Department of Medical Imaging, Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Anatomical Pathology, Ottawa Hospital, Ottawa, Ontario, Canada.
J Magn Reson Imaging. 2019 Jul;50(1):279-287. doi: 10.1002/jmri.26594. Epub 2018 Dec 25.
Prostatic intraductal carcinoma (IDC-P) is an aggressive variant of prostate cancer (PCa) characterized by proliferation of malignant cells within prostatic ducts/acini and nucleomegaly.
PURPOSE/HYPOTHESIS: To compare apparent diffusion coefficient (ADC) values and Prostate Imaging and Data Reporting System (PI-RADS) v. 2 scores in intermediate risk (International Society of Urological Pathology [ISUP] Grade Group [GG] 2 and 3) PCa with/without IDC-P to determine if IDC-P alters the MRI appearance of PCa.
Retrospective, case-control.
Fifteen consecutive men with ISUP GG 2/3 (Gleason score 3+4 = 7 [N = 4], 4+3 = 7 [N = 11]) PCa with IDC-P diagnosed at radical prostatectomy were compared with: 1) ISUP GG 2/3 PCa without IDC-P (matched for percentage Gleason pattern 4), and 2) ISUP GG 4 and 5 (Gleason score 8/9) PCa without IDC-P.
FIELD STRENGTH/SEQUENCE: 3T multiparametric MRI.
Two blinded radiologists (R1/R2) measured mean ADC, ADC.ratio (ADC.tumor/ADC.normal peripheral zone) and assigned PI-RADS v2 scores. Statistical Tests: Chi-square and analysis of variance (ANOVA).
There were no differences in age, prostate serum antigen, tumor size, or stage between groups (P = 0.063-0.912). Tumors with IDC-P had lower mean ADC and ADC.ratio (0.741 ± 0.152 mm /sec and 0.44 ± 0.07) compared with ISUP GG 2/3 tumors without IDC-P (0.888 ± 0.167 mm /sec and 0.62 ± 0.14), P = 0.012 and <0.001; and did not differ compared with ISUP GG 4/5 tumors (0.705 ± 0.141 mm /sec and 0.44 ± 0.08), P = 0.509 and 0.868. Tumors with IDC-P were nearly all PI-RADS v2 score 5 (14/15) compared with ISUP GG 2/3 tumors without IDC-P (10/15 R1, 8/15 R2) and GG 4/5 tumors (9/15), (P = 0.040 = 0.092). Agreement in PI-RADS v2 scoring was moderate (K = 0.68).
ISUP GG 2 and 3 (intermediate risk, Gleason score 7) PCa with IDC-P have lower ADC compared with tumors without IDC-P with a similar percentage of Gleason pattern 4 and resemble ISUP GG 4 and 5 high risk tumors on MRI. IDC-P lowers ADC values among intermediate risk prostate cancers.
3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:279-287.
前列腺管内癌（IDC-P）是一种侵袭性前列腺癌（PCa）变异型，其特征为前列腺导管/腺泡内恶性细胞增殖和核增大。
目的/假设：比较中危（国际泌尿病理学会[ISUP]分级组[GG] 2 和 3）伴或不伴 IDC-P 的 PCa 的表观扩散系数（ADC）值和前列腺影像报告和数据系统（PI-RADS）v.2 评分，以确定 IDC-P 是否改变了 PCa 的 MRI 表现。
回顾性、病例对照。
15 例连续接受根治性前列腺切除术的 ISUP GG 2/3（Gleason 评分 3+4=7[N=4]，4+3=7[N=11]）伴 IDC-P 的 PCa 患者与：1）无 IDC-P 的 ISUP GG 2/3 PCa（按 Gleason 模式 4 的百分比匹配），2）无 IDC-P 的 ISUP GG 4 和 5（Gleason 评分 8/9）PCa 进行比较。
磁场强度/序列：3T 多参数 MRI。
两位盲法放射科医生（R1/R2）测量平均 ADC、ADC.ratio（ADC.肿瘤/ADC.正常外周带）并分配 PI-RADS v2 评分。统计检验：卡方检验和方差分析（ANOVA）。
各组间年龄、前列腺血清抗原、肿瘤大小或分期无差异（P=0.063-0.912）。伴 IDC-P 的肿瘤平均 ADC 和 ADC.ratio 较低（0.741±0.152mm/sec 和 0.44±0.07），与无 IDC-P 的 ISUP GG 2/3 肿瘤相比（0.888±0.167mm/sec 和 0.62±0.14），P=0.012 和 <0.001；与 ISUP GG 4/5 肿瘤相比无差异（0.705±0.141mm/sec 和 0.44±0.08），P=0.509 和 0.868。伴 IDC-P 的肿瘤几乎均为 PI-RADS v2 评分 5（14/15），与无 IDC-P 的 ISUP GG 2/3 肿瘤（R1 为 10/15，R2 为 8/15）和 ISUP GG 4/5 肿瘤（9/15）相比，P=0.040=0.092）。PI-RADS v2 评分的一致性为中度（K=0.68）。
伴 IDC-P 的 ISUP GG 2 和 3（中危，Gleason 评分 7）PCa 的 ADC 低于无 IDC-P 的肿瘤，其 Gleason 模式 4 的百分比相似，在 MRI 上与 ISUP GG 4 和 5 高危肿瘤相似。IDC-P 降低了中危前列腺癌的 ADC 值。
3 技术功效阶段：2 J. Magn. Reson. Imaging 2019；50：279-287。
