Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging
Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging
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DOI：
10.1148/radiol.2532081390
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发表时间：
2009-11-01
期刊：
影响因子：
19.7
通讯作者：
Eastham, James A.
中科院分区：
文献类型：
--
作者：
Zhang, Jingbo;Hricak, Hedvig;Eastham, James A.
用途：评估直肠内磁共振（MR）成像和MR波谱成像在预测前列腺癌病理分期和临床T1 c期前列腺癌患者中临床上不重要疾病的存在方面的诊断准确性。材料和方法：机构审查委员会批准了这项涉及158名患者的符合健康保险责任法案的研究，（中位年龄，58岁;年龄范围，40-76岁），患有临床T1 c期前列腺癌，术前未接受治疗，并在2003年1月至2004年3月接受根治性前列腺切除术前接受了1.5 T直肠内MR成像-MR光谱成像联合检查。在MR图像和联合直肠内MR-MR光谱图像上，两位放射科医生回顾性地独立评定了12个前列腺区域的癌症可能性以及囊外扩展（ECE）、精囊浸润（SVI）和邻近器官浸润的可能性，并使用四分量表确定了临床上不重要的前列腺癌的概率。采用整体切片的阶梯切片病理图进行影像-病理对照分析。构建受试者工作特征曲线，并以非参数方式估计曲线下面积（AUC），以评估阅片者的准确性。（0.6%）例患者无癌症; 124例（78%）患者，器官局限性29例（18%）患者，ECE（pT 3a期）; 2例（1%）患者，SVI（pT 3b期）; 2例（1%）患者，膀胱颈浸润（pT 4期）。46例（29%）患者的肿瘤总体积小于0.5 cm（3）。结合磁共振成像-磁共振波谱成像，这两个读者实现了80%的准确性，疾病分期和AUC为0.62和0.71的预测临床上不重要cancer.Conclusion：临床分期T1 c前列腺癌的病理分期和体积是异质性的。磁共振成像可能有助于对临床T1 c期疾病患者进行分层，以进行适当的临床管理。(C)RSNA，2009年
Purpose: To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer.Materials and Methods: The institutional review board approved-and waived the informed patient consent requirement for-this HIPAA-compliant study involving 158 patients (median age, 58 years; age range, 40-76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy.Results: At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm(3). With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer.Conclusion: Clinical stage T1c prostate cancers are heterogeneous in pathologic stage and volume. MR imaging may help to stratify patients with clinical stage T1c disease for appropriate clinical management. (C) RSNA, 2009