Department of Radiology, Clinique de l'Alma, 75007, Paris, France.
Centre de Pathologie des Hauts de France, Amiens, France.
Eur Radiol. 2022 Nov;32(11):7504-7512. doi: 10.1007/s00330-022-08788-2. Epub 2022 Apr 22.
To prospectively determine the value of post-MRI micro-ultrasonography (microUS) in the diagnosis of transition zone (TZ) significant prostate cancer (sPCa).
Eighty-four consecutive men (66 ± 6.3 years) with a mean PSA level of 10.2 ± 7.4 ng/mL and at least one TZ-PI-RADS > 2 lesion were included. All patients had MRI-directed microUS and biopsy. Sensitivity and specificity of post-MRI microUS to visualize PI-RADS > 2 TZ lesions, the cancer detection rate of TZ-sPCa, and tumor characteristics according to their visibility on microUS were evaluated. Interreader agreement for detecting microUS+ lesions was evaluated using Cohen's kappa test.
Of the 92 PI-RADS > 2 lesions, 71 (71/92; 77%) were visible on microUS and biopsy was performed without image fusion, which was required for the 21 invisible lesions (21/92; 22.8%). TZ-sPCa detection rate was 51.1% (47/92). Sensitivity and specificity of MRI-directed microUS were 83% (39/47; 95% CI: 69.2-92.4%) and 28.9% (13/45; 95% CI: 16.4-44.3%), on a per-lesion basis and 86.4% (38/45; 95% CI: 72.6-94.8%) and 27.5% (11/40; 95% CI: 14.6-43.9%) on a per-patient basis. Visible tumors on microUS exhibited a larger volume and a lower mean ADC value than non-visible tumors (15.8 ± 5.1 vs. 12.5 ± 3.6 mm and 0.82 ± 1.1 × 10 vs. 0.9 ± 1.4 × 10 mm/s) (p = 0.02). Non-visible tumors showed a heterogeneous non-specific echotexture or were masked by the shadowing caused by corpora amylacea. Interreader agreement was almost perfect (kappa = 0.88; 95% CI: 0.79-0.95). The main limitation is the single-center feature of the study.
MRI-targeted transrectal microUS is effective to detect TZ-sPCa. TRUS-MRI image fusion helps overcome limitations due to TZ tissue heterogeneity.
microUS can visualize the majority of MRI-detected PI-RADS > 2 TZ lesions (sensitivity = 83%). Interreader agreement of MRI-directed microUS in the detection of TZ lesions appears excellent (kappa = 0.88). In 77% of PI-RADS > 2 TZ lesions, biopsy was performed under microUS visual control. MRI fusion system was only used to overcome limitations due to tissue heterogeneity of benign prostatic hyperplasia.
前瞻性评估 MRI 后微超声（microUS）在诊断转移区（TZ）显著前列腺癌（sPCa）中的价值。
84 例连续男性患者（66±6.3 岁），平均 PSA 水平为 10.2±7.4ng/ml，至少有一个 TZ-PI-RADS>2 病变。所有患者均行 MRI 引导的 microUS 和活检。评估 MRI 后 microUS 诊断 PI-RADS>2 TZ 病变的敏感性和特异性、TZ-sPCa 的检出率以及根据 microUS 可见性的肿瘤特征。采用 Cohen's kappa 检验评估检测 microUS+病变的读者间一致性。
92 个 PI-RADS>2 病变中，71 个（71/92；77%）在 microUS 上可见，而 21 个（21/92；22.8%）不可见的病变则无需进行图像融合（需要图像融合）。TZ-sPCa 的检出率为 51.1%（47/92）。MRI 引导的 microUS 在检测单个病变时的敏感性和特异性分别为 83%（39/47；95%CI：69.2-92.4%）和 28.9%（13/45；95%CI：16.4-44.3%），在检测每位患者时的敏感性和特异性分别为 86.4%（38/45；95%CI：72.6-94.8%）和 27.5%（11/40；95%CI：14.6-43.9%）。microUS 可见肿瘤的体积较大，平均 ADC 值较低，与不可见肿瘤相比（15.8±5.1 比 12.5±3.6mm 和 0.82±1.1×10 比 0.9±1.4×10mm/s）（p=0.02）。不可见肿瘤呈不均匀的非特异性回声或被前列腺钙化引起的阴影所掩盖。读者间的一致性几乎是完美的（kappa=0.88；95%CI：0.79-0.95）。该研究的主要局限性是单中心特征。
MRI 靶向经直肠 microUS 可有效检测 TZ-sPCa。TRUS-MRI 图像融合有助于克服因 TZ 组织异质性导致的局限性。
microUS 可显示大多数 MRI 检测到的 PI-RADS>2 TZ 病变（敏感性=83%）。MRI 引导的 microUS 检测 TZ 病变的读者间一致性良好（kappa=0.88）。在 77%的 PI-RADS>2 TZ 病变中，活检在 microUS 可视控制下进行。MRI 融合系统仅用于克服良性前列腺增生组织异质性导致的局限性。
