前列腺癌的MRI诊断与临床对照研究

目的：回顾性分析94例临床拟诊前列腺疾患患者的MRI，探讨MRI对前列腺癌诊断的敏感度、特异度与诊断符合率；通过分析MRI对前列腺癌漏诊、误诊的原因，以期提高MRI对前列腺癌诊断的敏感度及诊断符合率。方法：本研究中选取的94例临床诊断前列腺疾病的患者均行MRI、DRE、B-US检查及PSA化验检查。MRI常规采用快速自旋回波(FsE)T2加权扫描(T2WI)及自旋回波(SE)T1加权扫描(T1WI)，部分采用脂肪抑制序列(STIR)或加扫矢状位、冠状位；磁共振检查结果与其它检查结果、临床诊断及平行试验进行对照。结果：MRI对前列腺癌诊断的敏感度为82．69％，特异度为90．48％，似然比为8．6827，诊断符合率为86．17％，正确诊断指数为0．7317；平行试验对前列腺癌诊断敏感度为98．08％，特异度为85．71％，似然比为6．8654，诊断符合率为92．55％，正确诊断指数为0．8379；二者对前列腺癌诊断敏感度的差异有显著的统计学意义。结论：不同的MRI脉冲序列对各种病变显示率不同；设置适当的脉冲序列、扫描方位及参数，并仔细观察影像学所见，可以明显减少病变的漏诊；MRI表现密切结合临床资料，有利于病灶的鉴别诊断，较大地提高前列腺疾病诊断符合率；平行试验可以明显提高对前列腺癌诊断的敏感度。     

前列腺癌的MRI诊断

目的探讨前列腺癌的MRI诊断价值方法回顾性分析30例经手术与病理证实的前列腺癌MRI表现及分期,并与临床病理对照结果前列腺癌80%发生于外周带,T2WI在高信号的前列腺周边带内出现异常结节状低信号,或者前列腺带状结构破坏,周边带与中央带界线消失86.7%的前列腺癌发现已位于C、D期结论磁共振对诊断前列腺癌及其分期具有重要意义     

转运常数在前列腺癌内分泌治疗后疗效评价中作用的初步研究

目的 对容量转运常数(Ktrans)和速率常数(kep)在前列腺癌内分泌治疗后疗效评价中的作用进行初步研究.方法 42例前列腺癌患者在内分泌治疗前后均在3.0T磁共振机上进行前列腺动态增强扫描.所得图像经过软件处理后,对前列腺癌在内分泌治疗前后的时间-信号强度曲线(TIC)类型及Ktrans值、kep值进行对比分析.结果 治疗前,前列腺癌区的TIC类型为:Ⅰ型,无;Ⅱ型,9例(21.43％);Ⅲ型,33例(78.57％).治疗后TIC类型为:Ⅰ型,36例(85.71％);Ⅱ型,6例(14.29％);Ⅲ型,无.内分泌治疗后,有27个癌区的TIC类型从Ⅲ型转为Ⅰ型,转为Ⅱ型6例,所有Ⅱ型曲线均转为Ⅰ型.内分泌治疗前癌区的Ktrans值和kp值分别为(90.81±33.52)×10-3min-1和(169.20±57.35)×10-3 min-1,治疗后两者下降为(31.28±14.13)×10-3 min-1和(54.83±20.81)×10-3 min-1.治疗前后有统计学差异(t=17.03和11.22,P＜0.01).结论 磁共振动态增强扫描(DCE-MRI)有助于评价前列腺癌内分泌治疗的效果,Ktrans值和kep值可用于定量评价治疗后肿瘤血管的改变.     

前列腺癌MRI诊断的探讨

目的 :探讨磁共振诊断前列腺癌的准确性和临床意义。方法 :选择 60岁以上临床怀疑前列腺癌的病人 59例 ,均行磁共振轴、矢、冠位平扫 ,运用盆腔相控线圈、采用自旋回波序列 ( SE) T1加权像和快速自旋回波序列 ( FSE) T2 加权像 ,加或不加脂肪抑制技术。结果 :在 59例临床怀疑前列腺癌病人中 ,经 MRI检查提示前列腺癌 37例 ,经病理证实 2 9例 ,假阳性 8例 ,假阴性 4例。结论 :磁共振是目前诊断前列腺癌及其分期的最有效影像手段 ,对临床治疗方法的选择具有重要的指导意义     

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。     

MRI动态增强检查在前列腺癌诊断的价值

目的：分析前列腺癌动态扫描的影像学表现，以提高对本病诊断准确率。资料与方法：回顾性分析手术病理证实的前列腺癌患者20例，患者术前均做MRI平扫十动态增强检查，平扫包括T1W1横断位、冠状位、矢状位成像及横断位T2W1，将动态增强后T1w1分别与平扫T1W1、T2W1进行对照，以比较确定肿瘤位置、大小、形态、及肿瘤穿破包膜及周围脏器侵范的显示情况。结果：MRI动态增强大部分肿瘤组织可见早期强化，与正常前列腺信号差异增大，相对平扫其对肿瘤大小、形态、范围的显示提高、对肿瘤侵犯周围结构显示能力有较明显提高。结论：MRI动态增强扫描对前列腺癌的诊断及周围侵犯情况具有重要意义。     

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。     

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.     

