Prostate Cancer: Value of Multiparametric MR Imaging at 3 T for Detection-Histopathologic Correlation
Prostate Cancer: Value of Multiparametric MR Imaging at 3 T for Detection-Histopathologic Correlation
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DOI：
10.1148/radiol.09090475
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发表时间：
2010-04-01
期刊：
影响因子：
19.7
通讯作者：
Choyke, Peter L.
中科院分区：
文献类型：
--
作者：
Turkbey, Baris;Pinto, Peter A.;Choyke, Peter L.
目的：利用T2加权磁共振成像、磁共振波谱和动态对比剂增强磁共振成像，以整体病理结果为参考标准，确定在3T进行多参数成像对前列腺癌的诊断价值。材料和方法：这项前瞻性设计、符合HIPAA标准的单机构研究获得了当地机构审查委员会的批准。纳入连续病例70例(平均年龄60.4岁；前列腺特异性抗原平均水平5.47 ng/mL[5.47mg/L]；范围1-19.9 ng/mL[1-19.9mg/L])；征得患者知情同意。所有患者都有经活检证实的前列腺癌，Gleason评分中位数为7(范围6-9)。使用六通道心脏和直肠内线圈相结合的方法获得图像。对MRI和病理结果进行独立、盲法评估，并与病理结果进行对照分析。采用原始的严格方法和替代的相邻方法进行分析，这些方法考虑了手术变形、收缩和病理标本中不均匀的切片因素。广义估计方程(GES)被用来估计所有三种模式对区域特定的、病理确定的癌症的预测价值。结果：对于T2加权磁共振成像，严格法的敏感度和特异度分别为0.42(95%可信区间：0.36，0.47)和0.83(95%可信区间：0.81，0.86)；替代邻接法的敏感度和特异度分别为0.73(95%CI：0.67，0.78)和0.89(95%CI：0.85，0.93)。通过不同的技术组合计算T2加权MR成像、动态对比增强MR成像和MR波谱对周围区肿瘤的联合诊断准确性；当使用GES时，T2加权MR成像、动态增强MR成像和MR波谱提供了显著的独立和相加的预测价值(P<；.001，P=0.02，P=0.002)。结论：前列腺3T的多参数MR成像(T2加权MR成像、MR波谱和动态增强MR成像)能够检测肿瘤，具有合理的灵敏度和特异度。(C)RSNA，2010年
Purpose: To determine utility of multiparametric imaging performed at 3 T for detection of prostate cancer by using T2-weighted magnetic resonance (MR) imaging, MR spectroscopy, and dynamic contrast material-enhanced MR imaging, with whole-mount pathologic findings as reference standard.Materials and Methods: This prospectively designed, HIPAA-compliant, single-institution study was approved by the local institutional review board. Seventy consecutive patients (mean age, 60.4 years; mean prostate-specific antigen level, 5.47 ng/mL [5.47 m g/L]; range, 1-19.9 ng/mL [1-19.9 m g/L]) were included; informed consent was obtained from each patient. All patients had biopsy-proved prostate cancer, with a median Gleason score of 7 (range, 6-9). Images were obtained by using a combination of six-channel cardiac and endorectal coils. MR imaging and pathologic findings were evaluated independently and blinded and then correlated with histopathologic findings by using side-by-side comparison. Analyses were conducted with a raw stringent approach and an alternative neighboring method, which accounted for surgical deformation, shrinkage, and nonuniform slicing factors in pathologic specimens. Generalized estimating equations (GEEs) were used to estimate the predictive value of region-specific, pathologically determined cancer for all three modalities. This approach accounts for the correlation among multiple regions in the same individual.Results: For T2-weighted MR imaging, sensitivity and specificity values obtained with stringent approach were 0.42 (95% confidence interval [CI]: 0.36, 0.47) and 0.83 (95% CI: 0.81, 0.86), and for the alternative neighboring approach, sensitivity and specificity values were 0.73 (95% CI: 0.67, 0.78) and 0.89 (95% CI: 0.85, 0.93), respectively. The combined diagnostic accuracy of T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy for peripheral zone tumors was examined by calculating their predictive value with different combinations of techniques; T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy provided significant independent and additive predictive value when GEEs were used (P < .001, P = .02, P = .002, respectively).Conclusion: Multiparametric MR imaging (T2-weighted MR imaging, MR spectroscopy, dynamic contrast-enhanced MR imaging) of the prostate at 3 T enables tumor detection, with reasonable sensitivity and specificity values. (C) RSNA, 2010