多参数磁共振成像用于检测低剂量率近距离放射治疗后生化复发情况下前列腺癌的局部复发
Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy.
作者信息
Valle Luca F, Greer Matthew D, Shih Joanna H, Barrett Tristan, Law Yan Mee, Rosenkrantz Andrew B, Shebel Haytham, Muthigi Akhil, Su Daniel, Merino Maria J, Wood Bradford J, Pinto Peter A, Krauze Andra V, Kaushal Aradhana, Choyke Peter L, Türkbey Barış, Citrin Deborah E
机构信息
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Maryland, USA.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Maryland, USA.
出版信息
Diagn Interv Radiol. 2018 Jan-Feb;24(1):46-53. doi: 10.5152/dir.2018.17285.
PURPOSE
Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy.
METHODS
A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling.
RESULTS
Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI.
CONCLUSION
This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.
目的
前列腺多参数磁共振成像（mpMRI）在检测放疗后局部复发方面具有实用价值。我们开展了一项多阅片者研究，以评估mpMRI对低剂量率（LDR）近距离放射治疗后局部复发的诊断性能。
方法
19例LDR近距离放射治疗后出现生化复发的患者接受了3T直肠内线圈mpMRI检查，包括T2加权成像、动态对比增强成像（DCE）和扩散加权成像（DWI），并经病理证实。将一位经验丰富的前列腺放射科医生的前瞻性阅片结果与4位经验各异的放射科医生的阅片结果进行比较。阅片者识别出可疑病变并对每个MRI检测参数进行评分。经同侧病理证实的MRI检测到的病变被视为真阳性。使用自助重采样法对敏感性、特异性、阳性预测值（PPV）、kappa值和特定一致性指数进行推断。
结果
19例患者中有15例经病理证实复发。mpMRI识别出的真阳性复发灶常位于移行区（46.7%）和精囊（30%）。基于患者的分析显示，mpMRI的平均敏感性为88%（标准误[SE]，3.5%）。对于高度可疑病变，mpMRI的特异性为75%（SE，16.5%）。基于病变的分析显示，所有病变的平均PPV为62%（SE，6.7%），高度可疑病变的平均PPV为78.7%（SE，10.3%）。侵犯精囊的病变的平均PPV为88.8%（n = 13）。T2加权成像识别出的病变的平均PPV为66.6%（SE，5.8%），DCE为64.9%（SE，7.3%），DWI为70%（SE，7.3%）。
结论
本系列研究表明，LDR近距离放射治疗后进行mpMRI检查是可行的，基于患者的癌症检出率较高。不同经验的放射科医生在检测复发方面表现出中等程度的一致性。
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