Raeside Mitchell, Low Andrew, Cohen Penelope, Sutherland Peter, Gormly Kirsten
Dr Jones & Partners Medical Imaging, Eastwood, South Australia, Australia.
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
J Med Imaging Radiat Oncol. 2019 Aug;63(4):487-494. doi: 10.1111/1754-9485.12878. Epub 2019 Apr 5.
We conducted a retrospective audit to compare dominant nodule detection and local staging before and after the introduction of functional sequences and PI-RADS v2 reporting to MRI prostate scans in routine private practice.
A retrospective audit was performed of 245 patients in four separate groups undergoing robotic prostatectomy for prostate cancer by a single urologist between 2009 and 2017. The initial 100 consecutive patients had T2 imaging only. The next 43 patients had T2 and DWI. 52 subsequent patients had T2, DWI and DCE sequences (mpMRI). A final 50 consecutive patients had mpMRI using PI-RADS v2 reporting. Preoperative MRI reports were compared with prostatectomy histopathology to determine the sensitivity of MRI in detecting dominant tumour nodule and T3 extension.
The addition of DWI and DCE sequences improved sensitivity for detection of dominant tumour nodule, with a significant further increase using PI-RADS v2 reporting (38% for T2 vs. 62% for T2/DWI vs. 67% for mpMRI vs 91% for PI-RADS v2). The accuracy of detecting T3 disease was initially very low. The use of additional imaging techniques did not significantly influence this, but the use of a three category likelihood of extraprostatic extension in the PI-RADS v2 group had a significant increase in detection of T3 disease (sensitivity 27% vs. 23% vs. 38% vs 63%).
This audit tracks the significant improvements in MRI detection of prostate cancer dominant tumour nodule and T3 extension in patients undergoing prostatectomy with changing techniques and reporting standards in routine clinical practice.
我们进行了一项回顾性审计，以比较在常规私人诊所对前列腺MRI扫描引入功能序列和PI-RADS v2报告前后，主要结节的检测情况和局部分期。
对2009年至2017年间由一名泌尿外科医生为四组不同的前列腺癌患者进行机器人前列腺切除术的245例患者进行回顾性审计。最初的100例连续患者仅进行了T2成像。接下来的43例患者进行了T2和DWI检查。随后的52例患者进行了T2、DWI和DCE序列（多参数MRI）检查。最后50例连续患者进行了使用PI-RADS v2报告的多参数MRI检查。将术前MRI报告与前列腺切除术后的组织病理学进行比较，以确定MRI检测主要肿瘤结节和T3期扩展的敏感性。
添加DWI和DCE序列提高了检测主要肿瘤结节的敏感性，使用PI-RADS v2报告后有显著进一步提高（T2为38%，T2/DWI为62%，多参数MRI为67%，PI-RADS v2为91%）。检测T3期疾病的准确性最初非常低。使用额外的成像技术对此没有显著影响，但在PI-RADS v2组中使用前列腺外扩展的三类可能性显著提高了T3期疾病的检测率（敏感性分别为27%、23%、38%和63%）。
这项审计追踪了在常规临床实践中，随着技术和报告标准的变化，接受前列腺切除术患者的前列腺癌主要肿瘤结节和T3期扩展的MRI检测的显著改善。
