Department of Radiology, Baskent University School of Medicine, Marasel Fevzi Cakmak Blvd, No: 45, Ankara, Turkey.
Department of Radiology, VKF American Hospital, Tesvikiye, Güzelbahce Street. No:20 Sisli, 34365, İstanbul, Turkey.
Eur J Radiol. 2019 Mar;112:192-199. doi: 10.1016/j.ejrad.2019.01.020. Epub 2019 Jan 22.
To assess the most optimal multi-parametric magnetic resonance imaging sequence (Mp-MRI) in determining pathological length of capsular contact (LCC) for the diagnosis of prostate cancer extraprostatic extension (EPE).
105 patients with prostate cancer who underwent Mp-MRI of prostate prior to radical prostatectomy were enrolled in this retrospective study. LCC was determined from T2-weighted images (T2WI), Apparent Diffusion Coefficient (ADC) map, dynamic contrast-enhanced MRI (DCE-MRI) separately by two blinded radiologists. The LCCs in patients with and without EPE were compared with Mann Whitney-U test. The relationship between pathological LCC and the LCC that was measured from each Mp-MRI sequences were calculated by using Spearman test. The ability of all individual Mp-MRI sequences in determining pathological LCC was calculated by drawing receiver operator characteristic (ROC) curves. The diagnostic accuracy of LCC based on each MRI sequences for EPE diagnosis was also calculated with ROC curve analysis.
The patients with EPE had longer median LCC than patients without EPE for each Mp-MRI sequences and for both readers. In addition, the LCC showed a broader overlapping between patients with and without EPE on ADC map (reader-1, p = 0.01; reader-2, p = 0.01) when compared with T2WI (reader-1, p = 0.002; reader-2, p = 0.001) and DCE-MRI (reader-1, p = 0.001; reader-2, p = 0.001). LCC based on DCE-MRI showed the strongest correlation with pathological LCC. The area under the curve (AUC) based on LCC was higher when using the DCE-MRI (reader-1: 0.874, p = 0.030; reader-2: 0.862, p = 0.02) than when using T2WI and ADC map in predicting pathological LCC for both readers. While the LCC based on ADC map showed poor diagnostic accuracy, LCC based on T2WI and DCE-MRI had fair diagnostic accuracy for EPE diagnosis.
The contact between prostate tumor and capsule seems to be a useful and objective parameter for evaluating the EPE of prostate cancer with Mp-MRI. More specifically, LCC based on DCE-MRI has highest correlation with pathological LCC and has better ability to predict pathological LCC when compared with other Mp-MRI sequences. However, the performance of LCC based on T2WI and DCE-MRI was similar for EPE diagnosis. It seems measurement of LCC from DCE-MRI and measurement of LCC from T2WI does not show any difference in clinical EPE assessment.
评估多参数磁共振成像序列（Mp-MRI）中确定包膜接触病理性长度（LCC）以诊断前列腺癌前列腺外延伸（EPE）的最佳方法。
回顾性分析 105 例前列腺癌患者，这些患者在根治性前列腺切除术前均接受了前列腺 Mp-MRI 检查。由两位盲法阅片医生分别从 T2 加权成像（T2WI）、表观扩散系数（ADC）图、动态对比增强 MRI（DCE-MRI）上确定 LCC。比较有和无 EPE 患者的 LCC，并采用 Mann-Whitney-U 检验进行比较。用 Spearman 检验计算病理 LCC与各 Mp-MRI 序列测量的 LCC 之间的关系。用绘制受试者工作特征（ROC）曲线计算各 Mp-MRI 序列在确定病理 LCC 中的能力。用 ROC 曲线分析基于各 MRI 序列的 LCC 对 EPE 诊断的诊断准确性。
在每位患者中，EPE 患者的 LCC 中位数均长于无 EPE 患者，且各 Mp-MRI 序列的结果均具有统计学意义（两位阅片医生的结果分别为 p<0.001 和 p<0.001）。此外，与 T2WI（两位阅片医生的结果分别为 p=0.002 和 p=0.001）和 DCE-MRI（两位阅片医生的结果分别为 p=0.001 和 p=0.001）相比，ADC 图上 EPE 患者与无 EPE 患者之间的 LCC 重叠更宽（两位阅片医生的结果分别为 p=0.01 和 p=0.01）。DCE-MRI 上的 LCC 与病理 LCC 相关性最强。基于 DCE-MRI 的 LCC 的曲线下面积（AUC）高于 T2WI 和 ADC 图（两位阅片医生的结果分别为 p=0.030 和 p=0.02）。虽然 ADC 图上的 LCC 诊断准确性较差，但 T2WI 和 DCE-MRI 上的 LCC 对 EPE 诊断具有较好的诊断准确性。
Mp-MRI 上前列腺肿瘤与包膜之间的接触似乎是评估前列腺癌 EPE 的一种有用且客观的参数。具体而言，基于 DCE-MRI 的 LCC 与病理 LCC 的相关性最高，与其他 Mp-MRI 序列相比，其预测病理 LCC 的能力更强。然而，T2WI 和 DCE-MRI 上的 LCC 对 EPE 诊断的性能相似。基于 DCE-MRI 和 T2WI 的 LCC 似乎在临床 EPE 评估中没有差异。