MRI在胃癌术后复发诊断中的应用价值

目的:探讨MRI在胃癌术后复发诊断中的价值及临床意义.方法:选择2组胃癌术后患者,胃癌术后复发组33例,未复发对照组10例,均经胃镜活检、病理检查证实.2组病例均应用1.5 T MRI行TSE DRIVE/T2WI、T1-FFE T1WI等序列及动态增强扫描检查,测量残胃壁及吻合口胃壁厚度,观察吻合口胃壁MRI常规序列及动态增强信号变化.结果:未复发对照组残胃壁厚度(4.5±0.3)mm,吻合口胃壁厚度(6.3±1.4)mm;术后复发组残胃吻合口胃壁增厚＞8 mm 30例,吻合口邻近胃壁厚度＞5 mm 19例,吻合口软组织肿块并邻近胃壁增厚11例,肝脾胰腺等周围脏器转移5例,肝胃之间、腹腔、腹膜后淋巴结转移9例.病灶在动脉期不均匀强化9例,静脉期及平衡期病灶呈渐进性、延迟强化30例.结论:MRI能够较好地显示残胃壁及吻合口胃壁的厚度,准确判断肿瘤浸润深度及与周围组织毗邻关系、是否有淋巴结和腹腔内脏器转移等,可指导临床选择手术方案或综合治疗,对提高胃癌术后生存率具有重要的临床意义.     

Radiologists’ Contribution to Variation in Detecting Clinically Significant Prostate Cancer in Men With Prostate MRI

ObjectiveAssess radiologists’ contribution to variation in clinically significant prostate cancer (csPCa) detection in patients with elevated prostate-specific antigen (PSA) and multiparametric MRI (mpMRI).MethodsThis institutional review board–approved, retrospective cohort study was performed at a tertiary, academic, National Cancer Institute–designated Comprehensive Cancer Center with a multidisciplinary prostate cancer program. Men undergoing mpMRI examinations from January 1, 2015, to December 31, 2019, with elevated PSA (≥4 ng/mL) and biopsy within 6 months pre- or post-MRI or prostatectomy within 6 months post-mpMRI were included. Univariate and multivariable hierarchical logistic regression assessed impact of patient, provider, mpMRI examination, mpMRI report, and pathology factors on the diagnosis of Grade Group ≥ 2 csPCa.ResultsStudy cohort included 960 MRIs in 928 men, mean age 64.0 years (SD ± 7.4), and 59.8% (555 of 928) had csPCa. Interpreting radiologist was not significant individually (P > .999) or combined with mpMRI ordering physician and physician performing biopsy or prostatectomy (P = .41). Prostate Imaging Reporting and Data System (PI-RADS) category 2 (odds ratio [OR] 0.18, P = .04), PI-RADS category 4 (OR 2.52, P < .001), and PI-RADS category 5 (OR 4.99, P < .001) assessment compared with no focal lesion; PSA density of 0.1 to 0.15 ng/mL/cc (OR 2.46, P < .001), 0.15 to 0.2 ng/mL/cc (OR 2.77, P < .001), or ≥0.2 ng/mL/cc (OR 4.52, P < .001); private insurance (reference = Medicare, OR 0.52, P = .001), and unambiguous extraprostatic extension on mpMRI (OR 2.94, P = .01) were independently associated with csPCa. PI-RADS 3 assessment (OR 1.18, P = .56), age (OR 0.99, P = .39), and African American race (OR 0.90, P = .75) were not.DiscussionAlthough there is known in-practice variation in radiologists’ interpretation of mpMRI, in our multidisciplinary prostate cancer program we found no significant radiologist-attributable variation in csPCa detection.     

