Park Hyungin, Kim Seung Ho, Kim Joo Yeon
Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-gu, Busan, Korea.
Department of Pathology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-gu, Busan, Korea.
Quant Imaging Med Surg. 2022 Jan;12(1):742-751. doi: 10.21037/qims-21-455.
To investigate the usefulness of perfusion parameters derived from dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of patients diagnosed as prostate cancer (PCa) in differentiating clinically significant cancer [CSC, Gleason score (GS) ≥7] from non-CSC (GS 6).
A total of 94 patients diagnosed between August 2018 and September 2020 as PCa by radical prostatectomy were included in this retrospective study (mean age: 68.7 years, range, 47-83 years). All of the patients had undergone DCE-MRI on a single 3T-MR scanner. Whole-tumor volume was measured by reviewing a pathologic topographic map as a reference standard. The quantitative DCE perfusion parameters, including volume transfer constant (K), rate constant (k), extracellular extravascular space (EES) volume fraction (v), plasma volume fraction (v) and area of region of interest (ROI) were calculated under an extended Tofts model. A receiver operating characteristic (ROC) curve analysis by pair-wise comparison was performed to compare the diagnostic performances of the perfusion parameters.
The study population comprised GS 6 (n=17), GS 7 (n=57), GS 8 (n=9) and GS 9 (n=11) cases. Among the perfusion parameters, v differed significantly between CSC (0.238±0.095) and non-CSC (0.300±0.126) (P=0.0308). Area under the curve (AUC) was 0.643 (95% CI, 0.538-0.739), and a maximum accuracy of 64%, a sensitivity of 66%, and a specificity of 53% were estimated. Area of ROI also differed significantly between CSC (201.89±163.87 mm) and non-CSC (84.99±85.82 mm) (P=0.0054). AUC was 0.807 (95% CI, 0.713-0.881), and maximum accuracy, sensitivity, and specificity were 81%, 82%, and 76%, respectively.
Size of the tumor and interstitial space volume fraction are significant parameters in differentiating aggressiveness in PCa.
探讨动态对比增强（DCE）-磁共振成像（MRI）得出的灌注参数对诊断为前列腺癌（PCa）的患者区分临床显著性癌[CSC， Gleason评分（GS）≥7]与非CSC（GS 6）的作用。
本回顾性研究纳入了2018年8月至2020年9月期间经根治性前列腺切除术诊断为PCa的94例患者（平均年龄：68.7岁，范围47 - 83岁）。所有患者均在一台3T MR扫描仪上接受了DCE-MRI检查。通过回顾病理地形图作为参考标准测量全肿瘤体积。在扩展Tofts模型下计算定量DCE灌注参数，包括容积转移常数（K）、速率常数（k）、细胞外血管外间隙（EES）容积分数（v）、血浆容积分数（vp）和感兴趣区（ROI）面积。通过两两比较进行受试者操作特征（ROC）曲线分析，以比较灌注参数的诊断性能。
研究人群包括GS 6（n = 17）、GS 7（n = 57）、GS 8（n = 9）和GS 9（n = 11）的病例。在灌注参数中，CSC（0.238±0.095）与非CSC（0.300±0.126）之间的v差异有统计学意义（P = 0.0308）。曲线下面积（AUC）为0.643（95%CI，0.538 - 0.739），估计最大准确率为64%，灵敏度为66%，特异度为53%。CSC（201.89±163.87 mm）与非CSC（84.99±85.82 mm）之间的ROI面积也有显著差异（P = 0.0054）。AUC为0.807（95%CI，0.713 - 0.881），最大准确率、灵敏度和特异度分别为81%、82%和76%。
肿瘤大小和间质间隙容积分数是区分PCa侵袭性的重要参数。
