The current and future role of magnetic resonance imaging in prostate cancer detection and management.
The current and future role of magnetic resonance imaging in prostate cancer detection and management.
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DOI：
10.3978/j.issn.2223-4683.2015.06.05
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发表时间：
2015-06
影响因子：
2
通讯作者：
Hadaschik BA
中科院分区：
文献类型：
--
作者：
Radtke JP;Teber D;Hohenfellner M;Hadaschik BA
准确检测临床上显著的前列腺癌（PC）和正确的风险归因是必不可少的个人咨询PC男性。多参数MRI（mpMRI）有助于前列腺内指示病变的正确定位，MRI靶向前列腺活检（TPB）有助于避免传统活检的缺点，如假阴性结果或侵袭性PC的诊断不足。在这篇综述中，我们总结了不同的mpMRI序列，描述了将MRI纳入活检工作流程的可能性，并概述了靶向和系统性核心在重大癌症检测中的性能。此外，我们概述了MRI在接受主动监测（AS）和术前设置的患者中的潜力。进行了截至2015年2月的MEDLINE/PubMed电子检索。对英文文献的纳入能力进行了审查，并对数据进行了提取、分析和总结。靶向活检在检测显著性前列腺癌方面明显优于常规系统活检，并且与经会阴饱和活检相比并不逊色。MpMRI可以检测到约90%的病例中的指标病变，与切除标本相比。双参数MRI（T2 w + DWI）的诊断性能不劣于mpMRI，提供了减少成本和时间消耗的选项。由于大约10%的显著病变仍然是MRI不可见的，因此系统核心似乎是必要的。与认知融合相比，钻孔活检和MRI/TRUS融合引导活检往往是上级技术。在AS中，mpMRI避免了显著PC的检测不足，并准确地确认了低风险疾病。在高风险疾病中，术前MRI可以在多达三分之一的病例中改变基于临床的手术计划。mpMRI和靶向活检能够准确检测显著的PC并减轻不显著的PC检测。只要阴性预测值（NPV）仍然是不完善的，系统的核心不应该被省略的疾病的最佳分期。正确分类AS患者疾病侵袭性以及指导和计划椎间盘切除术的潜力正在发展。
Accurate detection of clinically significant prostate cancer (PC) and correct risk attribution are essential to individually counsel men with PC. Multiparametric MRI (mpMRI) facilitates correct localization of index lesions within the prostate and MRI-targeted prostate biopsy (TPB) helps to avoid the shortcomings of conventional biopsy such as false-negative results or underdiagnosis of aggressive PC. In this review we summarize the different sequences of mpMRI, characterize the possibilities of incorporating MRI in the biopsy workflow and outline the performance of targeted and systematic cores in significant cancer detection. Furthermore, we outline the potential of MRI in patients undergoing active surveillance (AS) and in the pre-operative setting. An electronic MEDLINE/PubMed search up to February 2015 was performed. English language articles were reviewed for inclusion ability and data were extracted, analyzed and summarized. Targeted biopsies significantly outperform conventional systematic biopsies in the detection of significant PC and are not inferior when compared to transperineal saturation biopsies. MpMRI can detect index lesions in app. 90% of cases as compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering options to diminish cost- and time-consumption. Since app 10% of significant lesions are still MRI-invisible, systematic cores seem to be necessary. In-bore biopsy and MRI/TRUS-fusion-guided biopsy tend to be superior techniques compared to cognitive fusion. In AS, mpMRI avoids underdetection of significant PC and confirms low-risk disease accurately. In higher-risk disease, pre-surgical MRI can change the clinically-based surgical plan in up to a third of cases. mpMRI and targeted biopsies are able to detect significant PC accurately and mitigate insignificant PC detection. As long as the negative predictive value (NPV) is still imperfect, systematic cores should not be omitted for optimal staging of disease. The potential to correctly classify aggressiveness of disease in AS patients and to guide and plan prostatectomy is evolving.