Radiology Department of Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain.
Radiology Department of Hospital de Santa Marta, CHULC, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal.
Abdom Radiol (NY). 2021 Jul;46(7):3401-3409. doi: 10.1007/s00261-021-03011-0. Epub 2021 Mar 8.
To assess the need of the dynamic contrast-enhanced (DCE) sequence in addition to T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for the detection of clinically significant prostate cancer in the presence of artifacts associated with rectal gas (which compromise the diffusion assessment) and/or PIRADS 3 lesions.
This retrospective study was approved by the institutional review board; informed consent was not required. Patients referred consecutively over a period of 5 months for elevated PSA underwent multiparametric magnetic resonance imaging (mpMRI). mpMRI was performed using a 3T MRI system without an endorectal coil. The MRI findings were reviewed by two radiologists and were scored according to the Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2). Any discrepancies were resolved by consensus. For statistical purposes, lesions were classified as PIRADS 1-2, PIRADS 3, or PIRADS 4-5. First, all studies were reviewed using a biparametric assessment (T2-WI + DWI), and the presence or absence of susceptibility artifacts was assessed for each prostate. Subsequently, all images were analyzed using the standard multiparametric approach (T2-WI + DWI + DCE).
The biparametric evaluation (T2-WI + DWI) showed artifacts (due to the presence of rectal gas or other) in 87 patients (43.5%) and no artifacts in 113 patients (56.5%). In the latter group, 15 patients had peripheral zone (PZ) PIRADS 3 lesions. Thus, a total of 102 patients (51%) had artifacts or PZ PIRADS 3 lesions and therefore required DCE. When evaluating the group of prostates without artifacts, 13.3% of prostates required DCE. A total of 17 (23.9%) PIRADS 4-5 prostate lesions would have not been detected without the use of DCE.
Biparametric evaluation of the prostate revealed some limitation due to the presence of artifacts or PIRADS 3 PZ lesions. Artifacts were present in almost 44% of our patients, but when the DWI was correctly evaluated, only 13.3% of prostates required DCE.
评估在直肠气体（影响扩散评估）和/或 PI-RADS 3 病变存在的情况下，动态对比增强（DCE）序列对检测临床显著前列腺癌的必要性，同时结合 T2 加权成像（T2-WI）和弥散加权成像（DWI）。
本回顾性研究经机构审查委员会批准；无需获得知情同意。连续 5 个月因 PSA 升高就诊的患者接受多参数磁共振成像（mpMRI）检查。mpMRI 使用 3T MRI 系统进行，无直肠内线圈。两名放射科医生对 MRI 结果进行了回顾，并根据前列腺影像报告和数据系统第 2.0 版（PI-RADSv2）进行了评分。任何分歧均通过共识解决。出于统计学目的，病变分为 PI-RADS 1-2、PI-RADS 3 和 PI-RADS 4-5。首先，所有研究均采用双参数评估（T2-WI+DWI）进行评估，并评估每个前列腺的顺磁性伪影的存在或不存在。随后，所有图像均采用标准多参数方法（T2-WI+DWI+DCE）进行分析。
双参数评估（T2-WI+DWI）显示 87 例患者（43.5%）存在伪影（由于直肠气体或其他原因），113 例患者（56.5%）无伪影。在后一组中，15 例患者有外周带（PZ）PI-RADS 3 病变。因此，共有 102 例患者（51%）存在伪影或 PZ PI-RADS 3 病变，因此需要 DCE。当评估无伪影的前列腺组时，13.3%的前列腺需要 DCE。如果不使用 DCE，总共 17 个（23.9%）PI-RADS 4-5 前列腺病变将无法检测到。
由于存在伪影或 PZ PI-RADS 3 病变，前列腺的双参数评估存在一定的局限性。我们的患者中有近 44%存在伪影，但当正确评估 DWI 时，只有 13.3%的前列腺需要 DCE。
