Transition Zone Prostate Cancer: Revisiting the Role of Multiparametric MRI at 3 T
Transition Zone Prostate Cancer: Revisiting the Role of Multiparametric MRI at 3 T
复制标题
DOI：
10.2214/ajr.14.12955
复制
发表时间：
2015-03-01
影响因子：
5
通讯作者：
Taneja, Samir S.
中科院分区：
文献类型：
--
作者：
Rosenkrantz, Andrew B.;Kim, Sooah;Taneja, Samir S.
OBJECTIVE.本研究的目的是回顾性评价多参数前列腺MRI的影响，包括使用不同B值进行的弥散加权成像（DWI）以及动态对比增强MRI（DCE-MRI）对移行区（TZ）肿瘤检测和定位的准确性、灵敏度和特异性。我们纳入了106例前列腺癌患者（平均年龄[+/- SD]，62 +/- 7岁），他们在根治性前列腺切除术前接受了盆腔相控阵线圈的3-T MRI。三名放射科医生独立审查病例，记录六个TZ区域中每个区域的肿瘤可能性。最初仅使用T2加权成像分配评分，在积分B = 1000 s/mm（2）的DWI和相应的表观扩散系数（ADC）图后重新分配评分，在积分B = 2000 s/mm（2）的DWI后再次重新分配评分，并在积分DCE-MRI后重新分配最终时间。基于二元逻辑回归的广义估计方程被用来比较TZ肿瘤检测的时间，以乳腺癌切除术的结果作为参考标准。在TZ六等分线中，9.7%（62/636）包含肿瘤。与单独的T2加权成像相比，所有读片者对T2加权成像结合B = 1000 s/mm（2）的DWI和ADC的敏感性更高（阅片人1，54.8% vs 33.9%;阅片人2，53.2% vs 22.6%;阅片人3，50.0% vs 19.4% [p = 0.002]）;两名读片员的灵敏度进一步提高，也包括B = 2000 s/mm（2）（读者1，74.2%;读者2，62.9%; p = 0.011），1名阅片人的灵敏度进一步增加，同时纳入B = 2000 s/mm（2）和DCE-MRI（阅片人3，61.3%，p = 0.013）。除此之外，DCE-MRI并未改善灵敏度（p = 0.054）。其他指标在四个阶段中相似（阅片人1，特异性97.4-98.3%，准确性91.2-95.9%;阅片人2，特异性95.8-98.4%，准确性91.0-92.6%;阅片人3，特异性90.9-96.7%，准确性88.1-89.2%）。DWI通过更高的灵敏度辅助TZ肿瘤检测，特别是当使用非常高的B值时; DCE-MRI缺乏进一步的额外益处。
OBJECTIVE. The purpose of this study was to retrospectively evaluate the impact of multiparametric prostate MRI, including diffusion-weighted imaging (DWI) performed using different b values as well as dynamic contrast-enhanced MRI (DCE-MRI) on the accuracy, sensitivity, and specificity for transition zone (TZ) tumor detection and localization.MATERIALS AND METHODS. We included 106 prostate cancer patients (mean age [+/- SD], 62 +/- 7 years) who underwent 3-T MRI with a pelvic phased-array coil before radical prostatectomy. Three radiologists independently reviewed cases to record the likelihood of tumor in each of six TZ regions. Scores were initially assigned using T2-weighted imaging alone, reassigned after integration of DWI at b = 1000 s/mm(2) and corresponding apparent diffusion coefficient (ADC) maps, reassigned again after integration of DWI at b = 2000 s/mm(2), and reassigned a final time after integration of DCE-MRI. Generalized estimating equations based on binary logistic regression were used to compare sessions for TZ tumor detection, using prostatectomy findings as reference standard.RESULTS. Of the TZ sextants, 9.7% (62/636) contained tumor. All readers had higher sensitivity for T2-weighted imaging integrated with DWI at b = 1000 s/mm(2) and ADC compared with T2-weighted imaging alone (reader 1, 54.8% vs 33.9%; reader 2, 53.2% vs 22.6%; and reader 3, 50.0% vs 19.4% [p = 0.002]); two readers had further increased sensitivity also incorporating b = 2000 s/mm(2) (reader 1, 74.2% and reader 2, 62.9%; p = 0.011), and one reader had further increased sensitivity also incorporating both b = 2000 s/mm(2) and DCE-MRI (reader 3, 61.3%, p = 0.013). DCE-MRI otherwise did not improve sensitivity (p = 0.054). Other measures were similar across the four sessions (reader 1, specificity 97.4-98.3% and accuracy 91.2-95.9%; reader 2, specificity 95.8-98.4% and accuracy 91.0-92.6%; reader 3, specificity 90.9-96.7% and accuracy 88.1-89.2%).CONCLUSION. DWI assists TZ tumor detection through higher sensitivity, particularly when using a very high b value; DCE-MRI lacks further additional benefit.