前列腺机器人辅助经会阴融合前列腺活检前前列腺双参数与多参数 MRI 的头对头比较。
Head-to-head comparison of biparametric versus multiparametric MRI of the prostate before robot-assisted transperineal fusion prostate biopsy.
机构信息
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
出版信息
World J Urol. 2022 Oct;40(10):2431-2438. doi: 10.1007/s00345-022-04120-1. Epub 2022 Aug 4.
PURPOSE
Prostate biparametric magnetic resonance imaging (bpMRI) including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) might be an alternative to multiparametric MRI (mpMRI, including dynamic contrast imaging, DCE) to detect and guide targeted biopsy in patients with suspected prostate cancer (PCa). However, there is no upgrading peripheral zone PI-RADS 3 to PI-RADS 4 without DCE in bpMRI. The aim of this study was to evaluate bpMRI against mpMRI in biopsy-naïve men with elevated prostate-specific antigen (PSA) scheduled for robot-assisted-transperineal fusion-prostate biopsy (RA-TB).
METHODS
Retrospective single-center-study of 563 biopsy-naïve men (from 01/2015 to 09/2018, mean PSA 9.7 ± 6.5 ng/mL) with PI-RADSv2.1 conform mpMRI at 3 T before RA-TB. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2 in any core. Two experienced readers independently evaluated images according to PI-RADSv2.1 criteria (separate readings for bpMRI and mpMRI sequences, 6-month interval). Reference standard was histology from RA-TB.
RESULTS
PI-RADS 2 was scored in 5.1% of cases (3.4% cancer/3.4% csPCa), PI-RADS 3 in 16.9% (32.6%/3.2%), PI-RADS 4 in 57.6% (66.1%/58.3%) and PI-RADS 5 in 20.4% of cases (79.1%/74.8%). For mpMRI/bpMRI test comparison, sensitivity was 99.0%/97.1% (p < 0.001), specificity 47.5%/61.2% (p < 0.001), PPV 69.5%/75.1% (p < 0.001) and NPV 97.6%/94.6% (n.s.). csPCa was considered gold standard. 35 cases without cancer were upgraded to PI-RADS 4 (mpMRI) and six PI-RADS 3 cases with csPCa were not upgraded (bpMRI).
CONCLUSION
In patients planned for RA-TB with elevated PSA and clinical suspicion for PCa, specificity was higher in bpMRI vs. mpMRI, which could solve constrains regarding time and contrast agent.
目的
前列腺双参数磁共振成像（bpMRI）包括 T2 加权成像（T2WI）和扩散加权成像（DWI）可能是多参数磁共振成像（mpMRI，包括动态对比成像，DCE）的替代方法，用于检测和指导疑似前列腺癌（PCa）患者的靶向活检。然而，在 bpMRI 中，没有 DCE 的情况下，外周带 PI-RADS 3 升级为 PI-RADS 4 的情况并不多见。本研究的目的是评估 bpMRI 在接受机器人辅助经会阴融合前列腺活检（RA-TB）的前列腺特异性抗原（PSA）升高的活检初治男性中的作用。
方法
回顾性单中心研究 563 名前列腺特异性抗原（PSA）升高的活检初治男性（2015 年 1 月至 2018 年 9 月，平均 PSA 9.7±6.5ng/ml），行 3T 磁共振成像（mpMRI）检查，采用 PI-RADSv2.1 标准。临床显著前列腺癌（csPCa）定义为任何部位的 ISUP 分级≥2。两名有经验的阅片者根据 PI-RADSv2.1 标准（bpMRI 和 mpMRI 序列分别进行独立评估，间隔 6 个月）独立评估图像。参考标准为 RA-TB 活检的组织学结果。
结果
PI-RADS 2 评分病例占 5.1%（3.4%癌症/3.4% csPCa），PI-RADS 3 评分病例占 16.9%（32.6%/3.2%），PI-RADS 4 评分病例占 57.6%（66.1%/58.3%），PI-RADS 5 评分病例占 20.4%（79.1%/74.8%）。mpMRI/bpMRI 检测比较，灵敏度分别为 99.0%/97.1%（p<0.001），特异度分别为 47.5%/61.2%（p<0.001），阳性预测值分别为 69.5%/75.1%（p<0.001），阴性预测值分别为 97.6%/94.6%（无统计学差异）。csPCa 被认为是金标准。35 例无癌患者的 PI-RADS 评分升级为 4 分（mpMRI），6 例有 csPCa 的 PI-RADS 3 分患者未升级（bpMRI）。
结论
在接受 PSA 升高且临床怀疑患有 PCa 的 RA-TB 治疗的患者中，bpMRI 的特异性高于 mpMRI，这可以解决时间和造影剂方面的限制。
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