Scheltema Matthijs J, Postema Arnoud W, de Bruin Daniel M, Buijs Mara, Engelbrecht Marc R, Laguna M Pilar, Wijkstra Hessel, de Reijke Theo M, de la Rosette Jean J M C H
Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
Diagn Interv Radiol. 2017 Sep-Oct;23(5):365-370. doi: 10.5152/dir.2017.16608.
Imaging plays a crucial role in ablative therapies for prostate cancer (PCa). Irreversible electroporation (IRE) is a new treatment modality used for focal treatment of PCa. We aimed to demonstrate what imaging modalities can be used by descriptively reporting contrast-enhanced ultrasonography (CEUS), multiparametric magnetic resonance imaging (mpMRI), and grey-scale transrectal ultrasound (TRUS) results. Furthermore, we aimed to correlate quantitatively the ablation zone seen on mpMRI and CEUS with treatment planning to provide therapy feedback.
Imaging data was obtained from two prospective multicenter trials on IRE for localized low- to intermediate-risk PCa. The ablation zone volume (AZV) seen on mpMRI and CEUS was 3D reconstructed to correlate with the planned AZV.
Descriptive examples are provided using mpMRI, TRUS, and CEUS for treatment planning and follow-up after IRE. The mean AZV on T2-weighted imaging 4 weeks following IRE was 12.9 cm3 (standard deviation [SD]=7.0), 5.3 times larger than the planned AZV. Linear regression showed a positive correlation (r=0.76, P = 0.002). For CEUS the mean AZV was 20.7 cm3 (SD=8.7), 8.5 times larger than the planned AZV with a strong positive correlation (r=0.93, P = 0.001). Prostate volume is reduced over time (mean= -27.5%, SD=11.9%) due to ablation zone fibrosis and deformation, illustrated by 3D reconstruction.
The role of imaging in conjunction with IRE is of crucial importance to guide clinicians throughout the treatment protocol. CEUS and mpMRI may provide essential treatment feedback by visualizing the ablation zone dimensions and volume.
成像在前列腺癌（PCa）的消融治疗中起着至关重要的作用。不可逆电穿孔（IRE）是一种用于PCa局部治疗的新治疗方式。我们旨在通过描述性报告对比增强超声（CEUS）、多参数磁共振成像（mpMRI）和灰阶经直肠超声（TRUS）结果，展示可使用哪些成像方式。此外，我们旨在将mpMRI和CEUS上所见的消融区与治疗计划进行定量关联，以提供治疗反馈。
成像数据来自两项关于IRE治疗局限性低至中度风险PCa的前瞻性多中心试验。对mpMRI和CEUS上所见的消融区体积（AZV）进行三维重建，以与计划的AZV相关联。
提供了使用mpMRI、TRUS和CEUS进行IRE治疗计划和随访的描述性示例。IRE后4周，T2加权成像上的平均AZV为12.9 cm³（标准差[SD]=7.0），比计划的AZV大5.3倍。线性回归显示呈正相关（r=0.76，P = 0.002）。对于CEUS，平均AZV为20.7 cm³（SD=8.7），比计划的AZV大8.5倍，呈强正相关（r=0.93，P = 0.001）。由于消融区纤维化和变形，前列腺体积随时间减小（平均=-27.5%，SD=11.9%），三维重建对此进行了说明。
成像与IRE结合的作用对于在整个治疗方案中指导临床医生至关重要。CEUS和mpMRI可通过显示消融区尺寸和体积提供重要的治疗反馈。
