Asfuroğlu Umut, Asfuroğlu Berrak Barutcu, Özer Halil, İnan Mehmet Arda, Uçar Murat
Ankara Etlik City Hospital, Department of Radiology, Varlık, 06170 Ankara, Turkey.
Ankara Etlik City Hospital, Department of Radiology, Varlık, 06170 Ankara, Turkey.
Eur J Radiol. 2024 Dec;181:111753. doi: 10.1016/j.ejrad.2024.111753. Epub 2024 Sep 21.
This study aims to evaluate the diagnostic performance of curvilinear and linear measurement methods in different magnetic resonance imaging (MRI) sequences for detecting extraprostatic extension (EPE) in prostate cancer, and to evaluate the added value of apparent diffusion coefficient (ADC) in detecting EPE.
A retrospective analysis was conducted on 84 patients who underwent multiparametric MRI (mp-MRI) prior to radical prostatectomy between January 2019 and February 2022. Tumor contact length (TCL) was assessed curvilinearly and linearly on T2-weighted imaging (T2WI), ADC maps, and dynamic contrast-enhanced (DCE) MRI by two radiologists. MRI-based EPE positivity was defined as a curvilinear or linear contact length of >15 mm. Statistical comparisons were conducted using chi-squared and independent samples t-tests, with interreader agreement evaluated using weighted κ statistics. Univariate and multivariate logistic regression identified independent predictors of EPE, and two prediction models were constructed. Diagnostic performance was assessed using receiver operator characteristic (ROC) curve analysis.
A total of 32 (38%) and 52 (62%) patients with EPE and non-EPE, respectively, were included in this study. Patients with EPE demonstrated significantly larger tumor sizes, lower ADC values, and lower ADC ratios than those without EPE (p < 0.001). The curvilinear and linear TCL measurements for each sequence exhibited statistically significant correlations with EPE for both readers, with strong interreader agreement. Curvilinear TCL (c-TCL) and linear TCL (l-TCL) on DCE-MRI showed higher area under the curve (AUC) values than the other measurements for EPE prediction (reader 1: 0.815 and 0.803, reader 2: 0.746 and 0.713, respectively). However, there was no statistically significant difference between c-TCL and l-TCL. Multivariable models with mean ADC value improved predictive performance. Model 2 (ADC, ISUP, and c-TCL on DCE images) surpassed model 1 (ADC and c-TCL on DCE images) with an AUC of 0.919 and 0.874, respectively.
DCE-MRI demonstrated superior performance in predicting EPE compared to other sequences. Linear and curvilinear measurements had comparable diagnostic performance. Being more practical and easier, radiologists may use l-TCL measurement in daily practice. The mean ADC value provided additional diagnostic value.
本研究旨在评估不同磁共振成像（MRI）序列中曲线和线性测量方法在检测前列腺癌前列腺外侵犯（EPE）方面的诊断性能，并评估表观扩散系数（ADC）在检测EPE中的附加价值。
对2019年1月至2022年2月期间在根治性前列腺切除术前行多参数MRI（mp-MRI）检查的84例患者进行回顾性分析。两名放射科医生在T2加权成像（T2WI）、ADC图和动态对比增强（DCE）MRI上对肿瘤接触长度（TCL）进行曲线和线性评估。基于MRI的EPE阳性定义为曲线或线性接触长度>15mm。采用卡方检验和独立样本t检验进行统计比较，采用加权κ统计评估阅片者间一致性。单因素和多因素逻辑回归确定EPE的独立预测因素，并构建两个预测模型。使用受试者操作特征（ROC）曲线分析评估诊断性能。
本研究共纳入32例（38%）EPE患者和52例（62%）非EPE患者。EPE患者的肿瘤大小明显更大，ADC值和ADC比率更低，与非EPE患者相比差异有统计学意义（p<0.001）。两位阅片者对每个序列的曲线和线性TCL测量与EPE均表现出统计学显著相关性，阅片者间一致性较强。DCE-MRI上的曲线TCL（c-TCL）和线性TCL（l-TCL）在EPE预测方面的曲线下面积（AUC）值高于其他测量值（阅片者1：分别为0.815和0.803；阅片者2：分别为0.746和0.713）。然而，c-TCL和l-TCL之间无统计学显著差异。包含平均ADC值的多变量模型提高了预测性能。模型2（ADC、国际泌尿病理学会（ISUP）分级以及DCE图像上的c-TCL）的AUC分别为0.919和0.
