Prostate Cancer Detection in Patients With Total Serum Prostate-Specific Antigen Levels of 4-10 ng/mL: Diagnostic Efficacy of Diffusion-Weighted Imaging, Dynamic Contrast-Enhanced MRI, and T2-Weighted Imaging
Prostate Cancer Detection in Patients With Total Serum Prostate-Specific Antigen Levels of 4-10 ng/mL: Diagnostic Efficacy of Diffusion-Weighted Imaging, Dynamic Contrast-Enhanced MRI, and T2-Weighted Imaging
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DOI：
10.2214/ajr.10.5923
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发表时间：
2011-09-01
影响因子：
5
通讯作者：
Ito, Katsuyoshi
中科院分区：
文献类型：
--
作者：
Tamada, Tsutomu;Sone, Teruki;Ito, Katsuyoshi
目标。本研究的目的是评估t2加权成像、动态对比增强MRI （DCE-MRI）和弥散加权成像（DWI）在检测血清总前列腺特异性抗原（PSA）水平为4-10 ng/mL的前列腺癌患者中的应用价值，该水平被称为“灰色地带”。材料和方法。50例灰色区PSA水平患者在活检前行MRI检查。根据活检的位置，MRI扫描将前列腺分为八个区域。这些区域分别评估了以下特征：前列腺癌在每个区域和每个患者基础上的可检出性，肿瘤大小与肿瘤检测阳性或阴性MRI结果之间的关系。从各区域来看，t2加权成像对肿瘤检测的敏感性和特异性分别为36%和97%，DCE-MRI分别为43%和95%，DWI分别为38%和96%，MRI联合方法分别为53%和93%。联合MRI检测肿瘤的敏感性显著高于单独方法（p < 0.001 ~ p = 0.001）。MRI阳性区域的肿瘤大小明显大于MRI阴性区域（p = 0.004）。在每个患者的基础上，联合MRI检测前列腺癌的敏感性和特异性分别为83%和80%。t2加权成像、DWI和DCE-MRI的联合检查结果似乎对检测和治疗前列腺癌有潜在的帮助，即使对PSA水平处于灰色地带的患者也是如此。
OBJECTIVE. The purpose of this study is to evaluate the utility of T2-weighted imaging, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI) for detecting prostate cancer in patients with total serum prostate-specific antigen (PSA) levels of 4-10 ng/mL, which is referred to as the "gray zone."MATERIALS AND METHODS. Fifty patients with gray-zone PSA levels underwent MRI before biopsy. According to the sites of biopsy, the prostate was divided into eight regions on MRI scans. These regions were evaluated individually for the following features: detectability of prostate cancer on per-region and per-patient bases, and relationship between tumor size and positive or negative MRI findings for tumor detection.RESULTS. On a per-region basis, the sensitivity and specificity of tumor detection were 36% and 97% for T2-weighted imaging, 43% and 95% for DCE-MRI, 38% and 96% for DWI, and 53% and 93% for the combined method of MRI, respectively. The sensitivity of combined MRI to detect tumor was significantly higher than those of the individual methods (p < 0.001 to p = 0.001). Tumor size was significantly larger in regions with positive MRI findings than in regions with negative MRI findings (p = 0.004). On a per-patient basis, sensitivity and specificity of combined MRI to detect prostate cancer were 83% and 80%, respectively.CONCLUSION. Combined T2-weighted imaging, DWI, and DCE-MRI findings appear to be potentially useful for detecting and managing prostate cancer, even when performed for patients with gray-zone PSA levels.