Sanchez-Chapado M, Angulo J C, Ibarburen C, Aguado F, Ruiz A, Viaño J, García-Segura J M, Gonzalez-Esteban J, Rodriquez-Vallejo J M
Department of Urology, Hospital Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid, Spain.
Eur Urol. 1997;32(2):140-9.
A prospective study was designed to compare the potentials of digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) using integrated endorectal and pelvic phased-array coils for preoperative estimation of tumor volume and local extent of prostate cancer.
Evaluation of 20 consecutive patients undergoing radical retropubic prostatectomy included DRE, TRUS with a 7.5-MHz transducer, and MRI on a 1.5-tesla GE Signa system. Step sections (5 mm) of the entire specimen were performed, and tumor volume and percentage of gland involved were calculated.
DRE, TRUS, and endorectal and pelvic phased-array MRI showed 50, 75, and 95% of the cancers, respectively. There was a linear correlation on MRI between predicted tumor volume and pathological tumor volume (r = 0.82, p < 0.0001), but not between predicted volume on DRE or TRUS and real volume. The accuracy for detecting extracapsular penetration was 60% for DRE and TRUS and 79% for MRI. The accuracy for detecting seminal vesicle invasion was 60% for DRE, 66 for TRUS, and 89% for MRI. The negative predictive value for extracapsular and seminal vesicle extension was highest for MRI (85 and 93%, respectively). The accuracy for tumor location in the apex of the prostate was 30% for DRE, 47 for TRUS, and 89% for MRI.
MRI with integrated endorectal and pelvic phased-array coils satisfactorily predicted tumor volume and tumor extent preoperatively. Multicoil MRI can assist in decision making as it is valuable in the definition of patients that may benefit from surgery and can be of help for evaluating the risk of a positive margin, especially in the apical resection.
设计一项前瞻性研究，比较直肠指检（DRE）、经直肠超声（TRUS）以及使用集成式直肠内和盆腔相控阵线圈的磁共振成像（MRI）在术前评估前列腺癌肿瘤体积和局部范围方面的潜力。
对20例连续接受耻骨后根治性前列腺切除术的患者进行评估，包括直肠指检、使用7.5MHz探头的经直肠超声检查以及在1.5特斯拉GE Signa系统上进行的磁共振成像检查。对整个标本进行5毫米的连续切片，并计算肿瘤体积和腺体受累百分比。
直肠指检、经直肠超声以及直肠内和盆腔相控阵磁共振成像分别显示出50%、75%和95%的癌症。磁共振成像预测的肿瘤体积与病理肿瘤体积之间存在线性相关性（r = 0.82，p < 0.0001），但直肠指检或经直肠超声预测的体积与实际体积之间不存在相关性。检测包膜外侵犯的准确率，直肠指检和经直肠超声为60%，磁共振成像为79%。检测精囊侵犯的准确率，直肠指检为60%，经直肠超声为66%，磁共振成像为89%。磁共振成像对包膜外和精囊侵犯的阴性预测值最高（分别为85%和93%）。前列腺尖部肿瘤定位的准确率，直肠指检为30%，经直肠超声为47%，磁共振成像为89%。
使用集成式直肠内和盆腔相控阵线圈的磁共振成像在术前能够令人满意地预测肿瘤体积和肿瘤范围。多线圈磁共振成像有助于决策，因为它在确定可能从手术中获益的患者方面具有价值，并且有助于评估切缘阳性的风险，尤其是在尖部切除术中。
