Gualdi G F, Casciani E, Ferriano M G, Polettini E
Servizio TC-RM, Università degli Studi La Sapienza, Roma.
Radiol Med. 1998 May;95(5):498-505.
We investigated the accuracy of MRI of the prostate with an endorectal surface coil in determing penetration of the prostatic capsule and invasion of seminal vescicles in prostate carcinoma.
Endorectal coil MRI (1 Tesla) was performed in 300 patients with biopsy-proved cancer. The PSA levels were always calculated and all the patients were examined with transrectal ultrasound. The imaging protocol included Turbo Spin Echo T2-weigthed (3900/150 TR/TE) axial and coronal images and T1-weigthed (650/15 TR/TE) axial images, 4 mm thick interleaved sections with .4 mm intersection gap, FOV 180 mm, 256 x 256 matrix (reconstruction 512). Seventy-five patients underwent radical prostatectomy and MR images were compared with pathologic findings of capsular penetration and invasion of seminal vescicles. The MR signs specific for capsular penetration were: deformation (irregularity) of capsular profile, capsular retraction with irregular margins, capsular interruption, obliteration of periprostatic adipose tissue, asymmetry of neurovascular bundles.
MRI correctly depicted 37 of 45 pathologic stage T2 lesions and correctly depicted macroscopic capsular penetration (T3) in 18 of 23 cases. Microscopic capsular penetration was overestimated in all 7 cases. Sensitivity, specificity, accuracy, for microscopic and macroscopic capsular penetration were 60, 82, 73% respectively. Sensitivity, specificity, accuracy for macroscopic capsular penetration were 78, 82, 80% respectively. Sensitivity, specificity, accuracy for depiction of seminal vesicle involvment were 80, 100, 93%, respectively. The most reliable signs of capsular penetration were capsular interruption and invasion of periprostatic adipose tissue, while asymmetry of the neurovascular bundle was not seen.
MRI provides accurate preoperative local staging. The two main limitations of MRI were the high rate of microscopic capsular penetration and the difficulty in detecting capsular penetration of tumor when the lesions are in the prostate apex. Prostate enlargement also made diagnosis more difficult.
我们研究了使用直肠内表面线圈的前列腺MRI在确定前列腺癌中前列腺包膜穿透和精囊侵犯方面的准确性。
对300例经活检证实患有癌症的患者进行直肠内线圈MRI（1特斯拉）检查。始终计算前列腺特异性抗原（PSA）水平，并且所有患者均接受经直肠超声检查。成像方案包括快速自旋回波T2加权（3900/150 TR/TE）轴位和冠状位图像以及T1加权（650/15 TR/TE）轴位图像，4毫米厚的交错层面，层面间距0.4毫米，视野180毫米，256×256矩阵（重建为512）。75例患者接受了根治性前列腺切除术，并将MR图像与包膜穿透和精囊侵犯的病理结果进行了比较。包膜穿透的特异性MR征象为：包膜轮廓变形（不规则）、边缘不规则的包膜回缩、包膜中断、前列腺周围脂肪组织消失、神经血管束不对称。
MRI正确描绘了45例病理分期为T2病变中的37例，并在23例中的18例中正确描绘了宏观包膜穿透（T3）。所有7例微观包膜穿透均被高估。微观和宏观包膜穿透的敏感性、特异性、准确性分别为60%、82%、73%。宏观包膜穿透的敏感性、特异性、准确性分别为78%、82%、80%。精囊受累的描绘的敏感性、特异性、准确性分别为80%、100%、93%。包膜穿透最可靠的征象是包膜中断和前列腺周围脂肪组织侵犯，而未观察到神经血管束不对称。
MRI提供准确的术前局部分期。MRI的两个主要局限性是微观包膜穿透率高以及当病变位于前列腺尖部时难以检测肿瘤的包膜穿透。前列腺增大也使诊断更加困难。
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