Does body-coil magnetic-resonance imaging have a role in the preoperative staging of patients with clinically localized prostate cancer?
Does body-coil magnetic-resonance imaging have a role in the preoperative staging of patients with clinically localized prostate cancer?
复制标题
DOI：
10.1111/j.1464-410x.2004.05023.x
复制
发表时间：
2004-09-01
影响因子：
4.5
通讯作者：
Popert, R
中科院分区：
文献类型：
--
作者：
Allen, DJ;Hindley, R;Popert, R
探讨体线圈磁共振成像 (MRI) 在根治性前列腺切除术 (RP) 前前列腺癌局部分期中的准确性和应用。 56 名接受 RP 的患者在术前使用体线圈 MRI 进行分期；没有人因扫描结果而被拒绝接受手术。所有扫描均在 RP 之前由三名顾问放射科医生中的一位报告，随后由一位对前列腺 MRI 特别感兴趣的同事报告，不了解患者的临床细节。一般报告中 MRI 检测囊外扩展的总体敏感性为 50%，而由专业放射科医生报告时为 72%；特异性分别为84%和86%。在该研究纳入的 55 名患者中，组织学分析显示 18 名患者 (33%) 患有囊外疾病。 MRI 在 17 名高危患者（前列腺特异性抗原，PSA >10 ng/mL，格里森评分大于或等于 8）和 8 名中危患者（PSA < 10 ng/mL，格里森评分 7）中最为准确。在前一组专家分析中，敏感性为 100%，尽管一般报告的敏感性下降至 67%。两者的特异性均为 82%。无论报告方法如何，中等风险疾病的敏感性和特异性均为 75%。 30名低危患者（PSA<10ng/mL，格里森评分2-6分）MRI检测前列腺外肿瘤的能力较差；尽管这两种方法的特异性均>90%，但一般检查的敏感性为25%，专家检查的敏感性为50%。体线圈MRI对于识别高危或中危疾病患者的前列腺癌囊外扩散具有敏感性和特异性。低风险患者经常会出现未被检测到的微小扩展。即使不了解患者的临床细节，对前列腺 MRI 特别感兴趣的放射科医生的意见也可以提高报告的准确性。
To investigate the accuracy and use of body-coil magnetic resonance imaging (MRI) in the local staging of prostate cancer before radical prostatectomy (RP).Fifty-six patients undergoing RP were staged before surgery using body-coil MRI; none was denied surgery on the basis of their scan results. All scans were reported before RP by one of three consultant radiologists and afterward by a colleague with a special interest in prostate MRI, unaware of the patients' clinical details.The overall sensitivity of MRI at detecting extracapsular extension was 50% on general reporting and 72% when reported by the specialist radiologist; the respective specificities were 84% and 86%. Of the 55 patients included in the study, 18 (33%) had extracapsular disease on histological analysis. MRI was most accurate in the 17 patients at high-risk (prostate-specific antigen, PSA, >10 ng/mL and Gleason score greater than or equal to 8) and eight at intermediate risk (PSA < 10 ng/mL and Gleason score 7). In the former group with specialist analysis, the sensitivity was 100%, although this decreased to 67% with general reporting. Both gave a specificity of 82%. Intermediate risk disease gave a sensitivity and specificity of 75%, irrespective of reporting method. The ability of MRI to detect extraprostatic tumour in the 30 low-risk patients (PSA < 10 ng/mL and Gleason score 2-6) was poor; the sensitivity was 25% with general and 50% on specialist review, although both methods gave a specificity of >90%.Body-coil MRI is sensitive and specific for identifying extracapsular extension of prostate cancer in patients with high- or intermediate-risk disease. Patients at low risk frequently have microscopic extension which is not detected. Opinion from a radiologist with a special interest in prostate MRI can increase the reporting accuracy even when unaware of the patients' clinical details.