Palumbo Pierpaolo, Martinese Andrea, Antenucci Maria Rosaria, Granata Vincenza, Fusco Roberta, De Muzio Federica, Brunese Maria Chiara, Bicci Eleonora, Bruno Alessandra, Bruno Federico, Giovagnoni Andrea, Gandolfo Nicoletta, Miele Vittorio, Di Cesare Ernesto, Manetta Rosa
Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L'Aquila, Italy.
Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
Gland Surg. 2023 Dec 26;12(12):1806-1822. doi: 10.21037/gs-23-53. Epub 2023 Dec 22.
In recent years, magnetic resonance imaging (MRI) has shown excellent results in the study of the prostate gland. MRI has indeed shown to be advantageous in the prostate cancer (PCa) detection, as in guiding targeting biopsy, improving its diagnostic yield. Although current acquisition protocols provide for multiparametric acquisition, recent evidence has shown that biparametric protocols can be non-inferior in PCa detection. Diffusion-weighted imaging (DWI) sequence, in particular, plays a key role, particularly in the peripheral zone which accounts for the larger part of the prostate. High b-values are generally recommended, although with the possibility of obtaining non-Gaussian diffusion effects, which requires a more sophisticated model for the analysis, namely through the diffusion kurtosis imaging (DKI). Purpose of this narrative review was to analyze the current applications and clinical evidence regarding the use of DKI with a main focus on PCa detection, also in comparison with DWI.
This narrative review synthesized the findings of literature retrieved from main researches, narrative and systematic reviews, and meta-analyses obtained from PubMed.
DKI analyses the non-Gaussian water diffusivity and describe the effect of signal intensity decay related to high b-value through two main metrics (D and K). Differently from DWI-apparent diffusion coefficient (DWI-ADC) which reflects only water restriction outside of cells, DKI metrics are supposed to represent also the direct interaction of water molecules with cell membranes and intracellular compounds. This review describes current evidence on ADC and DKI metrics in clinical imaging, and finally collect the results derived from the main articles focused on DWI and DKI models in detecting PCa.
DKI advantages, compared to conventional ADC analysis, still remain controversial. Wider application and greater technical knowledge of DKI, however, may help in proving its intrinsic validity in the field of oncology and therefore in the study of clinically significant PCa. Finally, a deep understanding of DKI is important for radiologists to better understand what K and D mean in the context of different cancer and how these metrics may vary specifically in PCa imaging.
近年来，磁共振成像（MRI）在前列腺研究中显示出优异的结果。MRI在前列腺癌（PCa）检测中确实具有优势，例如在引导靶向活检方面，可提高其诊断率。尽管当前的采集方案提供多参数采集，但最近的证据表明，双参数方案在PCa检测中可能并不逊色。特别是扩散加权成像（DWI）序列，在前列腺占比更大的外周区发挥着关键作用。一般推荐使用高b值，不过可能会获得非高斯扩散效应，这需要更复杂的模型进行分析，即通过扩散峰度成像（DKI）。本叙述性综述的目的是分析DKI的当前应用和临床证据，主要聚焦于PCa检测，并与DWI进行比较。
本叙述性综述综合了从主要研究、叙述性和系统性综述以及从PubMed获得的荟萃分析中检索到的文献结果。
DKI分析非高斯水扩散率，并通过两个主要指标（D和K）描述与高b值相关的信号强度衰减的影响。与仅反映细胞外水扩散受限的DWI表观扩散系数（DWI-ADC）不同，DKI指标还应代表水分子与细胞膜和细胞内化合物的直接相互作用。本综述描述了临床成像中关于ADC和DKI指标的当前证据，最后收集了主要文章中关于DWI和DKI模型在检测PCa方面的结果。
与传统的ADC分析相比，DKI的优势仍存在争议。然而，DKI的更广泛应用和更多技术知识可能有助于证明其在肿瘤学领域的内在有效性，从而有助于临床显著性PCa的研究。最后，深入理解DKI对于放射科医生更好地理解K和D在不同癌症背景下的含义以及这些指标在PCa成像中如何具体变化非常重要。
