Hausmann Daniel, Rupp N, Kuzmanic B, Spielhofer N, Heimer J, Koelzer V, Nowak M, Gampp C, Hefermehl L, Kubik-Huch R A, Singer G, Burger I A
Department of Radiology, Kantonsspital Baden, affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Baden, Switzerland; Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland.
Acad Radiol. 2025 May;32(5):2689-2697. doi: 10.1016/j.acra.2024.10.040. Epub 2024 Dec 5.
Multiparametric MRI (mpMRI) substantially improves the detection of significant prostate carcinoma (PCa) compared to systematic biopsy. Nevertheless, mpMRI can overlook aggressive forms of PCa. Recent studies showed, that infiltrative growth (INF) has less restricted diffusion. This study aims to explore the impact of growth patterns on the detection of lesions.
This retrospective study analyzed 52 patients who underwent radical prostatectomy, with preoperative mpMRI. For each patient, one dominant lesion was identified on one whole-mount prostatectomy section. Two pathologists (P1, P2) independently classified the growth pattern whether as expansive (EXP) being defined with at least three 5mm² regions of interest consisting entirely of carcinoma without benign glands or else as infiltrative (INF). Two radiologists (R1, R2) independently classified selected lesions according to PI-RADSv2.1. based on pathological localization. Apparent diffusion coefficient (ADC) values were measured in correlation with matched histopathology slides. Interreader-agreement was evaluated using weighted Cohen's Kappa. The relationship between PI-RADS scores and pathological diagnoses was analyzed using logistic regression.
Pathologic lesion characterization regarding growth patterns achieved almost perfect agreement (κ = 0.88), so did PI-RADS classification of mpMRI (κ = 0.90). PI-RADS scores correlated significantly with EXP growth patterns. Average ADC values were lower for EXP lesions (0.83×10 mm/s, CI: 0.72-0.94×10 mm/s) compared to INF lesions (0.97×10 mm/s, CI: 0.86-1.07×10 mm/s; p = 0.08). On T2 images, 8 of 28 (29%) INF lesions and 1 of 24 (4%) EXP lesions were not visible.
PCa missed on mpMRI more frequently demonstrate INF growth patterns. Lesions with EXP growth patterns show lower ADC values and have higher PI-RADS scores.
与系统性活检相比，多参数磁共振成像（mpMRI）显著提高了对显著前列腺癌（PCa）的检测能力。然而，mpMRI可能会忽略侵袭性形式的PCa。最近的研究表明，浸润性生长（INF）的扩散受限程度较小。本研究旨在探讨生长模式对病变检测的影响。
这项回顾性研究分析了52例行根治性前列腺切除术且术前行mpMRI检查的患者。对于每位患者，在一张前列腺全切切片上确定一个主要病变。两名病理学家（P1、P2）独立将生长模式分类为膨胀性（EXP），即定义为至少有三个5mm²的感兴趣区域，完全由癌组织组成且无良性腺体，否则分类为浸润性（INF）。两名放射科医生（R1、R2）根据PI-RADSv2.1，基于病理定位对选定病变进行独立分类。测量表观扩散系数（ADC）值，并与匹配的组织病理学切片进行相关性分析。使用加权Cohen's Kappa评估阅片者间的一致性。使用逻辑回归分析PI-RADS评分与病理诊断之间的关系。
关于生长模式的病理病变特征达成了几乎完美的一致性（κ = 0.88），mpMRI的PI-RADS分类也是如此（κ = 0.90）。PI-RADS评分与EXP生长模式显著相关。与INF病变（0.97×10 mm/s，CI：0.86 - 1.07×10 mm/s；p = 0.08）相比，EXP病变的平均ADC值较低（0.83×10 mm/s，CI：0.72 - 0.94×10 mm/s）。在T2图像上，28个（29%）INF病变中有8个不可见，24个（4%）EXP病变中有1个不可见。
mpMRI上漏诊的PCa更常表现为INF生长模式。具有EXP生长模式
