Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy.
Clin Radiol. 2019 Apr;74(4):259-267. doi: 10.1016/j.crad.2018.08.017. Epub 2019 Feb 8.
To assess whether there is a significant difference in perfusion parameters between benign and malignant prostatic lesions, focusing on semi-quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and presence of late gadolinium enhancement (LGE).
Three hundred and thirteen patients who underwent multiparametric MRI (mpMRI) of the prostate and with available corresponding histology (prostatectomy or biopsy) were selected retrospectively for this study. The MRI protocol consisted of multiplanar T2-and diffusion-weighted imaging, DCE and delayed axial T1 images. Images were reviewed independently by two radiologists for LGE assessment and Prostate Imaging - Reporting and Data System (PI-RADS) scoring. For each lesion, semi-quantitative analysis of DCE-MRI was performed and the following data were evaluated: time to peak, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve. The presence or absence of LGE in delayed axial T1 images was assessed qualitatively. MRI results were compared to histology. The presence of significant prostate cancer was based both on Epstein criteria (SPC) and Gleason score (GS ≥7).
SPC and Gleason score ≥7 tumours showed significant lower time to peak and brevity of enhancement (p<0.001) with higher wash-in rate (p=0.001). LGE was observed in 152/313 (49%) cases; among them 103/152 (68%) did not show SPC whereas 49/152 (32%) had SPC (p<0.001). The presence of LGE determined a risk reduction of SPC resulting as an independent predictor at multivariate analysis (logOR=-0.78, SE 0.33, p=0.02).
Semi-quantitative perfusion analysis and LGE may help to predict the presence/absence of a significant prostate tumour and represent a promising tool to improve mpMRI diagnostic performance.
评估良恶性前列腺病变之间灌注参数是否存在显著差异，重点关注动态对比增强（DCE）磁共振成像（MRI）的半定量分析和晚期钆增强（LGE）的存在。
本研究回顾性选择了 313 名接受前列腺多参数 MRI（mpMRI）检查且有相应组织学（前列腺切除术或活检）的患者。MRI 方案包括多平面 T2 和弥散加权成像、DCE 和延迟轴向 T1 图像。由两名放射科医生独立评估 LGE 评估和前列腺成像报告和数据系统（PI-RADS）评分。对每个病变进行 DCE-MRI 的半定量分析，并评估以下数据：峰值时间、上升率、下降率、增强短暂性和曲线下面积。定性评估延迟轴向 T1 图像中 LGE 的存在。将 MRI 结果与组织学进行比较。根据 Epstein 标准（SPC）和 Gleason 评分（GS≥7）判断是否存在显著前列腺癌。
SPC 和 Gleason 评分≥7 肿瘤的峰值时间和增强短暂性明显较低（p<0.001），上升率较高（p=0.001）。在 313 例中有 152 例（49%）出现 LGE；其中 103 例（68%）未出现 SPC，而 49 例（32%）有 SPC（p<0.001）。LGE 的存在降低了 SPC 的风险，成为多变量分析的独立预测因素（logOR=-0.78，SE 0.33，p=0.02）。
半定量灌注分析和 LGE 可能有助于预测是否存在显著的前列腺肿瘤，是提高 mpMRI 诊断性能的有前途的工具。
