Updates in advanced diffusion-weighted magnetic resonance imaging techniques in the evaluation of prostate cancer

Diffusion-weighted magnetic resonance imaging (DW-MRI) is considered part of the standard imaging protocol for the evaluation of patients with prostate cancer. It has been proven valuable as a functional tool for qualitative and quantitative analysis of prostate cancer beyond anatomical MRI sequences such as T2-weighted imaging. This review discusses ongoing controversies in DW-MRI acquisition, including the optimal number of b-values to be used for prostate DWI, and summarizes the current literature on the use of advanced DW-MRI techniques. These include intravoxel incoherent motion imaging, which better accounts for the non-mono-exponential behavior of the apparent diffusion coefficient as a function of b-value and the influence of perfusion at low b-values. Another technique is diffusion kurtosis imaging (DKI). Metrics from DKI reflect excess kurtosis of tissues, representing its deviation from Gaussian diffusion behavior. Preliminary results suggest that DKI findings may have more value than findings from conventional DW-MRI for the assessment of prostate cancer.     

前列腺癌的质子磁共振波谱研究进展

早期诊断对前列腺癌预后至关重要。传统诊断方法均有较大的局限性。磁共振波谱可从代谢水平早期诊断前列腺癌。其技术的进展、可检测代谢物的特点以及对前列腺癌诊断和鉴别诊断、定位和体积估算、分级及侵袭力的评估、治疗后评价的临床研究均显示出明显的优势。     

肿瘤主动靶向性钆类磁共振分子影像探针的研究进展

肿瘤靶向性钆类磁共振探针在肿瘤早期诊断和个体化疗效评估中发挥越来越重要的作用,成为近年来分子影像学的研究热点所在.本文论述了肿瘤主动靶向性钆类磁共振分子影像探针的研究进展.     

基于MRI的前列腺癌放疗中标志物手动辨识与定位评价

目的 评价基于MRI的前列腺癌放疗中黄金基准标志物（GFM）手动辨识和定位方法的效能。 方法 纳入2019年6月至2021年6月于唐山市人民医院接受治疗的16例前列腺癌患者进行前瞻性研究,年龄（58.5±4.1）岁,每例患者均置入了3枚GFM后接受放疗定位CT扫描,然后采用单独序列（SS）法和组合序列（CS）法对所有患者进行MRI检查。由5名放疗医师分别对2种序列法获得的所有图像进行GFM手动辨识和定位。计算单个GFM中心（CsGFM）坐标均值和3枚GFM空间质心（CmGFM）坐标均值,并采用Bland-Altman分析法分别评价2种序列法定位的一致性。通过与CT定位比较并计算GFM的标志物间距（IMD）,评价2种序列法定位的准确度,组间比较采用配对样本t检验。 结果 SS法GFM辨识阳性率为79.17%（38/48）,CS法为93.75%（45/48）。（1）一致性结果。SS法中,每名放疗医师计算的GFM中心坐标同所有GFM的CsGFM坐标均值在左右、头脚、腹背3个方向上的95%一致性界限（LoA）范围分别为−1.46~0.97 mm、−1.06~1.73 mm、−1.96~1.12 mm;CS法中分别为−0.79~1.09 mm、0.10~1.47 mm、−0.87~1.40 mm。SS法中,每名放疗医师计算的3枚GFM空间质心坐标同所有患者的CmGFM坐标均值在左右、头脚、腹背3个方向上的95%LoA范围分别为−1.38~0.94 mm、−1.60~1.07 mm、−1.07~1.75 mm;CS法中分别为−0.57~0.76 mm、−0.71~0.98 mm、−1.16~0.76 mm。（2）准确度结果。与CT定位比较,SS法中IMD为（0.59±0.39） mm,显著大于CS法中的（0.32±0.17） mm,且差异有统计学意义（t=−1.89,P=0.027）。 结论 基于MRI的2种GFM手动辨识和定位方法的效能均可满足临床要求,其中CS法GFM手动辨识的阳性率、定位一致性和准确度均优于SS法。     

