Shenhar Chen, Degani Hadassa, Ber Yaara, Baniel Jack, Tamir Shlomit, Benjaminov Ofer, Rosen Philip, Furman-Haran Edna, Margel David
Department of Urology, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikva 4941492, Israel.
Department of Biological Regulation, Weizmann Institute of Science, Rehovot 7610001, Israel.
Diagnostics (Basel). 2021 Mar 20;11(3):563. doi: 10.3390/diagnostics11030563.
In the prostate, water diffusion is faster when moving parallel to duct and gland walls than when moving perpendicular to them, but these data are not currently utilized in multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) detection. Diffusion tensor imaging (DTI) can quantify the directional diffusion of water in tissue and is applied in brain and breast imaging. Our aim was to determine whether DTI may improve PCa detection. We scanned patients undergoing mpMRI for suspected PCa with a DTI sequence. We calculated diffusion metrics from DTI and diffusion weighted imaging (DWI) for suspected lesions and normal-appearing prostate tissue, using specialized software for DTI analysis, and compared predictive values for PCa in targeted biopsies, performed when clinically indicated. DTI scans were performed on 78 patients, 42 underwent biopsy and 16 were diagnosed with PCa. The median age was 62 (IQR 54.4-68.4), and PSA 4.8 (IQR 1.3-10.7) ng/mL. DTI metrics distinguished PCa lesions from normal tissue. The prime diffusion coefficient (λ) was lower in both peripheral-zone ( < 0.0001) and central-gland ( < 0.0001) cancers, compared to normal tissue. DTI had higher negative and positive predictive values than mpMRI to predict PCa (positive predictive value (PPV) 77.8% (58.6-97.0%), negative predictive value (NPV) 91.7% (80.6-100%) vs. PPV 46.7% (28.8-64.5%), NPV 83.3% (62.3-100%)). We conclude from this pilot study that DTI combined with T2-weighted imaging may have the potential to improve PCa detection without requiring contrast injection.
在前列腺中，水沿导管和腺壁平行方向扩散的速度比垂直方向更快，但目前这些数据尚未用于多参数磁共振成像（mpMRI）检测前列腺癌（PCa）。扩散张量成像（DTI）可以量化组织中水分子的扩散方向，已应用于脑部和乳腺成像。我们的目的是确定DTI是否能提高PCa的检测能力。我们对疑似PCa且正在接受mpMRI检查的患者进行了DTI序列扫描。我们使用专门的DTI分析软件，计算了疑似病变和外观正常的前列腺组织的DTI和扩散加权成像（DWI）的扩散指标，并比较了临床指征明确时靶向活检中PCa的预测值。对78例患者进行了DTI扫描，其中42例接受了活检，16例被诊断为PCa。中位年龄为62岁（四分位间距54.4 - 68.4），前列腺特异性抗原（PSA）为4.8（四分位间距1.3 - 10.7）ng/mL。DTI指标能够区分PCa病变和正常组织。与正常组织相比，外周区（<0.0001）和中央腺体（<0.0001）癌的表观扩散系数（λ）均较低。在预测PCa方面，DTI的阴性和阳性预测值高于mpMRI（阳性预测值（PPV）77.8%（58.6 - 97.0%），阴性预测值（NPV）91.7%（80.6 - 100%），而mpMRI的PPV为46.7%（28.8 - 64.5%），NPV为83.3%（62.3 - 100%））。我们从这项初步研究得出结论，DTI联合T2加权成像可能有潜力在无需注射造影剂的情况下提高PCa的检测能力。
