Diffusion-Weighted Magnetic Resonance Imaging in the Prostate Transition Zone Histopathological Validation Using Magnetic Resonance-Guided Biopsy Specimens
Diffusion-Weighted Magnetic Resonance Imaging in the Prostate Transition Zone Histopathological Validation Using Magnetic Resonance-Guided Biopsy Specimens
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DOI：
10.1097/rli.0b013e31828eeaf9
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发表时间：
2013-10-01
影响因子：
6.7
通讯作者：
Scheenen, Tom W.
中科院分区：
文献类型：
--
作者：
Hoeks, Caroline M. A.;Vos, Eline K.;Scheenen, Tom W.
目的：本研究的目的是评估扩散加权磁共振（MR）成像的表观扩散系数（ADC），用于区分移行区癌与非癌性移行区伴或不伴前列腺炎，以及用于使用MR引导活检标本作为参考标准区分移行区癌Gleason分级（GG）。材料和方法：从我们转诊中心的连续MR引导前列腺活检（2008-2012年）中，我们回顾性纳入了在MR引导活检期间获得弥散加权MR成像ADC值的患者，其活检芯（癌症）芯长度≥ 10 mm且起源于移行区。两名对ADC数据不知情的放射科医生一致注释了MR引导活检确认扫描的活检采样位置上的感兴趣区域。在MR引导活检核心标本中，感兴趣区域的中位ADC（mADC）与组织病理学结果相关。使用混合模型分析来评价7种组织病理学类别之间的mADC差异，这些组织病理学类别被预先定义为MR引导活检核心标本，具有原发性和继发性GG 4-5（1）、原发性GG 4-5继发性GG 2-3（II）、原发性GG 2-3继发性GG 4-5（III）以及原发性和继发性GG 2-3癌症（IV），和非癌组织，没有（V）或具有1度（VI）或2度前列腺炎（VII）。使用受试者工作特征（AUC）curve.Results下的面积评估诊断准确性：包括两名患者的87个含癌活检芯和53名患者的101个非癌活检芯。在癌组织（平均mADC，0.77-0.86 x 10（3）nm（2）/s）和非癌性移行区（无前列腺炎（1.12 x 10（-3）min/s）和1 - 2度前列腺炎（1.05-1.12 x 10（3）=2/S; P < 0.0001-0.05）之间存在显著的平均mADC差异。例外情况是混合性原发性和继发性HG癌症，而2度前列腺炎为0.06-0.09）。原发性和继发性HG癌的亚类之间（P = 0.17-0.91）以及1度和2度前列腺炎与无前列腺炎的非癌性过渡区之间（P = 0.48-0.94）没有发现显著差异。mADC具有0.84的AUC以区分癌症与非癌性过渡区。发现mADC的AUC为0.84和0.56，以区分前列腺炎与癌症和非癌性过渡区。结论：mADC值可区分移行区癌与非癌性移行区癌、1度前列腺炎及大多数2度前列腺炎。然而，由于大量的重叠，mA.DC具有中等的准确性来区分不同的原发性和继发性GG亚类，并且不能用于区分非癌性过渡区与1至2度前列腺炎。因此，弥散加权成像ADC可能有助于移行区癌症的检测;然而，作为单一功能性MR成像技术，弥散加权成像在区分高GG移行区癌症和低GG移行区癌症以及区分前列腺炎和非癌性移行区方面具有中等的诊断准确性。
Objectives: The objective of this study was to evaluate the apparent diffusion coefficient (ADC) of diffusion-weighted magnetic resonance (MR) imaging for the differentiation of transition zone cancer from non-cancerous transition zone with and without prostatitis and for the differentiation of transition zone cancer Gleason grade (GG) using MR-guided biopsy specimens as a reference standard.Materials and Methods: From consecutive MR-guided prostate biopsies (2008-2012) in our referral center, we retrospectively included patients from whom diffusion-weighted MR imaging ADC values were acquired during MR-guided biopsy and whose biopsy cores had a (cancer) core length 10 mm or greater and originated from the transition zone. Two radiologists, who were blinded to the ADC data, annotated regions of interest on biopsy sampling locations of MR-guided biopsy confirmation scans in consensus. Median ADC (mADC) of the regions of interest was related to histopathology outcome in MR-guided biopsy core specimens. Mixed model analysis was used to evaluate mADC differences between 7 histopathology categories predefined as MR-guided biopsy core specimens with primary and secondary, GG 4-5 (1), primary GG 4-5 secondary GG 2-3 (II), primary GG 2-3 secondary GG 4-5 (III) and primary and secondary GG 2-3 cancer (IV), and noncancerous tissue without (V) or with degree 1 (VI) or degree 2 prostatitis (VII). Diagnostic accuracy was evaluated using areas under the receiver operating characteristic (AUC) curve.Results: Filly-two patients with 87 cancer-containing biopsy cores and 53 patients with 101 non-cancerous biopsy cores were included. Significant mean mADC differences were present between cancers (mean mADC, 0.77-0.86 x 10(3) nm(2)/s) and noncancerous transition zone without (1.12 x 10(-3) min/s) and with degree 1 to 2 prostatitis (1.05-1.12 x 10(3) =2/S; P < 0.0001-0.05). Exceptions were mixed primary and secondary HG cancers versus a degree 2 of prostatitis 0.06-0.09). No significant differences were found between subcategories of primary and secondary HG cancers (P = 0.17-0.91) and between a degree 1 and 2 prastatitis and non-cancerous transition zone without prastatitis = 0.48-0.94). The mADC had an AUC of 0.84 to differentiate cancer versus non-cancerous transition zone. AUCs of 0.84 and 0.56 were found for mADC to differentiate prostatitis from cancer and from non-cancerous transition zone. The mADC had an AUC of 0.62 to differentiate a primary HG 4 versus HG 3 cancerConclusions: The mADC values can differentiate transition zone cancer from non-cancerou.s transition zone and from a degree 1, and from most cases of a degree 2 prostatitis. However, because of substantial overlap, mA.DC has a moderate accuracy to differentiate between different primary and secondary GG subcategories and cannot be used to differentiate non-cancerous transition zone from degrees 1 to 2 of prostatitis. Diffusion-weighted imaging ADC may therefore contribute in the detection of transition zone cancers; however, as a single functional MR imaging technique, difinsion-weighted imaging has a moderate diagnostic accuracy in separating higher from lower GG transition zone cancers and in differentiating prostatitis from non-cancerous transition zone.