多参数磁共振成像在前列腺癌中的应用进展

前列腺癌（PCa）的发病率位居全球男性恶性肿瘤的第二位,随着人口老龄化进程的加快,其发病率和病死率也在逐年上升。若PCa不被及早发现、检测、诊断,将严重危害老年男性的健康。自前列腺影像报告与数据系统V2.1版指南更新了多参数磁共振成像（mpMRI）序列及评分新规范以后,mpMRI在PCa中的应用前景更为广泛。多项研究报道了mpMRI在PCa活检前及指导靶向活检、主动监测、根治性前列腺切除术后局部复发及转移中的应用价值,但mpMRI评估PCa仍然存在局限性。笔者主要就mpMRI关键序列及评分的新规范、mpMRI评估PCa的应用进展、当前的局限性及潜在的解决方案展开综述。     

磁共振灌注成像在前列腺癌诊断中的应用

目的探讨前列腺癌的磁共振灌注成像的强化特征及前列腺不同组织灌注指标的差异。材料与方法回顾分析经组织病理学证实的前列腺癌49例,记录病人的临床资料。使用GE Echo-speed1.5T超导成像设备,联合应用盆腔相控阵线圈和直肠内表面线圈,采用单次激发平面回波序列进行灌注成像。通过GE高级工作站4.2进行数据处理,得到不同感兴趣区的灌注相关指标:负增强积分、增强平均时间、达峰值时间、信号降低最大斜率及血流速度,用闭孔内肌作为灌注指标的内参照,计算不同感兴趣区的相对灌注指标。结果前列腺癌信号-时间曲线为快速出现的信号降低倒置峰。前列腺癌(PCa)、前列腺增生(BPH)及正常前列腺外周带(PZ)的相对负增强积分(rNEI)、增强平均时间(rMTE)、达峰值时间(rTTM)、信号降低最大斜率(rMSD)及血流速度(rBF)的平均数值分别为6.44、0.71、0.68、1.93、8.17;3.01、0.82、0.83、1.33、3.64;1.29、0.95、0.94、0.64、1.43。前列腺癌的rNEI、rMSD和rBF明显高于前列腺增生的和正常前列腺外周带的(P<0.05)。前列腺癌的rMTE、rTTM低于前列腺增生的和正常前列腺外周带的(P<0.05)。结论磁共振灌注成像能有效反映出前列腺不同组织的微循环灌注差异,有助于提高前列腺癌的检出率。     

前列腺癌的多参数MRI研究进展

前列腺癌是威胁男性健康的常见恶性肿瘤。前列腺癌的检查手段较多,如前列腺特异性抗原、直肠指检、经直肠超声引导下穿刺及MRI等。MRI因具有软组织分辨力高,可以多方位、多序列成像等优势,目前被公认为是无创检查前列腺疾病最好的影像方法,尤其是多参数MRI(mp-MRI)包括T2WI、扩散加权成像、磁共振波谱,是目前研究的热点。就前列腺的mp-MRI研究进展予以综述。     

磁共振波谱联合MRI多参数技术组合对提高前列腺癌诊断特异度的价值探讨

目的 分析磁共振波谱成像联合常用多参数技术在前列腺癌中的诊断价值.方法 选取在我院进行治疗的33例确诊为前列腺癌患者,以病理穿刺确诊前列腺增生33例为对照组.两组患者穿刺前均进行磁共振多参数常规扫描和波谱扫描.影像学结果和病理穿刺结论对比分析.结果 常规MRI多参数技术组合方案确诊前列腺癌27例.上述方法再联合波谱扫描...     

Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Prostate cancer is a major public health burden throughout the world. The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and the slow natural progression and biological heterogeneity of the disease, has made its management a complex and controversial issue. There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits. There are a number of clinical parameters and clinical nomograms to help with the choice of treatment. Magnetic resonance imaging (MRI) is a technique which makes safer, more individualized therapies possible due to high spatial resolution, superior contrast resolution, multiplanar capability, and a large field of view. Other MRI techniques such as MR spectroscopic imaging, dynamic contrast-enhanced MRI or perfusion MRI, and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry, Brownian motion of water molecules, and capillary wall permeability, respectively. This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, some future prospects for MRI in prostate cancer management are given.     

Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis

Our objective was to determine the influence of patient-, study design-, and imaging protocol characteristics on staging performance of MR imaging in prostate cancer. In an electronic literature search and review of bibliographies (January 1984 to May 2000) the articles selected included data on sensitivity and specificity for local staging. Subgroup analyses examined the influence of age, prostate specific antigen, tumor grade, hormonal pre-treatment, stage distribution, publication year, department of origin, verification bias, time between biopsy and MR imaging; consensus reading, study design, consecutive patients, sample size, histology preparation, imaging planes, fast spin echo, fat suppression, endorectal coil, field strength, resolution, glucagon, contrast agents, MR spectroscopy, and dynamic contrast-enhanced MRI. Seventy-one articles and five abstracts were included, yielding 146 studies. Missing values were highly prevalent for patient characteristics and study design. Publication year, sample size, histologic gold standard, number of imaging planes, turbo spin echo, endorectal coil, and contrast agents influenced staging performance ( p=0.05). Due to poor reporting it was not possible to fully explain the heterogeneity of performance presented in the literature. Our results suggest that turbo spin echo, endorectal coil, and multiple imaging planes improve staging performance. Studies with small sample sizes may result in higher staging performance.     

烟雾病的MRI、MRA诊断价值

 目的探讨MRI、MRA对烟雾病(Moyamoya病)的诊断价值.方法对11例Moyamoya病患者行MRI和MRA检查,MRI包括横轴位和矢状位T1WI、T2WI、FLAIR;MRA采用3D TOF法,3例行增强MRA.结果MRI表现为:(1)Moyamoya血管:双侧3例,单侧8例;(2)脑梗死和脑软化灶11例;(3)局部脑萎缩3例.MRA表现为3例双侧颈内动脉狭窄,双侧大脑中、前动脉闭塞,大脑后动脉形成异常血管网;6例右侧颈内动脉、大脑中动脉狭窄;2例左侧颈内动脉、大脑中动脉狭窄.结论MRI能良好的显示脑内病变,MRA能较完整的显示异常血管,MRI与MRA相结合可作为烟雾病诊断的首选检查方法.     

Evaluation of prostate size: A comparison of ultrasound and magnetic resonance imaging

To determine the relative accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in the evaluation of prostate volume, we compared US and MR images with surgical findings in 15 patients. Transabdominal US was excellent for determining prostate size in patients with small to moderate enlargement. When compared with surgical specimens, the difference between the weight of the gland as predicted by US and the actual weight was 14% (SD±12). With the transabdominal approach, the length was often inaccurately imaged, but the addition of transrectal scans in the sagittal projection improved results: with combined transabdominal and transrectal US, the average difference in weight was 8% (SD±7). The MRI more accurately predicted prostatic volume (average difference, 6% (SD±6), but the difference between the latter 2 is not significant.     

不仅仅用于诊断:前列腺癌MRI的临床应用研究

前列腺癌是高度生物异质性肿瘤,可供选择的治疗方案多种多样,前列腺癌成像的主要目的在于更为精确地疾病定性.MRI有助于前列腺癌的检测、定位及分期,帮助临床选择治疗方案,还可用于前列腺癌术后随访观察.MRI导向下穿刺活检可明显提高前列腺癌的检出率,同时MRI导向下前列腺癌近距离放射治疗的疗效确切、不良反应较少.就传统MRI和分子MR成像对前列腺癌治疗的价值与限度予以综述.     

宫颈癌功能磁共振成像研究进展

宫颈癌是女性生殖系统最常见的恶性肿瘤,早期诊断和治疗是防治的关键。MR成像尤其是功能MR成像技术在宫颈癌的早期诊断、生物学评价、疗效和预后评估等方面具有明显的优势。综述宫颈癌的功能MRI研究进展,重点分析各种功能成像技术的临床应用价值及其不足,以期为临床工作中根据具体情况和技术条件选择和组合多种功能MRI技术提供有益提示,从而提高宫颈癌的诊断准确率。     

Future of prostate imaging: Artificial intelligence in assessing prostatic magnetic resonance imaging

