Dynamic Contrast-enhanced-magnetic Resonance Imaging Evaluation of Intraprostatic Prostate Cancer: Correlation with Radical Prostatectomy Specimens
Dynamic Contrast-enhanced-magnetic Resonance Imaging Evaluation of Intraprostatic Prostate Cancer: Correlation with Radical Prostatectomy Specimens
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DOI：
10.1016/j.urology.2009.04.102
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发表时间：
2009-11-01
期刊：
影响因子：
2.1
通讯作者：
Villers, Arnauld
中科院分区：
文献类型：
--
作者：
Puech, Philippe;Potiron, Eric;Villers, Arnauld
目的：确定动态对比增强磁共振成像（DCE-MRI）在组织病理学检查中识别与癌症体积相关的前列腺内癌灶的诊断性能，在接受根治性前列腺切除术治疗的临床局限性癌症患者中，方法83例连续的根治性前列腺切除术标本，特异性抗原升高与活检前MRI相关。MRI结果按5分量表分级，与8个前列腺部分的组织病理学图结果相关，包括体积、最大表面积和Gleason 4/5级百分比。结果前列腺特异性抗原中位数为8.15 ng/mL。在83名患者中，55名（66%）患者的DCE-MRI结果为可疑。664个八分体中有212个（34%）存在单独的癌灶（平均每例患者2.55个），212个八分体中有68个DCE-MRI可疑。DCE-MRI在3.4或5分时识别任何体积癌灶的灵敏度和特异性分别为32%和95%。对于> 0.5mL的癌灶，敏感性和特异性分别为86%和94%，受试者工作特征曲线为0.874。DCE-MRI检出和漏诊癌症的平均体积分别为2.44 mL（0.02-14.5）和0.16 mL（0.005-2.4）。DCE-MRI对Gleason分级> 10%的前列腺癌的敏感性为81%，特异性为82%。可能的应用是指导活检，选择病人观察等待，和重点治疗计划。泌尿学74：1094-1100，2009年。(C)2009爱思唯尔公司
OBJECTIVES To determine the diagnostic performance of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) in the identification of intraprostatic cancer foci related to cancer volume at histopathology, in patients with clinically localized cancer treated by radical prostatectomy, with whole-mount histopathologic sections as the reference standard.METHODS Eighty-three consecutive radical prostatectomy specimens from patients referred for a prostate-specific antigen elevation were correlated with prebiopsy MRI. MRI results ranked on a 5-point scale were correlated with the findings of histopathology maps in 8 prostate sectors, including volume, largest surface area, and percentage of Gleason grade 4/5. The area under the receiver operating characteristic curve was used.RESULTS Median prostate-specific antigen was 8.15 ng/mL. DCE-MRI was Suspicious in 55 (66%) out of 83 patients. A separate cancer foci (mean 2.55 per patient) was present in 212 (34%) of 664 octants and DCE-MRI was suspicious in 68 of 212. Sensitivity and specificity of DCE-MRI at score 3.4 or 5 for identification of cancer foci at any volume was 32% and 95%, respectively. For identification of cancer foci > 0.5 mL, the sensitivity and specificity were 86% and 94%, respectively, with the tinder the receiver operating characteristic curve of 0.874. Mean volume of DCE-MRI detected and missed cancers were 2.44 mL (0.02-14.5) and 0.16 mL (0.005-2.4), respectively. Sensitivity and specificity of DCE-MRI for identification of > 10% of Gleason grade 4/5 were 81% and 82%, respectively.CONCLUSIONS DCE-MRI can accurately identify intraprostatic cancer foci. Possible applications are guidance for biopsies, selection of patients for watchful waiting, and focal treatment planning. UROLOGY 74: 1094-1100, 2009. (C) 2009 Elsevier Inc.