Department of Radiological, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, China.
Radiol Med. 2023 Jun;128(6):668-678. doi: 10.1007/s11547-023-01645-2. Epub 2023 Jun 5.
Whether Intravoxel incoherent motion (IVIM) can be used as a predictive tool of positive surgical margins (PSMs) and Gleason score (GS) upgrading in prostate cancer (PCa) patients after radical prostatectomy (RP) still remains unclear. The aim of this study is to explore the ability of IVIM and clinical characteristics to predict PSMs and GS upgrading.
A total of 106 PCa patients after RP who underwent pelvic mpMRI (multiparametric Magnetic Resonance Imaging) between January 2016 and December 2021 and met the requirements were retrospectively included in our study. IVIM parameters were obtained using GE Functool post-processing software. Logistic regression models were fitted to confirm the predictive risk factor of PSMs and GS upgrading. The area under the curve and fourfold contingency table were used to evaluate the diagnostic efficacy of IVIM and clinical parameters.
Multivariate logistic regression analyses revealed that percent of positive cores, apparent diffusion coefficient and molecular diffusion coefficient (D) were independent predictors of PSMs (Odds Ratio (OR) were 6.07, 3.62 and 3.16, respectively), Biopsy GS and pseudodiffusion coefficient (D*) were independent predictors of GS upgrading (OR were 0.563 and 7.15, respectively). The fourfold contingency table suggested that combined diagnosis increased the ability of predicting PSMs but had no advantage in predicting GS upgrading except the sensitivity from 57.14 to 91.43%.
IVIM showed good performance in predicting PSMs and GS upgrading. Combining IVIM and clinical factors enhanced the performance of predicting PSMs, which may contribute to clinical diagnosis and treatment.
在接受根治性前列腺切除术（RP）后的前列腺癌（PCa）患者中，体素内不相干运动（IVIM）是否可作为预测阳性手术切缘（PSM）和Gleason 评分（GS）升级的工具仍不清楚。本研究旨在探讨 IVIM 和临床特征预测 PSM 和 GS 升级的能力。
回顾性纳入了 2016 年 1 月至 2021 年 12 月间接受盆腔多参数磁共振成像（mpMRI）检查且符合条件的 106 例 RP 后 PCa 患者。使用 GE Functool 后处理软件获取 IVIM 参数。使用逻辑回归模型确认 PSM 和 GS 升级的预测风险因素。采用曲线下面积和四格表评估 IVIM 和临床参数的诊断效能。
多变量逻辑回归分析显示，阳性核心百分比、表观扩散系数和分子扩散系数（D）是 PSM 的独立预测因素（优势比分别为 6.07、3.62 和 3.16），活检 GS 和假扩散系数（D*）是 GS 升级的独立预测因素（优势比分别为 0.563 和 7.15）。四格表提示，联合诊断提高了预测 PSM 的能力，但在预测 GS 升级方面除了敏感性从 57.14%提高到 91.43%之外，并没有优势。
IVIM 对预测 PSM 和 GS 升级具有良好的性能。IVIM 与临床因素相结合提高了预测 PSM 的能力，有助于临床诊断和治疗。
