MRI对前列腺癌的诊断与分期

目的：探讨高场强MRI在前列腺癌的诊断和分期中的作用。方法：回顾性分析经手术病理证实的26例前列腺癌的高场强MRI资料,并与病理结果和临床分期对照。结果：26例前列腺癌中MRI诊断前列腺炎2例,前列腺增生4例,前列腺癌20例,其中B期5例,C期13例,D期2例,定性诊断符合率为76.9%,20例前列腺癌分期符合率为85%;典型的前列腺癌在T1像呈稍低信号,与正常前列腺组织接近,在T2像上表现为正常较高信号的周围带内出现异常低信号灶,增强扫描多数早期较明显强化。结论：高场强MRI对前列腺癌诊断与分期有重要价值。     

MRI在前列腺疾病诊断中的价值

目的 探讨MRI在诊断前列腺癌及前列腺良性增生中的应用价值.方法 回顾性分析42例前列腺病变,其中前列腺癌（PC）20例,前列腺良性增生（BPH）22例,由2名放射科医师对MRI影像学表现进行研究,观察病变位置、大小、形态及信号特点,将诊断结果与病理结果对照.结果 MRI诊断PC的敏感性和特异性是85.0%和85.0%;诊断BPH的敏感性和特异性为86.3%和81.8%.PC组病变发生于外周带占85%（17/20）,发生于中央带占5%（1/20）,中央带与外周带分界不清10%（2/20）;周围组织或器官转移的部位包括：侵及包膜11例,侵及精囊腺8例,10例前列腺周围神经血管束受侵,侵及周围脏器4例,淋巴结转移8例,骨转移5例.BPH组86.4%（19/22）发生于中央带,表现为中央带体积增大,信号混杂;发生于外周带13.6%（3/22）,表现为低信号结节,边界清楚,均有完整包膜.结论 常规MRI对前列腺癌及前列腺良性增生的诊断有较高的敏感性和特异性,对临床治疗方法的选择具有重要指导意义.     

多模态MRI分级影像报告对前列腺外周带癌的诊断价值初探

目的：探讨多模态MRI分级影像报告对前列腺外周带癌的诊断价值。方法：44例经病理证实的前列腺疾病患者,其中前列腺癌21例,前列腺增生23例,术前行MRI （FS-T₂WI、DWI及DCE-MRI）检查;将MRI分级诊断结果与病理结果进行一致性检验,分析多模态MRI对前列腺癌的诊断价值。结果：MRI分级诊断标准对前列腺疾病的诊断敏感度、特异度、准确率、阳性预测值、阴性预测值可达100.0%、82.6%、93.2%、87.5%及100.0%;与病理结果的一致性检验Kappa值为0.864。结论：MRI分级诊断标准对前列腺外周带癌具有较高的诊断价值。     

前列腺MRS诊断外周带前列腺癌的价值

目的：分析前列腺外周带的MRS特征,探讨MRS技术及其在外周带前列腺癌诊断中的价值。方法：24例临床及常规MRI检查拟诊局限性前列腺外周带前列腺癌患者均成功行前列腺MRS检查,所有患者均经病理证实为前列腺癌,其中19例行穿刺活检,5例经手术证实。回顾性分析患者的临床资料、病变部位、大小、常规MRI特征、MRS检查结果,计算（胆碱＋肌酸）/枸橼酸盐（CC/C）。采用重复测量方差分析比较正常外周带与前列腺癌组织CC/C值差异。采用操作者工作特征曲线（ROC）分析CC/C值诊断前列腺癌的价值。结果：早期外周带前列腺癌T2WI表现为在外周带高信号内有局灶性低信号区。MRS示前列腺外周带肿瘤组织枸橼酸盐（Cit）峰明显下降,胆碱（Cho）峰升高,CC/C值为1.40±0.33,正常外周带为0.51±0.12,两者差异有统计学意义（F=95.189,P〈0.001）。CC/C值的ROC曲线下面积为0.994,这一指标可用于判断前列腺癌（P=0.002）;以0.85为阈值时,诊断前列腺癌的敏感度为95%,特异度为100%。结论：前列腺MRS检查能反映早期外周带前列腺癌的代谢变化,对常规MRI无法明确诊断的前列腺癌具有重要诊断价值。     

