对周围或移行区癌灶弥散加权 MRI 受限区域内 Gleason 分级的组织学成分和结构模式进行定量分析。
Quantified analysis of histological components and architectural patterns of gleason grades in apparent diffusion coefficient restricted areas upon diffusion weighted MRI for peripheral or transition zone cancer locations.
机构信息
Department of Urology, CHRU Lille, Lille university, Lille, France.
Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France.
出版信息
J Magn Reson Imaging. 2017 Dec;46(6):1786-1796. doi: 10.1002/jmri.25716. Epub 2017 Apr 6.
PURPOSE
To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps.
MATERIALS AND METHODS
Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures.
RESULTS
Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P < 0.0001). Effect of malignant glands/ROI area was different according to the localization of the ROI (P = 0.03). We observed an overall difference between the means for all of the histological components for the comparison of true positive and false negative (P < 0.0001), except for the percent of Gleason grade 4 (P = 0.18). In TZ cancers, a predominant grade 3 pattern was associated with low ADC values. In PZ cancers, a predominant grade 4 pattern was associated with low ADC values.
CONCLUSION
Determinants of low ADC were high ratio of malignant glands/ROI area which may be seen in Gleason grades 3 or 4 cancers.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1786-1796.
目的
在限制表观扩散系数 (ADC) 图的情况下，定量和比较癌灶中 Gleason 分级的组织学成分和结构模式。
材料与方法
共纳入 12 例连续病例，共 14 个单独的 ADC 受限区，这些病例在外周带 (PZ) 和移行带 (TZ) 中均为前列腺癌阳性。所有患者均行 3T MRI 检查和根治性前列腺切除术。在 14 个 ADC 受限区内选择 10 个癌灶 ROI。对每个 ROI，我们进行了以下定量分析：(a) 前列腺良性和恶性组织学成分的表面比，包括基质、腺体、上皮、管腔、细胞核；(b) Gleason 分级比例和 ADC 值的测量。根据癌灶 ADC 限制，对组织学成分的平均值进行方差分析和重复测量分析。
结果
癌症的独立预测因子为上皮/ROI 比值的中位数 (P = 0.001) 和细胞核/ROI 比值 (P = 0.03)。ADC 受限的独立预测因子为恶性腺体/ROI 和管腔空间/ROI (P < 0.0001)。ROI 定位不同，恶性腺体/ROI 面积的影响也不同 (P = 0.03)。我们观察到真阳性和假阴性之间所有组织学成分的平均值之间存在总体差异 (P < 0.0001)，除了 Gleason 分级 4 的百分比 (P = 0.18)。在 TZ 癌中，与低 ADC 值相关的主要为 3 级模式。在 PZ 癌中，与低 ADC 值相关的主要为 4 级模式。
结论
低 ADC 的决定因素是恶性腺体/ROI 面积的高比例，这可能见于 Gleason 分级 3 或 4 级的癌症。
证据水平
3 级技术功效：第 3 阶段 J. 磁共振成像 2017；46：1786-1796.
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