From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.).
Radiology. 2019 Mar;290(3):709-719. doi: 10.1148/radiol.2018181278. Epub 2019 Jan 22.
Purpose To evaluate MRI features associated with pathologically defined extraprostatic extension (EPE) of prostate cancer and to propose an MRI grading system for pathologic EPE. Materials and Methods In this prospective study, consecutive male study participants underwent preoperative 3.0-T MRI from June 2007 to March 2017 followed by robotic-assisted laparoscopic radical prostatectomy. An MRI-based EPE grading system was defined as follows: curvilinear contact length of 1.5 cm or capsular bulge and irregularity were grade 1, both features were grade 2, and frank capsular breach were grade 3. Multivariable logistic regression and decision curve analyses were performed to compare the MRI grade model and clinical parameters (prostate-specific antigen, Gleason score) for pathologic EPE prediction by using the area under the receiver operating characteristic curve (AUC) value. Results Among 553 study participants, the mean age was 60 years ± 8 (standard deviation); the median prostate-specific antigen value was 6.3 ng/mL. A total of 125 of 553 (22%) participants had pathologic EPE at radical prostatectomy. Detection of pathologic EPE, defined as number of pathologic EPEs divided by number of participants with individual MRI features, was as follows: curvilinear contact length, 88 of 208 (42%); capsular bulge and irregularity, 78 of 175 (45%); and EPE visible at MRI, 37 of 56 (66%). For MRI, grades 1, 2, and 3 for detection of pathologic EPE were 18 of 74 (24%), 39 of 102 (38%), and 37 of 56 (66%), respectively. Clinical features plus the MRI-based EPE grading system (prostate-specific antigen, International Society of Urological Pathology stage, MRI grade) predicted pathologic EPE better than did MRI grade alone (AUC, 0.81 vs 0.77, respectively; P < .001). Conclusion Higher MRI-based extraprostatic extension (EPE) grading categories were associated with a greater risk of pathologic EPE. Clinical features plus MRI grading had the highest diagnostic performance for prediction of pathologic EPE. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
目的 评估与前列腺癌病理性前列腺外延伸（EPE）相关的 MRI 特征，并提出一种用于病理性 EPE 的 MRI 分级系统。
材料与方法 本前瞻性研究纳入了 2007 年 6 月至 2017 年 3 月连续接受术前 3.0-T MRI 检查且随后接受机器人辅助腹腔镜根治性前列腺切除术的男性研究参与者。基于 MRI 的 EPE 分级系统定义如下：1.5cm 曲线接触长度或包膜膨出和不规则为 1 级，两者均为 2 级，包膜破裂为 3 级。多变量逻辑回归和决策曲线分析用于通过使用接受者操作特征曲线（ROC）下面积（AUC）值比较 MRI 分级模型和临床参数（前列腺特异性抗原、Gleason 评分）对病理性 EPE 进行预测。
结果 在 553 名研究参与者中，平均年龄为 60 岁±8（标准差）；中位前列腺特异性抗原值为 6.3ng/mL。553 名参与者中有 125 名（22%）在根治性前列腺切除术后存在病理性 EPE。病理性 EPE 的检出率（以病理 EPE 数量除以有个体 MRI 特征的参与者数量计算）如下：曲线接触长度为 208 例中的 88 例（42%）；包膜膨出和不规则为 175 例中的 78 例（45%）；MRI 可见的 EPE 为 56 例中的 37 例（66%）。MRI 分级 1、2 和 3 级的病理性 EPE 检出率分别为 74 例中的 18 例（24%）、102 例中的 39 例（38%）和 56 例中的 37 例（66%）。临床特征加基于 MRI 的 EPE 分级系统（前列腺特异性抗原、国际泌尿病理学会分期、MRI 分级）预测病理性 EPE 优于 MRI 分级（AUC：0.81 比 0.77，P<0.001）。
结论 较高的基于 MRI 的前列腺外延伸（EPE）分级与病理性 EPE 的风险增加相关。临床特征加 MRI 分级对预测病理性 EPE 具有最高的诊断性能。
