Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
PLoS One. 2018 Jun 22;13(6):e0199636. doi: 10.1371/journal.pone.0199636. eCollection 2018.
Diffusion-weighted imaging (DWI) has been shown to be an important component of multiparametric magnetic resonance imaging (mpMRI). We compared performance of DWI for detection of prostate cancer (PCa) in peripheral zone (PZ) and transition zone (TZ) of prostate.
We reviewed data of 460 subjects who underwent preoperative 3.0-Tesla mpMRI and subsequently radical prostatectomy. Level of suspicion for PCa was graded using 5-grade Likert-scale from DWI. Topographic analyses were performed for location of tumor foci at each surgical specimen. Among those with DWI grade ≥ III, we analyzed concordance rate on the location of radiologic and pathologic index lesions between DWI and surgical specimens.
Among 460 patients, 351 (76.3%) patients showed suspicious DWI lesions (57.5% in PZ, 42.5% in TZ). Multivariates regression analyses revealed significant associations between high DWI grade and adverse pathologic outcomes including pathologic stage, Gleason score, tumor volume and extracapsular extension (all p < 0.05). Overall concordance rates between DWI and surgical specimen were 75.8%, significantly higher in PZ than TZ (82.2% vs. 67.1% p = 0.002). Such concordance rate showed a positive linear association with increase in DWI grading (p < 0.001). Among 109 patients with DWI grade I-II, 28 (25.7%) harbored high grade disease (pathologic Gleason score ≥ 4 + 3).
DWI detects tumors in PZ of prostate more accurately than those in TZ. Such accuracy of DWI was shown to be more evident with higher DWI grade. Meanwhile, a negative DWI did not guarantee absence of high grade PCa.
弥散加权成像（DWI）已被证明是多参数磁共振成像（mpMRI）的重要组成部分。我们比较了 DWI 检测前列腺外周带（PZ）和移行带（TZ）前列腺癌（PCa）的性能。
我们回顾了 460 例接受术前 3.0TmpMRI 检查并随后接受根治性前列腺切除术的患者的数据。使用 5 级 Likert 量表对 PCa 的可疑程度进行分级。对每个手术标本的肿瘤灶位置进行了地形分析。在 DWI 分级≥III 的患者中，我们分析了 DWI 与手术标本之间影像学和病理指标病变位置的一致性率。
在 460 例患者中，351 例（76.3%）患者显示可疑 DWI 病变（PZ 中 57.5%，TZ 中 42.5%）。多变量回归分析显示，高 DWI 分级与不良病理结果（包括病理分期、Gleason 评分、肿瘤体积和包膜外延伸）之间存在显著相关性（均 p < 0.05）。DWI 与手术标本之间的总体一致性率为 75.8%，PZ 明显高于 TZ（82.2%vs.67.1%，p = 0.002）。这种一致性率与 DWI 分级的增加呈正线性相关（p < 0.001）。在 109 例 DWI 分级 I-II 的患者中，28 例（25.7%）存在高级别疾病（病理 Gleason 评分≥4+3）。
DWI 比 TZ 更准确地检测前列腺 PZ 中的肿瘤。DWI 的这种准确性随着 DWI 分级的升高而更加明显。同时，DWI 阴性并不能保证不存在高级别 PCa。
