Giganti Francesco, Stabile Armando, Giona Simone, Marenco José, Orczyk Clement, Moore Caroline M, Allen Clare, Kirkham Alex, Emberton Mark, Punwani Shonit
Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
Magn Reson Imaging. 2019 May;58:143-147. doi: 10.1016/j.mri.2019.02.003. Epub 2019 Feb 12.
To assess multiparametric magnetic resonance imaging (mpMRI) characteristics in prostate cancer (PCa) before and after irreversible electroporation (IRE) and to investigate their correlation with the presence of post-operative recurrence of PCa.
MpMRI was performed in 30 men with PCa prior to treatment, after 10 days and at 6 months. An additional scan at 1 year was available for 18 men. Two radiologists assessed retrospectively the following parameters by planimetry: tumour volume, necrotic volume (early post-treatment scan) and residual fibrosis. Residual tumour/recurrence were defined as a suspicious area within the treatment field scored ≥ 4 on a 1-to-5 scale. Oncological outcome was also assessed.
The median follow-up of the entire study was 16 months. Six men were undertreated and showed mpMRI recurrence after 6 months. At 1-year, three additional men had recurrence. Overall, four of these 9 men (44%) were retreated. The other five men did not receive any further treatment. Median time to re-treatment was 15 months. Median pre-treatment lesion volume was 0.65 cc, 0.66 cc and 0.43 cc on the different mpMRI sequences (T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging). Median necrotic volume was 10.77 cc. Median overall residual fibrosis volumes were 0.84 cc and 0.95 cc at 6-month and 1-year mpMRI. Pre-treatment, necrotic and residual fibrosis volumes were significantly different (p < 0.001). Pre-treatment tumour volumes on diffusion-weighted imaging and necrotic volumes were correlated (r = 0.18; p = 0.02).
MpMRI is able to visualise the IRE ablation effects in men with PCa. MpMRI-derived parameters - such as tumour, necrotic and fibrosis volumes - can be measured and are potentially useful for assessing efficacy in the medium term, as with other ablative techniques.
评估不可逆电穿孔（IRE）前后前列腺癌（PCa）的多参数磁共振成像（mpMRI）特征，并研究其与PCa术后复发的相关性。
对30例PCa男性患者在治疗前、治疗后10天及6个月进行mpMRI检查。18例男性患者在1年时进行了额外扫描。两名放射科医生通过平面测量法回顾性评估以下参数：肿瘤体积、坏死体积（治疗后早期扫描）和残余纤维化。残余肿瘤/复发定义为治疗区域内可疑区域，在1至5分的评分中≥4分。同时评估肿瘤学结局。
整个研究的中位随访时间为16个月。6例患者治疗不足，6个月后出现mpMRI复发。1年时，又有3例患者复发。总体而言，这9例患者中有4例（44%）接受了再次治疗。另外5例患者未接受任何进一步治疗。再次治疗的中位时间为15个月。在不同的mpMRI序列（T2加权、扩散加权和动态对比增强成像）上，治疗前病变体积的中位数分别为0.65 cc、0.66 cc和0.43 cc。坏死体积的中位数为10.77 cc。在6个月和1年的mpMRI检查中，总体残余纤维化体积的中位数分别为0.84 cc和0.95 cc。治疗前、坏死和残余纤维化体积有显著差异（p<0.001）。扩散加权成像上的治疗前肿瘤体积与坏死体积相关（r = 0.18；p = 0.02）。
MpMRI能够观察PCa男性患者的IRE消融效果。MpMRI得出的参数，如肿瘤、坏死和纤维化体积，可以进行测量，并且与其他消融技术一样，在中期评估疗效方面可能有用。
