Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation.
Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation.
复制标题
DOI：
10.1016/j.ultrasmedbio.2016.01.004
复制
发表时间：
2016-06
影响因子：
2.9
通讯作者：
Nightingale KR
中科院分区：
文献类型：
--
作者：
Palmeri ML;Glass TJ;Miller ZA;Rosenzweig SJ;Buck A;Polascik TJ;Gupta RT;Brown AF;Madden J;Nightingale KR
过度激进的前列腺癌 (PCa) 治疗会对患者产生不利影响，并给我们的医疗保健系统带来不必要的负担。无法识别和分级具有临床意义的 PCa 病变是导致过度激进的 PCa 治疗（例如根治性前列腺切除术）的一个因素，而不是更局灶性的前列腺保留手术（例如冷冻疗法和高剂量放射治疗）。我们使用机械旋转、侧射直肠内成像阵列进行了 3D 体内 B 模式和声辐射力脉冲 (ARFI) 成像，以识别 29 名接受根治性前列腺切除术治疗活检确诊 PCa 的患者中可疑的 PCa 区域。进行整体组织病理学分析，以确定临床上显着/不显着的 PCa 病变、萎缩和良性前列腺增生的区域。读者根据边界描绘、对比度、纹理和位置在 ARFI 图像中识别出 PCa 的可疑区域。使用最近邻区域定位方法将这些可疑区域与组织病理学确定的病变进行比较。在组织病理学鉴定的所有临床显着病变中，71.4% 也通过 ARFI 成像鉴定，包括 79.3% 的后部病变和 33.3% 的前部病变。在 ARFI 识别的病变中，79.3% 对应于临床显着的 PCa 病变，这些病变比临床不显着的 PCa 具有更高的怀疑指数。由于更大的位移信噪比和更精细的空间采样，ARFI 成像对后部病变比前部病变具有更高的敏感性。萎缩和良性前列腺增生可导致明显的前列腺解剖结构变形和异质性，从而混淆 ARFI PCa 病变识别；然而，总的来说，ARFI 可疑区域与这些良性病变并不相符。
Overly aggressive prostate cancer (PCa) treatment adversely affects patients and places an unnecessary burden on our health care system. The inability to identify and grade clinically significant PCa lesions is a factor contributing to excessively aggressive PCa treatment, such as radical prostatectomy, instead of more focal, prostate-sparing procedures such as cryotherapy and high-dose radiation therapy. We have performed 3-D in vivo B-mode and acoustic radiation force impulse (ARFI) imaging using a mechanically rotated, side-fire endorectal imaging array to identify regions suspicious for PCa in 29 patients being treated with radical prostatectomies for biopsy-confirmed PCa. Whole-mount histopathology analyses were performed to identify regions of clinically significant/insignificant PCa lesions, atrophy and benign prostatic hyperplasia. Regions of suspicion for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location. These regions of suspicion were compared with histopathology identified lesions using a nearest-neighbor regional localization approach. Of all clinically significant lesions identified on histopathology, 71.4% were also identified using ARFI imaging, including 79.3% of posterior and 33.3% of anterior lesions. Among the ARFI-identified lesions, 79.3% corresponded to clinically significant PCa lesions, with these lesions having higher indices of suspicion than clinically insignificant PCa. ARFI imaging had greater sensitivity for posterior versus anterior lesions because of greater displacement signal-to-noise ratio and finer spatial sampling. Atrophy and benign prostatic hyperplasia can cause appreciable prostate anatomy distortion and heterogeneity that confounds ARFI PCa lesion identification; however, in general, ARFI regions of suspicion did not coincide with these benign pathologies.