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。     

3.0T动态对比增强MRI对前列腺癌与前列腺增生的鉴别价值

目的 探讨动态对比增强磁共振成像(DCE-MRI)半定量及定量参数对前列腺癌(PCa)与前列腺增生(BPH)的鉴别价值.方法 本研究经医院伦理委员会批准,回顾性分析于本院行DCE-MRI扫描,并经病理证实的PCa患者24例(69.79岁±8.21岁)、BPH患者22例(69.77岁±10.36岁).扫描序列包括横轴位T1WI、T2WI及DCE-MRI.测量PCa及BPH病变半定量值:MxSlp、washout、AUC90、AUC180;定量值:转运常数(Ktrans)、速率常数(Kep)及血管外细胞外容积比(Ve)值.使用独立样本f检验比较以上各值,使用受试者工作特征曲线(ROC)评估各值对PCa和BPH的鉴别效能.结果 PCa与BPH的MxSlp、washout、AUC90、AUC180值间差异均无统计学意义(29.76±83.58 vs 8.65±4.51、1.29±3.36 vs 0.14±0.37、14.96±5.76 vs 12.76±4.21、28.80±14.08 vs 26.13±8.40),P值分别为0.243、0.117、0.150、0.443.PCa的Ktrans及Kep值均高于BPH[(0.36±0.11) min-1vs(0.24±0.11)min-1、(1.93±0.89) min-1vs (1.20±0.57) min-1)],P值分别为0.001、0.002.PCa与BPH的Ve值间差异无统计学意义(0.23±0.11 vs 0.25士0.18),P值为0.604.Ktrans及Kep值诊断PCa的曲线下面积(AUC)分别为0.813、0.737,当Ktrans值≥0.273 min-1,Kep值≥1.595 min-1时诊断PCa的灵敏度和特异度分别为79.2％和82.7％、62.5％和86.4％.结论 DCE-MRI可为PCa与BPH鉴别提供较可靠的定量值.     

MRI动态增强扫描对前列腺癌的诊断价值

目的:在1.5T场强下评价MRI动态增强扫描诊断前列腺癌的能力。方法:对照经直肠前列腺穿刺活检,在24例患者的前列腺动态增强图像中测量130个ROI,其中癌肿组50个,良性组80个,建立时间-信号强度曲线,标注曲线的类型,在曲线上测得开始时间、达峰时间、初始值、峰值,计算时间差、差值、强化速率和强化比率,并进行统计学分析。结果:癌肿组50个ROI中,渐升型6个(12%),平台型5个(10%),速升缓降型39个(78%);良性组80个ROI中,渐升型20个(25%),平台型40个(50%),速升缓降型20个(25%)。癌肿组和良性组强化类型、开始时间、达峰时间、时间差、强化速率的差异有统计学意义(P<0.05),初始值、差值、峰值、强化比率的差异无统计学意义(P>0.05)。受试者工作特征曲线表明强化速率指标优于开始时间、达峰时间和时间差,其最佳工作点为72.085,特异度为0.76,敏感度为0.62,曲线下面积为0.73±0.046。结论:动态增强扫描是鉴别前列腺癌与良性组织的有效手段,并以强化速率指标最具诊断价值。     

Clinical implication of negative conversion of predicted circumferential resection margin status after preoperative chemoradiotherapy for locally advanced rectal cancer

Objective

To evaluate the prognostic implication of the negative conversion of predicted circumferential resection margin status before surgery in patients with locally advanced rectal cancer with predicted circumferential resection margin involvement.

Methods

Thirty-eight patients (28 men, 10 women; median age, 61 years; age range, 39–80 years) with locally advanced rectal cancer with predicted circumferential resection margin involvement who underwent preoperative chemoradiotherapy followed by radical surgery were analyzed. Involvement of the circumferential resection margin was predicted on the basis of pre- and post-chemoradiotherapy magnetic resonance imaging. The primary endpoints were 3-year local recurrence-free survival and overall survival.

