使用多参数 MRI 检测复发性前列腺癌，PSA 和 Gleason 分级的影响。
Detecting recurrent prostate Cancer using multiparametric MRI, influence of PSA and Gleason grade.
机构信息
Department of Diagnostic Radiology, Division of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX, USA.
West Houston Radiology Associates, 21216 North West Freeway, Suite 2200, Cypress, TX, USA.
出版信息
Cancer Imaging. 2021 Jan 6;21(1):3. doi: 10.1186/s40644-020-00373-4.
BACKGROUND
The utility of multiparametric MRI (mpMRI) in detecting suspected local recurrence post radical prostatectomy (RP) may be associated with PSA and Gleason grade. The purpose of the study was to evaluate the likelihood of detecting locally recurrent prostate cancer utilizing mpMRI in patients with suspected recurrence following radical prostatectomy (RP) parsed by PSA and Gleason grade.
METHODS
One hundred ninety five patients with suspected local recurrence were imaged on a 1.5 T MRI with torso array and endorectal coil in this retrospective study. mpMRI interpretations were stratified by PSA and lower (Gleason < 7) vs. higher grade tumors (Gleason 8-10). Recursive partitioning was used to determine whether mpMRI interpretations could be classified as positive or negative.
RESULTS
The majority of mpMRI interpretations in patients with lower Gleason grade tumors and PSA < 0.5 ng/mL were negative (68/78, 87.2%, p = 0.004). The majority of mpMRI interpretations in patients with higher Gleason grade tumors and PSA > 1.5 ng/mL were positive (8/9, 88.9%, p = 0.003). Findings were corroborated by recursive partitioning, which identified a PSA = 0.5 ng/ml in patients with lower grade tumors and a PSA = 1.5 ng/mL in patients with higher grade tumors as differentiating negative and positive mpMRIs.
CONCLUSION
In the setting of suspected recurrence after RP, mpMRI results are associated with PSA and Gleason grade, both of which can help guide when mpMRI may find utility. mpMRI is likely to be low diagnostic yield and negative for recurrence (87%) in the setting of lower Gleason grade tumors and PSA < 0.5 ng/mL. mpMRI is likely to be of low diagnostic value and positive for recurrence (89%) in the setting of PSA > 1.5 ng/mL and higher grade tumors; in this case, mpMRI findings may be more useful for directing biopsy and local therapy. Between these extremes, PSA > 0.5 ng/mL and lower grade tumors or PSA < 1.5 ng/mL and higher grade tumors, mpMRI results are less predictable, suggesting greater diagnostic value for detecting recurrence post prostatectomy.
背景
多参数 MRI（mpMRI）在检测根治性前列腺切除术后（RP）可疑局部复发中的作用可能与 PSA 和 Gleason 分级有关。本研究的目的是评估在 PSA 和 Gleason 分级分层的疑似 RP 后复发患者中，利用 mpMRI 检测局部复发前列腺癌的可能性。
方法
在这项回顾性研究中，195 名疑似局部复发的患者在 1.5T MRI 上进行了检查，使用了体部阵列和直肠内线圈。mpMRI 解读根据 PSA 和低（Gleason<7）与高分级肿瘤（Gleason 8-10）进行分层。递归分割用于确定 mpMRI 解读是否可以分类为阳性或阴性。
结果
低 Gleason 分级肿瘤和 PSA<0.5ng/mL 患者的大多数 mpMRI 解读为阴性（68/78，87.2%，p=0.004）。高 Gleason 分级肿瘤和 PSA>1.5ng/mL 患者的大多数 mpMRI 解读为阳性（8/9，88.9%，p=0.003）。递归分割证实了这一发现，它确定了 PSA=0.5ng/ml 用于低分级肿瘤患者，PSA=1.5ng/mL 用于高分级肿瘤患者，可区分阴性和阳性 mpMRI。
结论
在 RP 后疑似复发的情况下，mpMRI 结果与 PSA 和 Gleason 分级相关，两者均可帮助指导何时可能发现 mpMRI 的作用。在低 Gleason 分级肿瘤和 PSA<0.5ng/mL 的情况下，mpMRI 结果可能具有较低的诊断产量，且对复发呈阴性（87%）。在 PSA>1.5ng/mL 和高分级肿瘤的情况下，mpMRI 结果可能具有较低的诊断价值，且对复发呈阳性（89%）；在这种情况下，mpMRI 结果可能更有助于指导活检和局部治疗。在这些极端情况之间，PSA>0.5ng/mL 和低分级肿瘤或 PSA<1.5ng/mL 和高分级肿瘤，mpMRI 结果不太可预测，提示对检测 RP 后复发具有更大的诊断价值。
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