El-Taji Omar, Evans Hannah, Arora Vandan, Amin Suzanne, Kumar Manal, Rajan Thiagarajan Nambi
Department of Urology Wirral University Teaching Hospitals Wirral UK.
Department of Radiology Wirral University Teaching Hospitals Wirral UK.
BJUI Compass. 2023 Jan 31;4(3):346-351. doi: 10.1002/bco2.210. eCollection 2023 May.
Current literature suggests that axial skeleton magnetic resonance imaging (AS-MRI) is more sensitive than Tc 99m bone scintigraphy (BS) for detecting bone metastases (BM) in high-risk prostate cancer (PCa). However, BS is still widely performed. Its diagnostic accuracy has been studied; however, its feasibility and cost implications are yet to be examined.
We reviewed all patients with high risk PCa undergoing AS-MRI over a 5-year period. AS-MRI was performed on patients with histologically confirmed PCa and either PSA > 20 ng/ml, Gleason ≥8, or TNM Stage ≥T3 or N1 disease. All AS-MRI studies were obtained using a 1.5-T AchievaPhilips™MRI scanner. We compared the AS-MRI positivity and equivocal rate with that of BS. Data were analysed according to Gleason score, T-stage and PSA. Multivariate logistic regression analyses were used to quantify the strength of association between positive scans and clinical variables. Feasibility and burden of expenditure was also evaluated.
Five hundred three patients with a median age of 72 and a mean PSA of 34.8 ng/ml were analysed. Eighty-eight patients (17.5%) were positive for BM on AS-MRI (mean PSA 99 [95% CI 69.1-129.9]). Comparatively 409 patients (81.3%) were negative for BM on AS-MRI (mean PSA 24.7 (95% CI [21.7-27.7]) ( = 0.007); 1.2% ( = 6) of patients had equivocal results (mean PSA 33.4 [95% CI 10.5-56.3]). There was no significant difference in age ( = 0.122) between this group and patients with a positive scan, but there was a significant difference in PSA ( = 0.028), T stage ( = 0.006) and Gleason score ( = 0.023). In comparison with BS, AS-MRI detection rate was equivalent or higher compared with the literature. Based on NHS tariff calculations, there would be a minimum cost saving of £8406.89. All patients underwent AS-MRI within 14 days.
The use of AS-MRI to stage BM in high-risk PCa is both feasible and results in a reduced burden of expenditure.
当前文献表明,在检测高危前列腺癌(PCa)的骨转移(BM)方面,轴向骨骼磁共振成像(AS-MRI)比锝99m骨闪烁显像(BS)更敏感。然而,BS仍被广泛应用。其诊断准确性已得到研究;但其可行性和成本影响尚待研究。
我们回顾了5年间所有接受AS-MRI检查的高危PCa患者。对组织学确诊为PCa且前列腺特异性抗原(PSA)>20 ng/ml、 Gleason评分≥8或TNM分期≥T3或N1期疾病的患者进行AS-MRI检查。所有AS-MRI研究均使用1.5-T Achieva Philips™磁共振成像扫描仪获得。我们将AS-MRI的阳性率和可疑率与BS的进行比较。根据Gleason评分、T分期和PSA对数据进行分析。采用多因素逻辑回归分析来量化阳性扫描与临床变量之间关联的强度。还评估了可行性和支出负担。
分析了503例患者,中位年龄72岁,平均PSA为34.8 ng/ml。88例患者(17.5%)AS-MRI显示BM阳性(平均PSA 99 [95%可信区间69.1 - 12