Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA; The Graduate Group in Bioengineering, University of California, San Francisco and Berkeley, Berkeley, CA 94720, USA.
Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA; Department of Urology, University of California, San Francisco, San Francsico, CA 94143, USA; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, USA.
Magn Reson Imaging. 2024 Dec;114:110233. doi: 10.1016/j.mri.2024.110233. Epub 2024 Sep 10.
To establish the incidence, size, zonal location and Gleason Score(GS)/Gleason Grade Group(GG) of sparse versus dense prostate cancer (PCa) lesions and to identify the imaging characteristics of sparse versus dense cancers on multiparametric MRI (mpMRI).
Seventy-six men with untreated PCa were scanned prior to prostatectomy with endorectal-coil 3 T MRI including T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Cancerous regions were outlined and graded on the whole-mount, processed specimens, with tissue compositions estimated. Regions with cancer comprising <50 % and ≥ 50 % of the tissue were considered sparse and dense respectively. Regions of interest (ROI) were manually drawn on T2-weighted MRI. Within each patient, area-weighted ROI averages were calculated for each imaging measure for each tissue type, GS/GG, and sparse/dense composition.
A large number of cancer regions were identified on histopathology (n = 1193: 939 (peripheral zone (PZ)) and 254 (transition zone (TZ))). Thirty-seven percent of these lesions were sparse. Sparse lesions were primarily low-grade with the majority of PZ and 100 % of TZ sparse lesions ≤GS3 + 3/GG1. Dense lesions were significantly larger than sparse lesions in both PZ and TZ, p < 0.0001. On imaging, 246/45 PZ and 109/8 TZ dense/sparse 2D cancerous ROIs were drawn. Sparse GS3 + 3 and sparse ≥GS3 + 4 cancers did not have significantly different MRI intensities to dense GS3 + 3 cancers, while sparse GS3 + 3/GG1 cancers differed from benign, p < 0.05.
Histopathologically identified prostate cancer lesions were sparse in 37 % of cases. Sparse cancers were entirely low grade in TZ and predominantly low-grade in PZ and generally small, thus likely posing lower risk for spread and progression than dense lesions. Sparse lesions were not distinguishable from dense lesions on mpMRI, but could be distinguished from benign tissues.
确定稀疏与密集前列腺癌（PCa）病变的发生率、大小、区域位置和 Gleason 评分（GS）/Gleason 分级组（GG），并确定多参数 MRI（mpMRI）上稀疏与密集癌症的影像学特征。
76 名未经治疗的 PCa 男性在前列腺切除术前接受了直肠内线圈 3T MRI 扫描，包括 T2 加权成像、扩散加权成像和动态对比增强 MRI。在整个标本上勾勒出癌性区域并进行分级，并估计组织成分。癌症占组织<50%和≥50%的区域分别被认为是稀疏和密集。在 T2 加权 MRI 上手动绘制感兴趣区（ROI）。对于每种组织类型、GS/GG 以及稀疏/密集成分，每位患者的 ROI 面积加权平均值均进行了计算。
在组织病理学上确定了大量的癌区（n=1193：939 个（周边区（PZ））和 254 个（移行区（TZ）））。这些病变中有 37%是稀疏的。稀疏病变主要为低级别，大多数 PZ 和 100%的 TZ 稀疏病变≤GS3+3/GG1。与稀疏病变相比，密集病变在 PZ 和 TZ 中均显著更大，p<0.0001。在影像学上，绘制了 45 个 PZ 和 8 个 TZ 的 2D 密集/稀疏癌症 ROI。GS3+3 稀疏和 GS3+3 以上稀疏癌症与密集 GS3+3 癌症的 MRI 强度没有显著差异，而 GS3+3/GG1 稀疏癌症与良性组织有差异，p<0.05。
组织病理学上确定的前列腺癌病变中有 37%是稀疏的。在 TZ 中，稀疏癌完全为低级别，在 PZ 中主要为低级别，且通常较小，因此与密集病变相比，其扩散和进展的风险较低。在 mpMRI 上，稀疏病变与密集病变无法区分，但可与良性组织区分。
