重新审视良性前列腺增生的定量多参数 MRI 及其与移行区癌的鉴别诊断。
Revisiting quantitative multi-parametric MRI of benign prostatic hyperplasia and its differentiation from transition zone cancer.
机构信息
Department of Radiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
Department of Pathology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, USA.
出版信息
Abdom Radiol (NY). 2019 Jun;44(6):2233-2243. doi: 10.1007/s00261-019-01936-1.
PURPOSE
This study investigates the multiparametric MRI (mpMRI) appearance of different types of benign prostatic hyperplasia (BPH) and whether quantitative mpMRI is effective in differentiating between prostate cancer (PCa) and BPH.
MATERIALS AND METHODS
Patients (n = 60) with confirmed PCa underwent preoperative 3T MRI. T2-weighted, multi-echo T2-weighted, diffusion weighted and dynamic contrast enhanced images (DCE) were obtained prior to undergoing prostatectomy. PCa and BPH (cystic, glandular or stromal) were identified in the transition zone and matched with MRI. Quantitative mpMRI metrics: T2, ADC and DCE-MRI parameters using an empirical mathematical model were measured.
RESULTS
ADC values were significantly lower (p < 0.001) in PCa compared to all BPH types and can differentiate between PCa and BPH with high accuracy (AUC = 0.87, p < 0.001). T2 values were significantly lower (p < 0.001) in PCa compared to cystic BPH only, while glandular (p = 0.27) and stromal BPH (p = 0.99) showed no significant difference from PCa. BPH mimics PCa in the transition zone on DCE-MRI evidenced by no significant difference between them. mpMRI values of glandular (ADC = 1.31 ± 0.22 µm/ms, T2 = 115.7 ± 37.3 ms) and cystic BPH (ADC = 1.92 ± 0.43 µm/ms, T2 = 242.8 ± 117.9 ms) are significantly different. There was no significant difference in ADC (p = 0.72) and T2 (p = 0.46) between glandular and stromal BPH.
CONCLUSIONS
Multiparametric MRI and specifically quantitative ADC values can be used for differentiating PCa and BPH, improving PCa diagnosis in the transition zone. However, DCE-MRI metrics are not effective in distinguishing PCa and BPH. Glandular BPH are not hyperintense on ADC and T2 as previously thought and have similar quantitative mpMRI measurements to stromal BPH. Glandular and cystic BPH appear differently on mpMRI and are histologically different.
目的
本研究旨在探讨不同类型良性前列腺增生（BPH）的多参数 MRI（mpMRI）表现，以及定量 mpMRI 是否有助于区分前列腺癌（PCa）和 BPH。
材料与方法
60 例经病理证实的 PCa 患者在术前 3T MRI 检查前行 T2 加权、多回波 T2 加权、扩散加权和动态对比增强成像（DCE）。在接受前列腺切除术之前，在移行区识别 PCa 和 BPH（囊性、腺性或基质性），并与 MRI 相匹配。测量定量 mpMRI 指标：使用经验数学模型测量 T2、ADC 和 DCE-MRI 参数。
结果
与所有 BPH 类型相比，PCa 的 ADC 值明显更低（p<0.001），并且可以以较高的准确性区分 PCa 和 BPH（AUC=0.87，p<0.001）。与囊性 BPH 相比，PCa 的 T2 值明显更低（p<0.001），而腺性（p=0.27）和基质性 BPH（p=0.99）与 PCa 之间无显著差异。DCE-MRI 上，BPH 在移行区模拟 PCa，两者之间无显著差异。BPH 在移行区模拟 PCa，两者之间无显著差异。
腺性（ADC=1.31±0.22μm/ms，T2=115.7±37.3ms）和囊性 BPH（ADC=1.92±0.43μm/ms，T2=242.8±117.9ms）的 ADC 和 T2 值有显著差异。腺性和基质性 BPH 的 ADC（p=0.72）和 T2（p=0.46）值无显著差异。
结论
多参数 MRI ，特别是定量 ADC 值可用于区分 PCa 和 BPH，提高移行区 PCa 的诊断率。然而，DCE-MRI 指标对区分 PCa 和 BPH 无效。腺性 BPH 在 ADC 和 T2 上不像以前认为的那样呈高信号，其定量 mpMRI 测量值与基质性 BPH 相似。腺性和囊性 BPH 在 mpMRI 上表现不同，且组织学上不同。
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