Jäderling Fredrik, Nyberg Tommy, Öberg Michael, Carlsson Stefan, Skorpil Mikael, Blomqvist Lennart
1Department of Radiology, Karolinska University Hospital, Solna, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Acta Radiol Open. 2018 Feb 8;7(2):2058460118754607. doi: 10.1177/2058460118754607. eCollection 2018 Feb.
The evidence supporting the use of magnetic resonance imaging (MRI) in prostate cancer detection has been established, but its accuracy in local staging is questioned.
To investigate the additional value of multi-planar radial reconstructions of a three-dimensional (3D) T2-weighted (T2W) MRI sequence, intercepting the prostate capsule perpendicularly, for improving local staging of prostate cancer.
Preoperative, bi-parametric prostate MRI examinations in 94 patients operated between June 2014 and January 2015 where retrospectively reviewed by two experienced abdominal radiologists. Each patient was presented in two separate sets including diffusion-weighted imaging, without and with the 3D T2W set that included radial reconstructions. Each set was read at least two months apart. Extraprostatic tumor extension (EPE) was assessed according to a 5-point grading scale. Sensitivity and specificity for EPE was calculated and presented as receiver operating characteristics (ROC) with area under the curve (AUC), using histology from whole-mount prostate specimen as gold standard. Inter-rater agreement was calculated for the two different reading modes using Cohen's kappa.
The AUC for detection of EPE for Readers 1 and 2 in the two-dimensional (2D) set was 0.70 and 0.68, respectively, and for the 2D + 3D set 0.62 and 0.65, respectively. Inter-rater agreement (Reader 1 vs. Reader 2) on EPE using Cohen's kappa for the 2D and 2D + 3D set, respectively, was 0.42 and 0.17 (i.e. moderate and poor agreement, respectively).
The addition of 3D T2W MRI with radial reconstructions did not improve local staging in prostate cancer.
支持磁共振成像（MRI）用于前列腺癌检测的证据已经确立，但其在局部分期方面的准确性受到质疑。
研究三维（3D）T2加权（T2W）MRI序列多平面径向重建（垂直于前列腺包膜截取）在改善前列腺癌局部分期方面的附加价值。
对2014年6月至2015年1月间接受手术的94例患者的术前双参数前列腺MRI检查进行回顾性分析，由两位经验丰富的腹部放射科医生进行。每位患者的检查分为两组，一组包括扩散加权成像，另一组包括3D T2W序列（含径向重建）。两组检查至少间隔两个月进行阅片。根据5分分级量表评估前列腺外肿瘤侵犯（EPE）情况。以全层前列腺标本的组织学检查结果作为金标准，计算EPE的敏感性和特异性，并以曲线下面积（AUC）的形式呈现为受试者操作特征（ROC）曲线。使用Cohen's kappa计算两种不同阅片模式下的评分者间一致性。
在二维（2D）组中，阅片者1和阅片者2检测EPE的AUC分别为0.70和0.68，在2D + 3D组中分别为0.62和0.65。在2D组和2D + 3D组中，使用Cohen's kappa计算的阅片者1与阅片者2在EPE方面的评分者间一致性分别为0.42和0.17（即分别为中等一致性和差一致性）。
添加具有径向重建的3D T2W MRI并未改善前列腺癌的局部分期。