MRI对前列腺癌及增生性疾病的诊断价值及其与病理对照研究

目的 探讨MRI诊断前列腺疾病的价值.方法 由2名放射科医生盲法分析经病理证实的43例前列腺癌(PC)和33例前列腺增生(BPH)患者临床资料及MRI所见,将诊断结果与病理结果进行对照,统计MRI诊断前列腺病变的敏感性、特异性、阳性预测值(PV )、阴性预测值(PV-)和准确性,分析漏、误诊原因.结果 MRI诊断PC和BPH的敏感性、特异性、阳性预测值(PV )、阴性预测值(PV-)及准确性分别为:90.7%、84.8%、88.6%、87.5%和88.2%;84.8%、90.7%、87.5%、88.6%和88.2%.PC组病变发生于外周带占67.4%(29/43例),中央带占9.3%(4/43例),前列腺不规则增大呈弥漫低信号16.3%(7/43例);知道病理结果后再分析MRI仍未找到病灶者占7.0%(3/43例).肿瘤最大径线0.3～10.0 cm,平均2.4 cm.所见40例癌性病变表现为低信号,边界不清.周围组织或器官受侵犯包括前列腺包膜34例,精囊腺24例,肌肉8例,直肠5例,膀胱6例,髂骨1例.淋巴结转移11例,骨转移13例及肺转移2例.按TNM分期:A、B期9例;C、D期34例.BPH组87.9%(29/33例)发生于中央带,中央带体积增大,信号混杂.12.1%(4/33例)发生于外周带,表现为低信号结节,边界清楚,2例有完整包膜.结论 常规MRI诊断前列腺疾病有较高的敏感性、特异性、阳性预测值(PV )、阴性预测值(PV-)及准确性.     

前列腺癌的MR诊断及影响因素

目的 :研究 MR对前列腺癌的定性诊断及分期诊断的能力 ,讨论对诊断准确性有影响的因素。方法 :回顾性分析 2 45例、30 8人次行前列腺 MR检查的影像资料及临床资料 ,着重研究了其中 15 8例病理证实的前列腺癌患者的 MR表现及分期 ,并与临床病理分期对照。结果 :MR能显示 80 .4%的前列腺癌 ,分期的准确率为 81.1%。前列腺活检后 3周内、内分泌治疗后、既往患前列腺炎的患者定性诊断准确率稍低 ,注意观察前列腺尖部、神经血管束及包膜轻度不规则的情况可提高定性和分期诊断的准确性。对中央带病灶 MR诊断效果不好。结论 :MR是评价前列腺癌的一种很好的影像学方法。对病史资料的全面了解、根据情况运用多种 MR检查方法及不断总结提高诊断者的经验会提高 MR对前列腺癌的定性诊断和分期诊断的准确率。     

MRI和PSA对前列腺癌和增生的诊断价值

目的　研究MRI和前列腺特异抗原 (PSA)对前列腺癌和增生的诊断能力。资料与方法　回顾性分析经手术病理证实的 2 6例前列腺癌和 4 0例前列腺增生的资料。研究MRI的表现并计算前列腺体积 ,结合以上病例血清PSA ,算出前列腺特异抗原密度 (PSAD)。结果　MRI对前列腺癌和前列腺增生的诊断准确率分别为 73.1%、80 %。按PSA肿瘤筛选界值PSA >10ng/ml作为标准 ,前列腺癌检出率为 6 9.2 % ,前列腺癌的误诊率为 2 2 .5 % ;按PSAD肿瘤筛选界值PSAD >0 .2 ,前列腺癌检出率为 92 .3% ,前列腺癌的误诊率为 5 %。结论　MRI和PSA结合可明显提高对前列腺癌和增生的诊断水平。     

多参数MRI对外周带早期前列腺良恶性病变的诊断价值

目的探讨多参数MRI对外周带早期前列腺良恶性病变的诊断效果。方法选取我院接受治疗的52例前列腺疾病患者进行多参数MRI影像检测,比较其多参数MRI影像中的多项指标。结果 MRI诊断前列腺增生敏感性为93.5%,MRI诊断前列腺癌的敏感性为91.3%。前列腺癌组中央线体以及外周带的ADC值分别为(0.6913±0.1123)×10-3mm2/s)和(0.6426±0.1213)×10-3mm2/s)皆低于前列腺增生患者中央线体和外周带的ADC值,差异具有统计学意义。统计分析所有患者的MRI表现,在前列腺增生的患者中,外周带增生3例,中央带增生患者29例,外周带增生患者在MRI图像中结节可见、边界明显、包膜完整,中央带增生患者在MRI图像中中央带明显增大,外周带变薄,内外信号不均。前列腺癌患者中,位于中央带的患者1例,占总比例的4.7%,位于外周带的患者15例,占总比例的71.4%。各项指标比较(P0.05),结果均具有差异性。结论使用多参数MRI影像能够准确地检测前列腺疾病及病灶特点。     

