Differentiating clinically significant prostate cancer from clinically insignificant prostate cancer using qualitative and semi-quantitative indices of dynamic contrast-enhanced MRI.

IF 2.9 4区医学 Q3 ENDOCRINOLOGY & METABOLISM Discover. Oncology Pub Date : 2024-12-18 DOI:10.1007/s12672-024-01668-9

Tsutomu Tamada, Mitsuru Takeuchi, Hiroyuki Watanabe, Atsushi Higaki, Kazunori Moriya, Akihiko Kanki, Yoshihiko Fukukura, Akira Yamamoto

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Abstract

Purpose: To investigate the utility of qualitative and semi-quantitative evaluation of DCE-MRI for detecting clinically significant prostate cancer (csPC).

Methods: This retrospective study analyzed 307 lesions in 231 patients who underwent 3.0T MRI. Experienced radiologists assessed PI-RADS v 2.1 assessment category, qualitative contrast enhancement (QCE), contrast enhancement pattern (CEP: type 1, 2, 3), tumor contrast ratio, and tumor size of PC lesions in consensus. Mean and 0-10th-percentile ADC value of the lesion (ADC_mean and ADC_0-10) were calculated. Specimens obtained from MRI-ultrasound fusion-guided prostate biopsy were used as the pathological reference standard.

Results: In assessment of tumor aggressiveness, PI-RADS assessment category, QCE, tumor size, and ratio of CEP 2 + 3 were significantly higher in PC with Gleason score (GS) ≥ 3 + 4 (n = 256) than in PC with GS = 6 (n = 51) (P ≤ 0.001). Tumor ADC_mean and tumor ADC_0-10 were comparable between PC with GS ≥ 3 + 4 and PC with GS = 6 (P = 0.164 to 0.504). Regarding diagnostic performance of csPC in 45 PI-RADS 3 transition zone lesions, only ratio of CEP 2 + 3 was significantly higher in PC with GS ≥ 3 + 4 (n = 31) than in PC with GS = 6 (n = 14) (P = 0.008).

Conclusion: Qualitative DCE-MRI indices may contribute to PC aggressiveness and improve detection of csPC in PI-RADS assessment category 3 lesions.

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利用动态对比增强磁共振成像的定性和半定量指标区分有临床意义的前列腺癌和无临床意义的前列腺癌。

目的：探讨定性和半定量评价DCE-MRI在诊断临床显著性前列腺癌（csPC）中的应用价值。方法：对231例3.0T MRI患者的307个病变进行回顾性分析。经验丰富的放射科医师对PC病变的PI-RADS v 2.1评估类别、定性对比增强（QCE）、对比增强模式（CEP: 1、2、3型）、肿瘤对比率和肿瘤大小进行了一致的评估。计算病变的平均和0-10百分位ADC值（ADCmean和ADC0-10）。mri超声引导下前列腺活检标本作为病理参考标准。结果：在评估肿瘤侵袭性方面，Gleason评分(GS)≥3 + 4的PC组（n = 256） PI-RADS评估类别、QCE、肿瘤大小、CEP 2 + 3比值显著高于GS = 6的PC组（n = 51）（P≤0.001）。GS≥3 + 4的PC和GS = 6的PC的ADCmean和ADC0-10具有可比性（P = 0.164 ~ 0.504）。在45例PI-RADS 3过渡区病变中csPC的诊断表现中，只有GS≥3 + 4的PC （n = 31）的CEP 2 + 3比值显著高于GS = 6的PC (n = 14) （P = 0.008）。结论：定性DCE-MRI指标可能有助于PI-RADS评估3类病变中PC的侵袭性，提高csPC的检出率。

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