前列腺癌骨转移的临床诊断:MRI与同位素骨扫描的比较

目的比较盆腔MRI和全身骨扫描对前列腺癌骨转移的临床诊断效能。方法收集183例前列腺疾病患者的资料,包括盆腔MRI和全身骨扫描检查结果。根据临床综合诊断结果,将所有患者分为骨转移组和非骨转移组。对获得的资料进行统计学分析。结果①183例患者中,37例确诊临床骨转移,146例无临床骨转移。37例骨转移患者的转移灶位置,5例位于盆腔内,3例位于盆腔外,29例位于盆腔内外。②盆腔MRI检查诊断24例骨转移,均经临床综合评价确诊为骨转移(100%,24/24)。全身骨扫描诊断27例骨转移,96.4%(27/28)经临床综合评价确诊为骨转移。其它骨转移的确诊均经临床综合诊断。③将盆腔MRI和同位素骨扫描的结果进行比较,盆腔MRI检查未见明确骨转移灶的患者共159例,其中仅有4例患者(4/159,2.52%)全身骨扫描可明确诊断骨转移。④评价2种影像检查方法对全身骨转移的预测和诊断效果,盆腔MRI对全身骨转移预测的敏感性、特异性和准确性分别为78.38%、87.0%和85.25%;全身骨扫描对骨转移的诊断敏感性、特异性和准确性分别为94.59%、62.33%和68.85%。MRI的特异性和准确性高于同位素骨扫描(χ2=23.458,P=0.000;χ2=13.906,P=0.000),同位素骨扫描的敏感性高于MRI(χ2=4.163,P=0.041)。结论盆腔MRI也可用作前列腺癌全身骨转移的诊断。当盆腔MRI检查未见骨转移灶时,发生全身骨转移的机会较低。     

Patient-Centered Outcomes From Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: A Systematic Review

ObjectiveTo identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRI-guided biopsy as diagnostic tests for possible prostate cancer.MethodsMedline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a standardized form.ResultsOverall, 2,762 database search hits were screened based on title and abstract. Of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias.DiscussionPCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.     

内分泌治疗后前列腺外周带癌区和非癌区ADC值变化初步研究

目的运用MR扩散加权成像研究内分泌治疗前后前列腺外周带癌区和非癌区的ADC值变化情况。方法28例B超引导下经直肠穿刺活检病理证实的前列腺外周带癌病人。根据穿刺活检结果,将前列腺外周带归类为癌区和非癌区。所有病人在内分泌治疗前和治疗后3~6个月内均进行了单次激发EPI序列的MR扩散加权成像检查,计算各个分区内的ADC平均值,并对所得数值进行配对或独立样本t检验。结果治疗前,所有非癌区(107个)和癌区(61个)的ADC平均值分别为(2.21±0.61)×10-3mm2/s(mean±SD)和(1.65±0.46)×10-3mm2/s,2组间具有统计学差异(t=4.36,P=0.039,独立样本t检验)。经过了3~6个月的内分泌治疗后,非癌区和癌区的ADC值均出现了下降,非癌区ADC值下降至(1.33±0.48)×10-3mm2/s,癌区下降至(1.28±0.53)×10-3mm2/s,均与内分泌治疗前该组区域的ADC值有统计学差异(t=5.28,P=0.024和t=7.39,P=0.015,配对样本t检验)。但是在治疗后癌区和非癌区ADC值之间原有的统计学差异消失(t=0.58,P=0.639,独立样本t检验)。结论内分泌治疗后前列腺外周带癌区和非癌区的ADC值均会出现下降,其中以非癌区下降为明显,致使癌区和非癌区原有的ADC值统计学差异消失。     

TURP手术对前列腺癌组织和非肿瘤组织血供影响的MRI评价

目的　应用动态增强MRI两室药物代谢动力学模型评价TURP手术对前列腺癌、前列腺良性增生和正常前列腺周围带血液供应的影响。方法　对 78例经病理组织学证实的前列腺癌 ,其中TURP手术组 2 4例 ,对照组 5 4例 ,使用GE 1.5T超导磁共振成像仪 ,采用FSPGR序列针对前列腺 ( 4层或 5层 )进行动态增强扫描 ,层厚 7mm ,层间间隔 2mm ,连续扫描采样 35次。应用两室药物代谢动力学模型进行分析 ,分别计算出前列腺癌、前列腺良性增生和正常前列腺周围带的最大增强指数、对造影剂的吸收幅度、造影剂的交换率和造影剂分布指数。结果　TURP组和对照组之间年龄、病理学分级、PSA和肿瘤的分期、大小均未见明显差异 (Ρ >0 .0 5 )。在TURP组中肿瘤区最大增强指数、造影剂分布指数和正常前列腺周围带的最大增强指数明显高于对照组 ,之间存在显著统计学差异 (Ρ <0 .0 5 )。结论　MRI药物代谢动力学模型 ,特别是最大增强指数和造影剂分布指数能够更准确地反映TURP手术对前列腺癌组织和非肿瘤组织的血液供应变化