Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Imaging, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
World J Urol. 2021 Aug;39(8):2937-2943. doi: 10.1007/s00345-020-03571-8. Epub 2021 Feb 1.
A whole-body MRI (WB-MRI) including T1, short time inversion recovery (STIR), diffusion-weighted imaging (high b value) was applied in our center for the detection of bone metastasis in prostate cancer (PCa) patients. We intended to assess the diagnostic performance of this examination.
547 cases of PCa patients with higher risk of metastasis were referred to bone scintigraphy with SPECT/CT (BS + SPECT/CT) and whole-body MRI in Shanghai Changhai Hospital. Best valuable comparator (BVC) was applied for the final diagnosis of metastasis. A panel of radiologists interpreted the results. Decision curve analysis (DCA) and receiver operating characteristic curve (ROC) analysis were applied.
Bone metastasis was diagnosed in 110 cases, and others were non-metastatic by BVC. The area under the receiver operating characteristic curve (AUC) was higher in WB-MRI (0.778) than BS + SPECT/CT (0.634, p < 0.001). A WB-MRI-based prediction model was established with AUC of 0.877. Internal validation showed that the predictive model was well-calibrated. The DCA demonstrated that the model had higher net benefit than the BS + SPECT/CT-based model.
WB-MRI is more effective in identifying metastasis in PCa patients than BS + SPECT/CT. The prediction model combined WB-MRI with clinical parameters may be a promising approach to the assessment of metastasis.
本研究中心采用全身 MRI（WB-MRI）平扫联合 T1 加权成像、短时间反转恢复序列（STIR）、弥散加权成像（高 b 值），用于检测前列腺癌（PCa）患者的骨转移情况。本研究旨在评估该检查的诊断性能。
上海长海医院对 547 例有较高转移风险的 PCa 患者进行全身骨扫描 SPECT/CT（BS+SPECT/CT）和全身 MRI 检查。采用最佳对比值（BVC）作为最终诊断转移的金标准。由一组放射科医生对结果进行解读。本研究采用决策曲线分析（DCA）和受试者工作特征曲线（ROC）分析。
BS+SPECT/CT 诊断为骨转移的患者有 110 例，BVC 诊断为非转移的患者有 437 例。WB-MRI 的 ROC 曲线下面积（AUC）高于 BS+SPECT/CT（0.778 比 0.634，p<0.001）。建立基于 WB-MRI 的预测模型，AUC 为 0.877。内部验证显示，该预测模型具有良好的校准度。DCA 表明，该模型的净获益高于基于 BS+SPECT/CT 的模型。
与 BS+SPECT/CT 相比，WB-MRI 更有助于识别 PCa 患者的转移病灶。WB-MRI 联合临床参数的预测模型可能是评估转移的一种很有前途的方法。
