Ghavimi Samrad, Abdi Hamidreza, Waterhouse Jennifer, Savdie Richard, Chang Silvia, Harris Alison, Machan Lindsay, Gleave Martin, So Alan, Goldenberg Larry, Black Peter C
Department of Urologic Sciences.
Department of Radiology; University of British Columbia, Vancouver, BC, Canada.
Can Urol Assoc J. 2018 Aug(12):8. doi: 10.5489/cuaj.4859. Epub 2018 Apr 6.
The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI.
All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4. Patients on active surveillance (AS) were analyzed for correlation of MRI progression to biopsy reclassification.
A total of 83 patients (54 on AS and 29 for diagnostic purposes) underwent serial MRI, with a mean interval of 1.9 years between scans. At baseline, 115 lesions (66 index, 49 non-index) were identified. Index lesions were more likely than non-index lesions to increase in size ≥2 mm (36.2 vs. 7.3 %; p=0.002). Overall progression was more likely to be seen among the index cohort (34.8 vs. 7.6%; p<0.001). New lesions with PIRADS ≥4 were seen on second imaging in 13 (16.5%) men, and became the index lesion in 29 cases (34.9%). Eighteen men on AS showed evidence of MRI progression (five with new lesions, 13 with progression of a previous lesion). Biopsy reclassification was present in three men (16.7%) with and seven men without MRI progression (19.4%).
Overall changes in size and PIRADS scores of index lesions on MRI were small. New lesions were common, but usually did not alter management.
多参数磁共振成像（mpMRI）所发现的前列腺病变的自然病程在很大程度上尚不清楚。我们旨在描述在系列磁共振成像中随时间观察到的变化。
确定了2008年至2015年间在我们机构进行了≥2次磁共振成像研究的所有患者。磁共振成像进展定义为前列腺影像报告和数据系统（PI-RADS；第2版）增加或现有病变大小增加，或出现新的PI-RADS≥4的病变。对接受主动监测（AS）的患者分析磁共振成像进展与活检重新分类的相关性。
共有83例患者（54例接受AS，29例用于诊断）接受了系列磁共振成像，扫描之间的平均间隔为1.9年。基线时，共识别出115个病变（66个索引病变，49个非索引病变）。索引病变比非索引病变更有可能增大≥2mm（36.2%对7.3%；p=0.002）。总体进展在索引队列中更常见（34.8%对7.6%；p<0.001）。在第二次成像时，13例（16.5%）男性出现了PI-RADS≥4的新病变，其中29例（34.9%）成为索引病变。18例接受AS的男性显示有磁共振成像进展的证据（5例有新病变，13例先前病变进展）。3例（16.7%）有磁共振成像进展的男性和7例无磁共振成像进展的男性出现活检重新分类（19.4%）。
磁共振成像上索引病变的大小和PI-RADS评分的总体变化较小。新病变很常见，但通常不会改变治疗方案。
