;5(8):2058460116663046. doi: 10.1177/2058460116663046. eCollection 2016 Aug.
BACKGROUND
Since multiparametric magnetic resonance imaging (mp-MRI) of the prostate exceeds 30 min, minimizing the evaluation time of significant (Gleason scores > 6) prostate cancer (PCa) would be beneficial. A reduced protocol might be sufficient for the diagnosis.
PURPOSE
To study whether a short unenhanced biparametric MRI (bp-MRI) matches mp-MRI in detecting significant PCa.
MATERIAL AND METHODS
A total of 204 men (median age, 65 years; mean ± SD, 64.1; range 45-75 years; median serum PSA level, 14 ng/mL; range, 2.2-120 ng/mL; median prostate volume, 60 mL; range, 23-263 mL) fulfilled the criteria for being enrolled. They underwent mp-MRI and prostate biopsy from January through June 2014. Of the included patients, 9.3% underwent prostatectomy, 90.7% had TRUS-bx, and 10.8 had MRI-targeted TRUS-bx. Two radiologists separately assessed the mp-MRI examination (T2-weighted [T2W] imaging, diffusion-weighted imaging [DWI], apparent diffusion coefficient map [ADC-map] and dynamic contrast-enhanced imaging [DCE]). Two months later, the bp-MRI version (T2W imaging, DWI, and ADC-map) was evaluated.
RESULTS
Reader 1: Assessing mp-MRI: 0 false negatives, sensitivity of 1, and specificity 0.04. Assessing bp-MRI: four false negatives, sensitivity of 0.94, and specificity 0.15. Reader 2: Assessing mp-MRI: five false negatives, sensitivity of 0.93, and specificity 0.16. Assessing bp-MRI: three false negatives, sensitivity of 0.96, and specificity 0.15. Intra-reader agreement Cohen's Kappa (κ) was 0.87 for reader 1 (95% confidence interval [CI], 0.83-0.92) and 0.84 for reader 2 (95% CI 0.78-0.89).
CONCLUSION
Bp-MRI is as good as mp-MRI at detecting PCa. A large prospective study seems to be strongly warranted.
背景
由于前列腺多参数磁共振成像（mp-MRI）检查时间超过30分钟，因此尽量缩短对显著（Gleason评分＞6）前列腺癌（PCa）的评估时间将大有裨益。简化的检查方案可能足以用于诊断。
目的
研究短时间非增强双参数MRI（bp-MRI）在检测显著PCa方面是否与mp-MRI效果相当。
材料与方法
共有204名男性（年龄中位数65岁；均值±标准差，64.1；范围45 - 75岁；血清PSA水平中位数14 ng/mL；范围2.2 - 120 ng/mL；前列腺体积中位数60 mL；范围23 - 263 mL）符合纳入标准。他们在2014年1月至6月期间接受了mp-MRI检查和前列腺活检。纳入患者中，9.3%接受了前列腺切除术，90.7%接受了经直肠超声引导下活检（TRUS-bx），10.8%接受了MRI靶向TRUS-bx。两名放射科医生分别评估mp-MRI检查（T2加权[T2W]成像、扩散加权成像[DWI]、表观扩散系数图[ADC图]和动态对比增强成像[DCE]）。两个月后，对bp-MRI版本（T2W成像、DWI和ADC图）进行评估。
结果
读者1：评估mp-MRI：0例假阴性，灵敏度为1，特异度为0.04。评估bp-MRI：4例假阴性，灵敏度为0.94，特异度为0.15。读者2：评估mp-MRI：5例假阴性，灵敏度为0.93，特异度为0.16。评估bp-MRI：3例假阴性，灵敏度为0.96，特异度为0.15。读者1的读者内一致性Cohen's Kappa（κ）为0.87（95%置信区间[CI]，0.83 - 0.92），读者2的为0.84（95% CI 0.78 - 0.89）。
结论
Bp-MRI在检测PCa方面与mp-MRI效果相当。一项大型前瞻性研究似乎很有必要。
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