Dynamic contrast-enhanced MRI for prostate cancer localization
Dynamic contrast-enhanced MRI for prostate cancer localization
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DOI：
10.1259/bjr/89518905
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发表时间：
2009-02-01
影响因子：
2.6
通讯作者：
Dearnaley, D. P.
中科院分区：
文献类型：
--
作者：
Jackson, A. S. N.;Reinsberg, S. A.;Dearnaley, D. P.
放射治疗剂量的增加改善了前列腺癌的肿瘤控制，但增加了毒性。仅增强局灶性肿瘤可能会以可接受的毒性增加剂量。调强放射治疗可以做到这一点，但肿瘤的可视化仍然有限。CT或常规MRI技术在肿瘤定位方面较差，但动态增强MRI(DCE-MRI)可能更好。18例前列腺癌患者在前列腺癌切除术前行T2加权(T2W)和DCE-MRI检查。对前列腺进行了细致的切片，以实现影像与病理的准确对照。DCE-MRI用于癌症检测的准确性是通过定量DCE-MRI参数图与病理逐个像素的相关性来计算的。此外，放射科医生对DCE-MRI和T2W图像进行了解释。比较DCE-MRI和T2W图像对肿瘤的定位与组织学定位的准确性。定量参数图逐像素比较，良性周边区和肿瘤区的K-tran、V-e和k(EP)参数有显著差异。受试者工作特征曲线下面积的计算表明，药代动力学参数只是癌症和良性腺体之间“公平”的区分因素。放射科医生对DCE-MRI和T2W图像的解释显示，DCE-MRI在肿瘤定位(50%比21%；p=0.006)和相似的特异性(85%比81%；p=0.593)方面比T2W图像更敏感。与T2W图像相比，DCE-MRI具有更高的灵敏度和高度的特异性，足以用于指导前列腺癌的放射治疗。(C)2009年英国放射学会
Radiotherapy dose escalation improves tumour control in prostate cancer but with increased toxicity. Boosting focal tumour only may allow dose escalation with acceptable toxicity. Intensity-modulated radiotherapy can deliver this, but visualization of the tumour remains limiting. CT or conventional MRI techniques are poor at localizing tumour, but dynamic contrast-enhanced MRI (DCE-MRI) may be superior. 18 patients with prostate cancer had T-2 weighted (T2W) and DCE-MRI prior to prostatectomy. The prostate was sectioned meticulously so as to achieve accurate correlation between imaging and pathology. The accuracy of DCE-MRI for cancer detection was calculated by a pixel-by-pixel correlation of quantitative DCE-MRI parameter maps and pathology. in addition, a radiologist interpreted the DCE-MRI and T2W images. The location of tumour on imaging was compared with histology, and the accuracy of DCE-MRI and T2W images was then compared. Pixel-by-pixel comparison of quantitative parameter maps showed a significant difference between the benign peripheral zone and tumour for the parameters K-trans, V-e and k(ep). Calculation of areas under the receiver operating characteristic curve showed that the pharmacokinetic parameters were only "fair" discriminators between cancer and benign gland. Interpretation of DCE-MRI and T2W images by a radiologist showed DCE-MRI to be more sensitive than T2W images for tumour localization (50% vs 21%; p=0.006) and similarly specific (85% vs 81%; p=0.593). The superior sensitivity of DCE-MRI compared with T2W images, together with its high specificity, is arguably sufficient for its use in guiding radiotherapy boosts in prostate cancer. (C) 2009 The British institute of Radiology