三维MRS定量分析对前列腺疾病的鉴别诊断研究

目的:探讨三维磁共振波谱(3D-MRS)成像对前列腺病变的诊断和鉴别诊断价值.方法:34例前列腺病变患者行常规MRI和3D-MRS检查,测量和计算(胆碱 肌酸)与枸橼酸盐的比值(CC/C),将3D-MRS的结果与病理结果进行对照分析.34例中前列腺癌12例,其中5例经穿刺活检、7例经手术病理证实;前列腺增生22例,均经手术病理证实.对前列腺癌区与非癌区的CC/C进行独立样本t检验.结果:12例前列腺癌灶的CC/C为2.57±1.10(0.9～6.0).22例前列腺增生,其中增生结节的CC/C为0.70±0.20(0.3～1.60),正常信号前列腺外周带的CC/C为0.56±0.22(0.17～0.72).前列腺癌病灶与正常前列腺外周带和前列腺增生组织的CC/C比较,差异有极显著性意义(t=2.597,P＜0.01),正常前列腺与前列腺增生组织的CC/C比较,差异无显著性意义(P＞0.05).结论:3D-MRS有助于鉴别前列腺良恶性病变,与常规MRI结合能准确直观地显示肿瘤的范围.     

前列腺癌的MRI诊断与分期

目的：研究磁共振成像对前列腺癌的诊断及分期能力。材料和方法：回顾性分析５４例经手术病理证实的前列腺癌ＭＲＩ资料，研究前列腺癌ＭＲＩ的表现及分期，并与临床和病理分期对照。结果：ＭＲＩ能显示７４．１％的前列腺癌，主要为发生或累及到周边带的癌症，但不能区别局限于中央带或过渡带的前列腺癌。在前列腺癌的分期方面，它易于显示前列腺癌对精囊、周边静脉丛、膀胱及肛提肌的侵犯。在盆腔范围内分期的准确率为８７．０％，优于其他影像学检查。结论：ＭＲＩ能显示大多数前列腺癌，在术前分期方面有重要应用价值     

动态增强MR与PSA在前列腺癌诊断及鉴别诊断中的应用价值

目的：探讨MRI快速序列动态增强在前列腺癌(PC)诊断及鉴别诊断中的价值，并观察PSA在PC与前列腺增生(BPH)诊断中的作用。方法：对5例无泌尿系症状健康志愿者、经病理证实的13例前列腺癌和36例前列腺增生患者进行MR平扫、动态增强及延迟扫描，测量并计算病灶和正常组织的相对信号强度值，并绘制正常周围带(PZ)、PC与BPH三者的时间信号强度曲线。结果：PZ轻度强化，并缓慢上升至晚期达峰值；36例BPH早期明显强化并逐渐上升至中晚期达峰值后缓慢下降：13例PC9例早期明显强化，并快速下降，4例T2WI像上弥漫性病灶呈现中晚期强化。PC尤其是晚期患者的PSA值明显高于增生。结论：PZ、PC及BPH的动态强化方式明显不同，结合PSA可对PC的诊断与鉴别诊断起积极作用。     

磁共振DWI及动态增强扫描在前列腺疾病诊断中的价值

目的探讨磁共振扩散加权成像(DWI)和动态增强扫描(DCE-MRI)在前列腺疾病中的诊断价值。方法经穿刺活检或手术病理证实的20例前列腺癌及31例前列腺增生(BPH)患者进行了MR常规扫描、DWI和DCE-MRI扫描,测量病变的表观扩散系数(ADC)值,观察病灶常规MRI、DWI和动态增强MRI特征,绘制信号强度-时间曲线(SI-T曲线),SI-T曲线分成3型:Ⅰ型为信号强度早期增高后仍持续增高;Ⅱ型为信号强度早期增高后出现平台期;Ⅲ型为信号强度早期增高后出现下降期。经方差分析比较不同组织和病灶间差异。结果经DCE-MRI检查,20例前列腺癌患者中17例病灶区呈Ⅲ型曲线,2例呈Ⅱ型曲线,1例呈Ⅰ型曲线;31例前列腺增生患者中26例呈Ⅰ型曲线,4例呈Ⅱ型曲线,1例呈Ⅲ型曲线。前列腺癌组与BPH组的SI-T曲线类型分布的差异有统计学意义(P<0.01)。20例前列腺癌病灶于DWI上为高信号,于ADC图上呈明显低信号,ADC值为(1.18±0.08)×10-3 mm2/s,未被癌组织侵及的外围叶于DWI、ADC图上均呈等信号,ADC值为(2.67±0.09)×10-3 mm2/s;31例前列腺增生患者中央叶和外围叶于DWI、ADC图上均呈等信号,ADC值分别为(1.87±0.07)×10-3 mm2/s、(2.64±0.11)×10-3mm2/s。除前列腺增生的外围叶与未被癌组织侵及的外围叶之间差异无统计学意义(P>0.05)外,前列腺增生、前列腺癌、前列腺增生的外围叶和未被癌组织侵及的外围叶各组之间差异均有统计学意义(P<0.05)。DCE-MRI和DWI联合应用在前列腺癌诊断的敏感度、特异度和准确度均达80%以上。结论 DCE-MRI、DWI在前列腺癌和前列腺增生中具有特征性影像学表现,2种方法联合应用提高了MRI诊断前列腺癌的诊断和分期准确率。     

