用于原发性前列腺癌评估的合成磁共振成像：通过弛豫测量增强的非对比增强双参数方法的诊断潜力
Synthetic magnetic resonance imaging for primary prostate cancer evaluation: Diagnostic potential of a non-contrast-enhanced bi-parametric approach enhanced with relaxometry measurements.
作者信息
Arita Yuki, Akita Hirotaka, Fujiwara Hirokazu, Hashimoto Masahiro, Shigeta Keisuke, Kwee Thomas C, Yoshida Soichiro, Kosaka Takeo, Okuda Shigeo, Oya Mototsugu, Jinzaki Masahiro
机构信息
Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
出版信息
Eur J Radiol Open. 2022 Feb 15;9:100403. doi: 10.1016/j.ejro.2022.100403. eCollection 2022.
PURPOSE
Bi-parametric magnetic resonance imaging (bpMRI) with diffusion-weighted images has wide utility in diagnosing clinically significant prostate cancer (csPCa). However, bpMRI yields more false-negatives for PI-RADS category 3 lesions than multiparametric (mp)MRI with dynamic-contrast-enhanced (DCE)-MRI. We investigated the utility of synthetic MRI with relaxometry maps for bpMRI-based diagnosis of csPCa.
METHODS
One hundred and five treatment-naïve patients who underwent mpMRI and synthetic MRI before prostate biopsy for suspected PCa between August 2019 and December 2020 were prospectively included. Three experts and three basic prostate radiologists evaluated the diagnostic performance of conventional bpMRI and synthetic bpMRI for csPCa. PI-RADS version 2.1 category 3 lesions were identified by consensus, and relaxometry measurements (T1-value, T2-value, and proton density [PD]) were performed. The diagnostic performance of relaxometry measurements for PI-RADS category 3 lesions in peripheral zone was compared with that of DCE-MRI. Histopathological evaluation results were used as the reference standard. Statistical analysis was performed using the areas under the receiver operating characteristic curve (AUC) and McNemar test.
RESULTS
In 102 patients without significant MRI artefacts, the diagnostic performance of conventional bpMRI was not significantly different from that of synthetic bpMRI for all readers (p = 0.11-0.79). The AUCs of the combination of T1-value, T2-value, and PD (T1 + T2 + PD) for csPCa in peripheral zone for PI-RADS category 3 lesions were 0.85 for expert and 0.86 for basic radiologists, with no significant difference between T1 + T2 + PD and DCE-MRI for both expert and basic radiologists (p = 0.29-0.45).
CONCLUSION
Synthetic MRI with relaxometry maps shows promise for contrast media-free evaluation of csPCa.
目的
具有扩散加权图像的双参数磁共振成像（bpMRI）在诊断具有临床意义的前列腺癌（csPCa）方面具有广泛用途。然而，与具有动态对比增强（DCE）-MRI的多参数（mp）MRI相比，bpMRI对PI-RADS 3类病变产生的假阴性更多。我们研究了具有弛豫测量图的合成MRI在基于bpMRI的csPCa诊断中的效用。
方法
前瞻性纳入了2019年8月至2020年12月期间因疑似前列腺癌在前列腺活检前接受mpMRI和合成MRI检查的105例未经治疗的患者。三名专家和三名初级前列腺放射科医生评估了传统bpMRI和合成bpMRI对csPCa的诊断性能。通过共识确定PI-RADS第2.1版3类病变，并进行弛豫测量（T1值、T2值和质子密度[PD]）。将外周区PI-RADS 3类病变的弛豫测量诊断性能与DCE-MRI的诊断性能进行比较。组织病理学评估结果用作参考标准。使用受试者操作特征曲线（AUC）下面积和McNemar检验进行统计分析。
结果
在102例无明显MRI伪影的患者中，对于所有读者，传统bpMRI的诊断性能与合成bpMRI的诊断性能无显著差异（p = 0.11 - 0.79）。外周区PI-RADS 3类病变csPCa的T1值、T2值和PD（T1 + T2 + PD）组合的AUC，专家为0.85，初级放射科医生为0.86，专家和初级放射科医生的T1 + T2 + PD与DCE-MRI之间均无显著差异（p = 0.29 - 0.45）。
结论
具有弛豫测量图的合成MRI在无造影剂评估csPCa方面显示出前景。
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