Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients.
Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients.
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DOI：
10.1016/j.ebiom.2016.03.041
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发表时间：
2016-05
期刊：
影响因子：
11.1
通讯作者：
Kim HL
中科院分区：
文献类型：
--
作者：
Sharif-Afshar AR;Nguyen C;Feng TS;Payor L;Fan Z;Saouaf R;Li D;Kim HL
高分辨率前列腺成像可以检测肿瘤大小的细微变化，减少对活检的依赖，并在消融术中帮助确定肿瘤边界。这项试点临床试验评估了一种新的高分辨率前列腺MRI，用于检测细小的、经活检证实的前列腺癌。我们团队开发了一个可以加载到任何现代MRI上的软件，以生成高分辨率扩散加权成像序列(HR-DWI)，并在一项针对主动监测患者的前瞻性试点试验中将其与标准扩散加权成像序列(S-DWI)进行了比较。HR-DWI可以捕捉整个前列腺体积，而不是切片，从而减少了条纹伪影和几何失真。使用多次拍摄而不是单次拍摄来区分信号和噪声，从而提高分辨率。所有图像都由两名放射科医生读取。主要结果是在17名患者中看到的活检证实区域的百分比。试验的能力是在单边阿尔法=0.0.05的情况下检测0.04和0.40的不协调比例。分辨率是使用标准模体定义的。与S弥散加权成像相比，高分辨率弥散加权成像在空间分辨率上提高了5倍。多参数磁共振结合S弥散加权成像对活检结果的预测是有用的(AuC0.72，Fisher‘s Exact p<；(0.001)；然而，使用HR-DWI可以使MP-MRI对活检结果有更高的预测性(AuC0.88，Fisher’s Exact p<；(0.001))。MP-MRI合并HR-DWI的AUC值显著大于MP-MRI合并S-DWI的AUC值(p=0.002)。MP-MRI结合HR-DWI的敏感性为95.7%，在活检证实为癌的23个区域中，有22个区域发现了肿瘤。而S弥散加权成像的敏感度为60.9%，仅检出23个活检阳性带中的14个(p=0.004)。我们开发了一种新的弥散加权成像，并在临床环境中评估了其提高的分辨率。这项技术有许多潜在的应用，应该在未来的临床试验中作为患者管理工具进行评估。体积、多次激发扩散加权前列腺成像提高了图像质量和分辨率。多参数磁共振结合高分辨率扩散加权成像在23个前列腺区中的22个区域发现了癌症。相比之下，标准的多参数磁共振成像在23个腺癌区域中的14个区域发现了癌症(p=0.004)。我们开发了一种用于前列腺癌成像的高分辨率MRI，它提高了图像质量和分辨率，对检测前列腺癌产生了更好的敏感性。更高分辨率的前列腺MRI将允许检测、监测和定位以前在标准MRI上看不到的或仅通过前列腺活检检测到的病变。更高分辨率的前列腺癌MRI可以检测到肿瘤大小随时间的细微变化，为监测前列腺癌提供了一种非侵入性工具，并更好地描绘了正在考虑进行局部消融治疗的患者的肿瘤边缘。
High-resolution prostate imaging may allow for detection of subtle changes in tumor size, decrease the reliance on biopsies, and help define tumor boundaries during ablation. This pilot clinical trial evaluates a novel high-resolution prostate MRI for detection of small, biopsy-proven prostate tumors. Our team developed a software that can be loaded on any modern MRI to generate high resolution diffusion-weighted imaging sequences (HR-DWI), which were compared to standard diffusion-weighted imaging sequence (S-DWI) in a prospective pilot trial in active surveillance patients. HR-DWI captures the entire volume of the prostate rather than sections, reducing streaking artifacts and geometric distortions. Multiple shots, rather than single shots, are used to differentiate signal and noise, enhancing resolution. All images were read by two radiologists. The primary outcome was the percent of biopsy-proven zones seen in 17 patients. The trial was powered to detect discordant proportions of 0.04 and 0.40 at one-sided alpha = 0.05. The resolution was defined using standard phantoms. HR-DWI produced a 5-fold improvement in spatial resolution when compared to S-DWI. Multiparametric (MP)-MRI incorporating S-DWI was useful for predicting biopsy results (AUC 0.72, Fisher's exact p < 0.001); however, using HR-DWI allowed MP-MRI to be more highly predictive of biopsy results (AUC 0.88, Fisher's exact p < 0.001). AUC for MP-MRI incorporating HR-DWI was significantly larger than MP-MRI incorporating S-DWI (p = 0.002). MP-MRI with HR-DWI had a sensitivity of 95.7% and identified tumor in 22 of 23 zones proven to have cancer on biopsy. In contrast, MP-MRI with S-DWI had a sensitivity of 60.9% and only identified 14 of 23 biopsy-positive zones (p = 0.004). We developed a novel DWI and evaluated its improved resolution in a clinical setting. This technology has many potential applications and should be evaluated in future clinical trials as a patient management tool. Volumetric, multishot diffusion-weighted prostate imaging improved image quality and resolution. Multiparametric-MRI incorporating high-resolution diffusion-weight imaging detected cancer in 22 of 23 prostate zones. In contrast, standard multiparametric-MRI detected cancer in 14 of 23 zones with adenocarcinoma (p = 0.004). We developed a high resolution MRI for prostate imaging that improves image quality and resolution, yielding better sensitivity for detecting prostate cancers. Higher resolution prostate MRI will allow for detection, monitoring and targeting of lesions not previously seen on standard MRI or only detected by prostate biopsy. Higher resolution prostate MRI may detect subtle changes in tumor size over time, providing a non-invasive tool for monitoring prostate cancer, and better delineate tumor margins in patients being considered for focal ablative therapy.