Local staging of prostate carcinoma with endorectal coil MRI: correlation with whole-mount radical prostatectomy specimens

The purpose of this study was to investigate the accuracy of endorectal coil MRI in the local staging of prostate carcinoma. A total of 73 patients with biopsy-proven prostate carcinoma were examined at 0.5 T prior being submitted to radical prostatectomy. The gold standard was provided in all patients by findings at whole-mount sectioning of the surgical specimens. At pathology 28 patients had stage T2, 30 had stage T3a/b, and 15 had stage T3c lesions. Overall accuracy of endorectal coil MRI in defining local tumor stage was 82% (60 of 73 patients). Of 73 patients, 5 (7%) were underestimated and 8 (11%) overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 95% and 82%, respectively. Seminal vesicle invasion was detected with 80% sensitivity and 93% specificity. Our data indicate that endorectal coil MRI is an accurate method for local staging of prostate cancer.Correspondence to: C. Bartolozzi     

Apparent diffusion coefficient: prostate cancer versus noncancerous tissue according to anatomical region

PURPOSE: To evaluate diagnostic performance of apparent diffusion coefficient (ADC) in differentiating prostate cancer from noncancerous tissue according to anatomical region. MATERIALS AND METHODS: In 47 patients with diffusion-weighted-MR (b-value, 0 and 1000 sec/mm2) on a 1.5 T unit, ADCs were measured in prostate cancer and in three noncancerous tissues (transitional zone, peripheral zone, and prostatic base). Diagnostic performance of ADC for differentiating cancer from noncancerous tissue was evaluated using receiver-operating-characteristics (ROC) analysis. RESULTS: Mean ADC of prostate cancer (0.963x10(-3) mm2/s) was lower than those of all noncancerous tissues (P<0.001). In noncancerous tissue, ADC differed according to anatomical region (peripheral zone, 1.572x10(-3) mm2/sec; transitional zone, 1.441x10(-3) mm2/sec; prostatic base, 1.146x10(-3) mm2/sec) (P<0.01). ADC was lower in prostate cancer than in all noncancerous tissues in 34 (72%) patients. Area under the ROC curve for differentiating cancer from noncancerous tissue in prostatic base (0.725) was less than those for differentiating cancer from noncancerous tissue in peripheral (0.952) and transitional zones (0.906) (P<0.05). Sensitivity differed according to anatomical region (peripheral zone, 98%; transitional zone, 82%; prostatic base, 66%) (P<0.05). CONCLUSION: Variable ADC in noncancerous tissue according to anatomical region may limit diagnostic performance of ADC for cancer detection.     

Comparative evaluation between external phased array coil at 3 T and endorectal coil at 1.5 T: preliminary results

OBJECTIVE: The aim of this study was to compare the image quality and the diagnostic accuracy of endorectal coil 1.5 T MRI (erMRI) and phased-array coil 3 T MRI (3-T MRI) in the pretherapeutic staging of prostate cancer. METHODS: Twenty-nine consecutive patients, with pathological proven prostate cancer, have been examined in the same week with both erMRI and 3-T MRI. Two radiologists independently evaluated the image quality focusing on the following points: cancer tissue conspicuity, capsular infiltration and tumor involvement of seminal vesicles, neuro-vascular bundles, and apex. The radiologists assigned to each one of the above findings an image-quality score ranging from 1 to 5 (with 1 meaning "not visible," 2 "poorly visible," 3 "fairly visible," 4 "well visible with some artifacts," and 5 "clearly visible without artifacts".) Afterwards a comparative evaluation of the mean score obtained respectively by erMRI and 3 T MRI was done. Twenty-two of these 29 patients underwent radical prostatectomy. Assuming as gold standard the pathological report from the resected specimen, we compared the diagnostic accuracy of 3TMRI and erMRI in differentiating between tumors confined within the prostate gland (stage相似文献   