Prostate cancer (Pca; adenocarcinoma) is one of the most common cancers in adult males and one of the leading causes of death in both men and women. The diagnosis of Pca requires substantial experience, and even then the lesions can be difficult to detect. Moreover, although the diagnostic approach for this disease has improved significantly with the advent of multiparametric magnetic resonance, that technology has certain unresolved limitations. In recent years artificial intelligence (AI) has been introduced to the field of radiology, providing new software solutions for prostate diagnostics. Precise mapping of the prostate has become possible through AI and this has greatly improved the accuracy of biopsy. AI has also allowed for certain suspicious lesions to be attributed to a given group according to the Prostate Imaging-Reporting & Data System classification. Finally, AI has facilitated the combination of data obtained from clinical, laboratory (prostate-specific antigen), imaging (magnetic resonance), and biopsy examinations, and in this way new regularities can be found which at the moment remain hidden. Further evolution of AI in this field is inevitable and it is almost certain to significantly expand the efficacy, accuracy and efficiency of diagnosis and treatment of Pca.     

扩散加权成像鉴别前列腺癌及良性前列腺增生的价值

目的探讨良性前列腺增生(BPH)和前列腺癌(PCa)的扩散加权成像(DWI)和表观扩散系数(ADC)图表现,及对PCa的鉴别诊断价值。方法分析18例BPH和25例PCa的DWI和ADC图表现,并分别测量癌肿区的ADC值及BPH的外周带(PZ)及中央腺体(CG)的ADC值,比较其间是否存在差异。结果BPH的DWI和ADC图上PZ信号近似均一,CG信号欠均匀。PCa在DWI上呈高信号,ADC图呈低信号,均能直观显示癌灶范围。受侵犯的精囊和骨盆骨转移灶DWI上呈高信号,ADC图呈低信号。PCa的ADC值[(0．49±0．09)×10-3mm2／s]与BPH的PZ及CG的ADC值[(1．27±0．14)×10-3mm2／s、(0．96±0．14)×10-3mm2／s]比较,差异均有统计学意义(t值分别为-52．46、-31．49,P值均<0．01),PCa的ADC值与BPH的PZ无重叠,与CG也仅有少量重叠(1／127,0．7％)。结论DWI和ADC图可显示PCa位置、范围及周围侵犯、转移情况;根据DWI和ADC图上病变的信号特点及ADC值可以鉴别BPH和PCa。     

前列腺癌内分泌治疗疗效的MRI评价

目的 用ＭＲＩ定量评价前列腺癌内分泌疗法的治疗效果。方法 ２０例经病理证实的前列腺癌患者用分泌疗法平均治疗１１０ｄ,对治疗前后的ＭＲＩ表现进行比较。结果 内分泌疗法治疗约１１０ｄ,前列腺、肿瘤部分和非肿瘤部分体积分别减少了５１．５６％（ｔ＝１９．３４,Ｐ〈０．０５）、８０．８７％（ｔ＝９．７６,Ｐ〈０．０５）和４８．９４％（ｔ＝１７．１７,Ｐ〈０．０５）,提示肿瘤部分较非肿瘤部分对分泌治疗更敏感。     

Database for serial magnetic resonance imaging in multiple sclerosis

The unique sensitivity of magnetic resonance imaging (MRI) in detecting disease activity in multiple sclerosis (MS) and the objective nature of the information obtained suggest that MRI will be a useful and reliable way of monitoring treatment trials. There is a need to develop an appropriate database which would provide a standardised means of assessment, not only of MRI, but also of essential clinical information. As part of the program of Concerted Action in Multiple Sclerosis, funded by the Commission of the European Community (CEC), we have developed a database for recording serial brain MRI results. The database consists of core, entry and follow-up sections. Both entry and follow-up parts are subdivided into clinical, MR system and MRI data. We expect that the use of this database will maximise efficiency of MRI monitoring in MS treatment trials, particularly in multicentre studies.     

不同MR脉冲序列在乳腺癌中的应用

MRI经历了从结构成像到功能成像,从单纯T1WI、T2WI序列到多脉冲序列成像的发展过程。利用多个MR脉冲序列成像可获得乳腺癌病变的定性、定量信息,在乳腺癌的早期诊断、生物学评价、疗效和预后评估等方面可发挥重要作用,但其也存在敏感性高而特异性相对较低且费用较高的问题。就乳腺癌MRI的应用现状、存在的问题及前景进行综述。