功能磁共振成像在评估前列腺癌包膜外侵犯方面有作用吗？

Is There a Role for Functional MRI for the Assessment of Extracapsular Extension in Prostate Cancer?

作者信息

Sertdemir Metin, Weidner Anja M, Schoenberg Stefan O, Morelli John N, Haecker Axel, Kirchner Matthias, Weiss Christel, Hausmann Daniel, Dinter Dietmar J, Attenberger Ulrike I

机构信息

Diagnostische Gemeinschaftspraxis, Karlsruhe, Germany.

Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany

出版信息

Anticancer Res. 2018 Jan;38(1):427-432. doi: 10.21873/anticanres.12240.

DOI:10.21873/anticanres.12240

PMID:29277805

Abstract

BACKGROUND/AIM: Exctracapsular extension (ECE) in prostate cancer has a high impact on treatment decision. MRI might predict presence of ECE non-invasively.

PATIENTS AND METHODS

Triplanar T2w-sequences, DWI (diffusion weighted imaging) and DCE (dynamic contrast-enhanced imaging) of 34 patients with PCa were analyzed to prior prostatectomy. Sensitivity (SS) and specificity (SP) of T2w, apparent diffusion coefficient (ADC), plasma flow (PF) and mean transit time (MTT) normalized by PCa/normal tissue ratio for prediction of CI (capsular infiltration)/ECE were determined by area-under-the-receiver-operating-characteristics analysis.

RESULTS

SS/SP for detecting ECE was 29/85. AUC (area under the curve) of ECE cases was 0.98/0.92/0.69 (cut-off-ratios 3.2/0.51/0.46), SS 93/100/86% and SP 95/80/50% for PF-/MTT-/ADC-ratios, respectively. PF- and MTT-ratios between CI and without CI/ECE differed significantly (PF, p<0.0001; MTT, p=0.0134) with SS/SP 84/89% for PF and SS/SP 52/100% for MTT-ratios. No significant differences regarding ADC-ratios were identified.

CONCLUSION

ECE/CI can be assessed by quantitative DCE analysis with great diagnostic confidence and higher specificity than ADC.

摘要

背景/目的：前列腺癌的包膜外扩展（ECE）对治疗决策有重大影响。MRI可能无创地预测ECE的存在。

患者与方法

对34例前列腺癌患者在前列腺切除术前的三平面T2加权序列、扩散加权成像（DWI）和动态对比增强成像（DCE）进行分析。通过受试者操作特征曲线下面积分析，确定以前列腺癌/正常组织比值标准化的T2加权成像、表观扩散系数（ADC）、血浆流量（PF）和平均通过时间（MTT）对包膜浸润（CI）/ECE预测的敏感性（SS）和特异性（SP）。

结果

检测ECE的SS/SP为29/85。ECE病例的曲线下面积（AUC）分别为0.98/0.92/0.69（截断比值3.2/0.51/0.46），PF-/MTT-/ADC-比值的SS分别为93/100/86%，SP分别为95/80/50%。CI组与无CI/ECE组之间的PF和MTT比值差异显著（PF，p<0.0001；MTT，p=0.0134），PF比值的SS/SP为84/89%，MTT比值的SS/SP为52/100%。未发现ADC比值有显著差异。