磁共振超高b值弥散序列指导前列腺穿刺的初步研究

目的探讨MR超高b值弥散序列指导前列腺穿刺的临床意义。方法前列腺穿刺病理证实患者共计48例,其中前列腺癌15例,前列腺增生33例。所有患者行MR常规扫描及弥散序列扫描,b=800,1500。以穿刺所得病理结果为金标准,分别观察前列腺癌及前列腺增生的常规b值及超高b值弥散图像特点。同时评价常规b值,超高b值及两组联合的诊断灵敏度、特异度、阳性预测值、阴性预测值。结果常规b值,超高b值及两组联合的诊断灵敏度分别为79.17%,62.5%,91.67%;特异度分别为75.61%,95.12%,95.12%;阳性预测分别为60%,88.24%,91.67%;阴性预测值分别为86.11%,81.25%,95.12%。前列腺癌在超高b值图像上呈高信号,具有明显的特征,在常规b值图像上前列腺癌及前列腺增生均可呈等信号或高信号影。在诊断效能方面,超高b值联合常规b值对比2种单独引导具有明显优越性。结论趟高b值弥散序列有助于前列腺癌的诊断,尤其在联合常规b值的情况下,明显提高诊断效能。     

Combined morphological, [1H]-MR spectroscopic and contrast-enhanced imaging of human prostate cancer with a 3-Tesla scanner: preliminary experience

PURPOSE: The objective of this study was to explore the feasibility of combined morphological magnetic resonance imaging (MRI), [(1)H]magnetic resonance spectroscopic imaging (MRSI) and quantitative dynamic contrast-enhanced MRI (DCE-MRI) of human prostate cancer at 3 Tesla using a pelvic phased-array coil. MATERIALS AND METHODS: MRI, MRSI and DCE-MRI with a 3-Tesla whole-body scanner were performed in 30 patients with biopsy-proven prostate cancer before radical prostatectomy. High-resolution T2-weighted turbo spin echo (TSE) images were evaluated for visualisation of the peripheral zone, central gland, visibility of the cancer lesion, prostatic capsule delineation and overall image quality according to a five-point scale. Relative levels of the prostate metabolites citrate, choline and creatine were determined in cancer and in the normal peripheral zone (PZ) and central gland (CG). Spectra were also evaluated for the separation of the signal of citrate, choline and creatine and suppression of lipid and water signals. Time-intensity curves were obtained for prostatic cancer and healthy PZ and CG from DCE-MRI. Finally, time of arrival, time to peak, maximum enhancement and wash-in rate in cancer, normal PZ and CG were calculated. RESULTS: The high signal-to-noise ratio (SNR) at 3 Tesla provided T2-weighted TSE images with excellent anatomical detail (in-plane voxel size of 0.22 x 0.22 mm) and good T2 contrast. The increased spectral resolution was sufficient to separate the choline and creatine resonances and allow delineation of the four peaks of citrate resonance. The (choline + creatine)/citrate ratio was elevated in cancer in comparison with PZ and CG (p<0.001). Dynamic contrast-enhanced images showed good temporal resolution. All parameters obtained from DCE-MRI showed a statistically significant (P<0.05) difference between cancer tissue and normal PZ and CG. Wash-in rate and (choline+creatine)/citrate ratio were significantly correlated (r=0.713, P=0.001) in PZ cancer, whereas the correlation was not significant (r=0.617, P=0.06) in CG and in PZ (r=0.530, P=0.08). CONCLUSIONS: It is possible to perform MRI of prostate cancer at 3 Tesla using a pelvic phased-array coil with high spatial, temporal and spectral resolution. The combination of vascular information from DCE-MRI and metabolic data from MRSI has excellent potential for improved accuracy in delineating and staging prostate carcinoma. These results suggest that high magnetic field strengths offer the possibility of studying prostate cancer without use of an endorectal coil.     

MRI与骨扫描诊断前列腺癌骨转移的比较

目的 通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断,以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法 回顾性分析2011年1月-2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁,平均年龄（73±7.98）岁,分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（ＮＰＶ）。结果 54例病人诊断为骨转移（成骨性骨转移48例,混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA）>50 ng/mL,而92%（182/19８）的前列腺癌无骨转移病人的PSA<50 ng/mL。MRI诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为85.1%、100%、96.8%、100%、96.1%;全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高,骨扫描的敏感度较高。MRI与骨扫描可以实现优势互补,利于前列腺癌的准确临床分期。