Department of Radiology, Ronald Reagan UCLA Medical Center, 757 Westwood Blvd, Los Angeles, CA 90095.
Department of Radiology, Weill Cornell Medical College, New York, NY.
AJR Am J Roentgenol. 2019 Dec;213(6):1253-1258. doi: 10.2214/AJR.19.21637. Epub 2019 Jul 30.
The purpose of this study was to compare in a multireader manner the diagnostic accuracies of 3-T multiparametric MRI interpretation and serial prostate-specific antigen (PSA) measurement in predicting the presence of residual clinically significant prostate cancer after focal laser ablation. Eighteen men had undergone focal laser ablation for low- or intermediate-risk prostate cancer as part of two National Cancer Institute-funded phase 1 clinical trials. Multiparametric MRI was performed immediately after and 6 and 12 months after focal laser ablation. Serial PSA measurements after focal laser ablation were recorded, and MRI-ultrasound fusion biopsy was performed 6 and 12 months after ablation and served as the reference standard. Multiparametric MRI was performed at 3 T with pelvic phased-array coils. T2-weighted, DW, and dynamic contrast-enhanced MR images were retrospectively assessed by two blinded radiologists using a 3-point Likert scale (0-2). Inter-reader agreement was assessed with the Cohen kappa statistic. The diagnostic accuracies of multiparametric MRI and PSA measurement were compared. Residual clinically significant prostate cancer was identified in 11 of 18 (61%) men. Logistic regression analysis of serial PSA measurements yielded a correct classification rate of 61.1% ( > 0.05). Using a multiparametric MRI threshold score of 4 or greater, both radiologists made correct classifications for 16 of 18 men (89%) at 6 months and 15 of 17 men (88%) at 12 months. Interreader agreement was substantial to excellent for T2-weighted imaging, DWI, and dynamic contrast-enhanced MRI and improved uniformly from 6 to 12 months. Logistic regression analysis of the retrospectively reviewed multiparametric MR images yielded AUCs greater than 0.90 for each radiologist 6 and 12 months after focal laser ablation ( < 0.001). Multiparametric MRI 6 and 12 months after focal laser ablation significantly outperformed serial PSA measurements for predicting the presence of residual clinically significant prostate cancer.
本研究旨在多读者模式下比较 3-T 多参数 MRI 解读和连续前列腺特异性抗原（PSA）测量在预测局灶性激光消融后残留临床显著前列腺癌中的诊断准确性。18 名男性接受了局灶性激光消融治疗低危或中危前列腺癌，作为两项美国国立癌症研究所资助的 1 期临床试验的一部分。局灶性激光消融后立即进行多参数 MRI 检查，并在激光消融后 6 个月和 12 个月进行检查。记录局灶性激光消融后的连续 PSA 测量值，并在消融后 6 个月和 12 个月进行 MRI-超声融合活检作为参考标准。多参数 MRI 在 3 T 上使用盆腔相控阵线圈进行。使用 3 点李克特量表（0-2）由两名盲法放射科医生对 T2 加权、DW 和动态对比增强 MR 图像进行回顾性评估。使用 Cohen kappa 统计量评估读者间的一致性。比较多参数 MRI 和 PSA 测量的诊断准确性。在 18 名男性中有 11 名（61%）发现残留的临床显著前列腺癌。连续 PSA 测量的逻辑回归分析得出正确分类率为 61.1%（>0.05）。使用多参数 MRI 阈值评分≥4，两位放射科医生在 6 个月时正确分类了 18 名男性中的 16 名（89%），在 12 个月时正确分类了 17 名男性中的 15 名（88%）。T2 加权成像、DWI 和动态对比增强 MRI 的读者间一致性为中等至高，并且从 6 个月到 12 个月均匀改善。局灶性激光消融后 6 个月和 12 个月回顾性分析多参数 MR 图像的逻辑回归分析得出的 AUC 均大于 0.90（<0.001）。局灶性激光消融后 6 个月和 12 个月的多参数 MRI 显著优于连续 PSA 测量，可预测残留的临床显著前列腺癌的存在。
