Vellet A D, Saliken J, Donnelly B, Raber E, McLaughlin R F, Wiseman D, Ali-Ridha N H
Department of Diagnostic Imaging, Foothills Hospital, University of Calgary, Alberta, Canada.
Radiology. 1997 Jun;203(3):653-9. doi: 10.1148/radiology.203.3.9169684.
To evaluate the usefulness of contrast material-enhanced magnetic resonance (MR) imaging in objective assessment of prostatic cryosurgery and the role of MR imaging in the modification of prostatic cryosurgical technique.
Thirty-eight consecutive patients with localized (T1-3, N0, M0) prostatic adenocarcinoma treated with prostatic cryosurgery underwent MR imaging without contrast enhancement before cryosurgery and unenhanced and gadolinium-enhanced MR imaging within 1-3 weeks after cryosurgery. The first 20 patients also underwent MR imaging at 3 months after cryosurgery. MR imaging findings were correlated with those from transrectal ultrasound-directed prostatic staging biopsy.
Cryonecrotic prostate was identified as avascular regions characterized by absolute signal void on contrast-enhanced images. With progressive modification of cryosurgical technique, complete cryoablation of the prostate was achieved in the latter nine of the 38 patients. When cryoablation was considered complete according to MR imaging criteria, findings invariably correlated with those at biopsy, with no residual prostate tissue or tumor.
Gadolinium-enhanced MR imaging of the prostate after cryosurgery provides a highly accurate means of monitoring success. Objective MR imaging findings allow modifications to the technology and technique, resulting in optimal therapeutic results with prostatic cryosurgery.
评估对比剂增强磁共振成像（MR）在前列腺冷冻手术客观评估中的作用以及MR成像在改良前列腺冷冻手术技术方面的作用。
38例接受前列腺冷冻手术的局限性（T1-3，N0，M0）前列腺腺癌患者，在冷冻手术前接受了非增强MR成像，在冷冻手术后1-3周内接受了非增强及钆增强MR成像。前20例患者在冷冻手术后3个月也接受了MR成像。MR成像结果与经直肠超声引导的前列腺分期活检结果相关。
冷冻坏死的前列腺在对比增强图像上表现为无血管区域，特征为绝对信号缺失。随着冷冻手术技术的逐步改良，38例患者中的后9例实现了前列腺的完全冷冻消融。根据MR成像标准判断冷冻消融完成时，结果始终与活检结果相关，无残留前列腺组织或肿瘤。
冷冻手术后钆增强MR成像为监测手术成功提供了一种高度准确的方法。客观的MR成像结果有助于改良技术和工艺，从而在前列腺冷冻手术中获得最佳治疗效果。
