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目的对于临床诊断低风险前列腺癌的病人,前瞻性评价T2WI和MRS在检测不同病理体积和Gleason评分的前列腺癌中的诊断效能。材料与方法本前瞻性研究获得单位伦理委员会批准,符合HIPAA原则。对183例临床患低风险前列腺癌病人[T1-T2a期,活检Gleason评分≤6,前列腺特异性抗原(PSA)<10ng/mL]在前列腺切除前行MR检查,所有病人均签署了知情同意书。2名放射学医师分别在T2WI上对前列腺六分区中肿瘤存在的可能性进行评分,按照1～5分的标准(1分,绝对没有肿瘤;5分,确定存在肿瘤)。2名波谱学专家共同记录病灶的位置,评价其在MRS中的代谢特点是否与肿瘤相一致。参考标准为整体组织的病理学分析。评价前列腺六分区内0.5cm3或更大体积病灶的诊断效能(T2WI)和检测敏感性(T2WI联合MRS)。结果 2位阅片者在T2WI上发现六分区内病灶的ROC曲线下面积分别为0.77和0.82。当病灶体积≥0.5cm3而<1cm3时,对于Gleason评分≤6的病灶的敏感度(阅片者1,0.44;阅片者2,0.61)较Gleason评分≥7者的敏感度(阅片者1,0.73,P=0.02;阅读者2,0.84,P=0.05)明显降低。对于体积≥1cm3的病灶,病灶的Gleason评分对敏感度并无显著的影响(Gleason评分≤6,阅片者1,0.83,阅片者2,1.0;Gleason评分≥7,分别为0.82,0.92;P≥0.07)。MRS的敏感性较低,与病灶体积或Gleason评分无明显联系。结论对于临床低风险前列腺癌的病人,在T2WI上发现体积<1cm3的病灶明显受Gleason评分的影响;对于体积≥1cm3的病灶检测明显优于小病灶,并且不受病灶Gleason评分的影响。在这类病人中,单独应用MRS的作用有限。
Objectives To prospectively evaluate the diagnostic efficacy of T2WI and MRS in the detection of prostate cancer with different pathological volumes and Gleason scores for patients with clinically diagnosed low-risk prostate cancer. Materials and Methods This prospective study was approved by the unit ethics committee and complies with HIPAA principles. 183 patients with low-risk prostate cancer were undergoing MR examinations prior to prostatectomy (T1-T2a, Gleason score ≤6, PSA <10 ng / mL) and all patients signed informed consent . Two radiologists scored on the T2WI, respectively, for the probability of a tumor in the six-prostatic region, with a standard of one to five points (one point with absolutely no tumor; five points with the presence of a tumor). Two spectroscopists recorded the location of the lesion and evaluated whether the metabolic characteristics of the MRS were consistent with the tumor. Reference standard for the overall organization of the pathological analysis. To evaluate the diagnostic efficacy (T2WI) and detection sensitivity (T2WI combined with MRS) of 0.5 cm3 or larger volume lesions in the sixth prostate. Results The area under the receiver operating characteristic (ROC) curve of two patients who were found to have intra-six-zone lesions on T2WI was 0.77 and 0.82, respectively. Sensitivity to lesions with a Gleason score of ≤ 6 (reader 1, 0.44; reader 2, 0.61) was greater than that of subjects with a Gleason score of ≥7 when the lesion volume was ≥ 0.5 cm 3 <1 cm 3 (reader 1 , 0.73, P = 0.02; reader 2, 0.84, P = 0.05). For lesions ≥1 cm3 in size, there was no significant effect of Gleason score on the sensitivity (Gleason score ≤6, reader reading 1,0.83, reader reading1,2,1.0; Gleason score ≥7, respectively, 0.82, 0.92; P ≧ 0.07). MRS is less sensitive and has no significant correlation with lesion volume or Gleason score. Conclusions For patients with clinically low-risk prostate cancer, lesion volumes <1 cm3 were found to be significantly affected by Gleason scores on T2WI; lesion size ≥1 cm3 was significantly better than lesser lesions on T2WI and was not affected by lesion Gleason scores. In such patients, the role of MRS alone is limited.