Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology Nanjing University, 321 Zhongshan Rd, Nanjing, Jiangsu, China.
Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Clin Radiol. 2019 Nov;74(11):895.e17-895.e26. doi: 10.1016/j.crad.2019.06.012. Epub 2019 Jul 20.
To compare the diagnostic performance of multiparametric MRI (mpMRI) parameters for Gleason score (GS) and cellularity metrics of prostate cancer (PCa) in the peripheral zone (PZ) and transition zone (TZ) separately.
In total, 225 PCa patients with preoperative mpMRI and whole-mount pathological sections were enrolled retrospectively. Detection rates of index lesions (highest GS or largest dimension) and clinically significant PCa (csPCa) were evaluated. Tumour-to-muscle ratio and skewness of T2 signal intensity, average apparent diffusion coefficient (ADC) and 10th percentile ADC (ADC) were derived and correlation with GS was performed with Spearman's correlation coefficient (ρ), while effectiveness in differentiating GS 6 from GS ≥7 was compared with receiver operating characteristic (ROC) analysis. Moreover, correlation of cellularity metrics with mpMRI parameters was evaluated with Pearson's correlation coefficient (r).
In total, 398 lesions were identified, with 87.1% (196/225) index lesions and 86.8% (249/287) csPCa detected. Compared to T2 parameters, ADC parameters, especially ADC, correlated better with GS (maximal ρ: -0.58 versus -0.33, p=0.011) and yielded significantly higher area under the curve (AUC) in differentiating GS 6 from GS ≥7 (maximal AUC: 0.854 versus 0.731, p=0.020) among PZ lesions. Moreover, ADC demonstrated significantly moderate correlation with the nuclear-to-cytoplasmic ratio and nuclear fraction (r=-0.403 and -0.514, p<0.001); however, for TZ lesions, all parameters demonstrated poor correlation with GS and cellularity metrics.
mpMRI could effectively detect index and csPCa lesions. ADC parameters, especially ADC, correlated better with GS and cellularity metrics than T2 in PZ, while all parameters demonstrated poor performance within TZ lesions.
分别比较多参数 MRI（mpMRI）参数在前列腺外周带（PZ）和移行带（TZ）中对前列腺癌（PCa）Gleason 评分（GS）和细胞密度指标的诊断性能。
回顾性纳入 225 例术前接受 mpMRI 检查和全器官病理切片的 PCa 患者。评估了指数病变（最高 GS 或最大直径）和临床显著 PCa（csPCa）的检出率。得出肿瘤与肌肉比和 T2 信号强度的偏度、平均表观扩散系数（ADC）和第 10 百分位数 ADC（ADC），并用 Spearman 相关系数（ρ）对其与 GS 进行相关性分析，同时用受试者工作特征（ROC）分析比较其在区分 GS≥7 与 GS=6 的效能。此外，还用 Pearson 相关系数（r）评估细胞密度指标与 mpMRI 参数的相关性。
共发现 398 个病灶，其中 87.1%（196/225）为指数病变，86.8%（249/287）为 csPCa。与 T2 参数相比，ADC 参数，尤其是 ADC，与 GS 相关性更好（最大 ρ：-0.58 比-0.33，p=0.011），在区分 PZ 病变的 GS≥7 与 GS=6 时，AUC 显著更高（最大 AUC：0.854 比 0.731，p=0.020）。此外，ADC 与核质比和核分数有显著的中度相关性（r=-0.403 和-0.514，p<0.001）；然而，对于 TZ 病变，所有参数与 GS 和细胞密度指标均相关性较差。
mpMRI 可有效检测指数病变和 csPCa 病灶。在 PZ 中，ADC 参数，尤其是 ADC，与 GS 和细胞密度指标的相关性优于 T2，而在 TZ 病变中，所有参数的表现均较差。
