Chang Chun-Bi, Lin Yu-Chun, Wong Yon-Cheong, Lin Shin-Nan, Lin Chien-Yuan, Lin Yu-Han, Sheng Ting-Wen, Huang Chen-Chih, Yang Lan-Yan, Wang Li-Jen
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.
Front Oncol. 2021 Jul 1;11:659014. doi: 10.3389/fonc.2021.659014. eCollection 2021.
To elucidate the usefulness of intravoxel incoherent motion (IVIM)/apparent diffusion coefficient (ADC) parameters in preoperative risk stratification using International Society of Urological Pathology (ISUP) grades.
Forty-five prostate cancer (PCa) patients undergoing radical prostatectomy (RP) after prostate multiparametric magnetic resonance imaging (mpMRI) were included. The ISUP grades were categorized into low-risk (I-II) and high-risk (III-V) groups, and the concordance between the preoperative and postoperative grades was analyzed. The largest region of interest (ROI) of the dominant tumor on each IVIM/ADC image was delineated to obtain its histogram values (i.e., minimum, mean, and kurtosis) of diffusivity (D), pseudodiffusivity (D*), perfusion fraction (PF), and ADC. Multivariable logistic regression analysis of the IVIM/ADC parameters without and with preoperative ISUP grades were performed to identify predictors for the postoperative high-risk group.
Thirty-two (71.1%) of 45 patients had concordant preoperative and postoperative ISUP grades. D, D*, PF, ADC, and ADC were significantly associated with the postoperative ISUP risk group (all p < 0.05). D and D* (model I, both p < 0.05) could predict the postoperative ISUP high-risk group with an area under the curve (AUC) of 0.842 and a 95% confidence interval (CI) of 0.726-0.958. The addition of D* to the preoperative ISUP grade (model II) may enhance prediction performance, with an AUC of 0.907 (95% CI 0.822-0.992).
The postoperative ISUP risk group could be predicted by D and D* from mpMRI, especially D*. Obtaining the biexponential IVIM parameters is important for better risk stratification for PCa.
探讨体素内不相干运动（IVIM）/表观扩散系数（ADC）参数在使用国际泌尿病理学会（ISUP）分级进行术前风险分层中的作用。
纳入45例在前列腺多参数磁共振成像（mpMRI）后接受根治性前列腺切除术（RP）的前列腺癌（PCa）患者。将ISUP分级分为低风险（I-II）组和高风险（III-V）组，并分析术前和术后分级的一致性。在每个IVIM/ADC图像上勾勒出主要肿瘤的最大感兴趣区（ROI），以获得其扩散率（D）、伪扩散率（D*）、灌注分数（PF）和ADC的直方图值（即最小值、平均值和峰度）。对不包括和包括术前ISUP分级的IVIM/ADC参数进行多变量逻辑回归分析，以确定术后高风险组的预测因素。
45例患者中有32例（71.1%）术前和术后ISUP分级一致。D、D*、PF、ADC和ADC与术后ISUP风险组显著相关（均p<0.05）。D和D*（模型I，均p<0.05）可预测术后ISUP高风险组，曲线下面积（AUC）为0.842，95%置信区间（CI）为0.726-0.958。在术前ISUP分级中加入D*（模型II）可能会提高预测性能，AUC为0.907（95%CI 0.822-0.992）。
mpMRI中的D和D*，尤其是D*，可预测术后ISUP风险组。获取双指数IVIM参数对于更好地进行PCa风险分层很重要。