Results

The median follow-up time was 41.1 months (range, 13.9–85.2 months). The negative conversion rate of predicted circumferential resection margin status after preoperative chemoradiotherapy was 65.8%. Patients who experienced negative conversion of predicted circumferential resection margin status had a significantly higher 3-year local recurrence-free survival rate (100.0% vs. 76.9%; P = 0.013), disease-free survival rate (91.7% vs. 59.3%; P = 0.023), and overall survival rate (96.0% vs. 73.8%; P = 0.016) than those who had persistent circumferential resection margin involvement.

Conclusions

The negative conversion of the predicted circumferential resection margin status as predicted by magnetic resonance imaging will assist in individual risk stratification as a predictive factor for treatment response and survival before surgery. These findings may help physicians determine whether to administer more intense adjuvant chemotherapy or change the surgical plan for patients displaying resistance to preoperative chemoradiotherapy.     

前列腺中央腺体癌肿MRI多项技术成像的影像诊断

目的 探讨MRI多项技术成像应用在前列腺中央腺体癌肿的诊断与鉴别诊断中的价值.方法 收集并分析经过手术、穿刺后病理或经临床治疗后证实的21例前列腺中央腺体有癌肿患者的资料,所有患者均进行多项MRI技术成像：T2WI、扩散加权成像、波谱及动态增强扫描.结果 多项技术成像检查上能够显示前列腺中央腺体癌灶的形态、侵犯的范围,准确定性且能预测恶性程度;主要依据为常规T2WI序列上显示欠清,在DWI图像上则为高信号,在相应ADC图上呈低信号改变,波谱成像Cho峰明显升高,Cit峰下降,两峰呈倒置状态,病灶在增强后出现早期明显强化,时间-强化曲线为流出型.结论 MRI多项技术影像具有特征性,可提高前列腺中央腺体癌肿检出率及诊断率,在临床上有较高的应用价值.     

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.     

MRI-经直肠超声融合靶向穿刺对有临床意义前列腺癌的检出价值

目的探讨MRI-经直肠超声(TRUS)融合靶向穿刺对有临床意义前列腺癌(PCa)的检出价值。方法前瞻性收集2015年9月至2017年6月苏州大学附属第一医院临床疑诊的PCa患者168例。对多参数MRI(mpMRI)上的可疑病灶进行第二版前列腺图像报告和数据系统(PI-RADS V2)评分。所有患者均行TRUS引导下前列腺系统穿刺,其中108例PI-RAD V2评分≥3分的患者行MRI-TRUS融合靶向穿刺。以穿刺病理结果为金标准,采用χ2检验比较两种穿刺方法对PCa及有临床意义癌的检出率。结果168例中,PCa患者86例101个病灶,非PCa患者82例91个病灶。TRUS系统穿刺检出PCa 78例(46.43%,78/168),MRI-TRUS靶向穿刺检出PCa 63例(58.33%,63/108),二者间差异有统计学意义(χ2=3.73,P=0.035)。168例患者共穿刺2300针,其中经MRI-TRUS靶向穿刺的单针阳性率(51.76%,147/284)高于TRUS系统穿刺(19.64%,396/2016),差异有统计学意义(χ2=142.38,P<0.05)。在所有穿刺阳性病灶中,MRI-TRUS靶向穿刺阳性率(68.69%,147/214)高于TRUS系统穿刺组(38.37%,396/1032),差异有统计学意义(χ2=66.27,P<0.05)。MRI-TRUS靶向穿刺组检出有临床意义PCa占所有阳性病例穿刺针数的69.74%(106/152),TRUS系统穿刺检出有临床意义PCa为54.50%(351/644),两组间差异有统计学意义(χ2=11.67,P<0.05)。结论MRI-TRUS靶向穿刺与PI-RADS V2相结合较系统穿刺可有效提高前列腺的穿刺阳性率,并且能够提高有临床意义PCa的检出率。     

Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

Purpose:

To compare diffusion‐weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT).

Materials and Methods:

This prospective study was approved by our Institutional Review Board. Thirty‐four patients underwent three MR examinations: pre‐CRT (before CRT), early CRT (2 weeks after CRT initiation), and post‐CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis.

Results:

The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre‐CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre‐CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry.

Conclusion:

Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

肛瘘的术前MRI表现与手术结果的对照分析

目的 探讨术前MRI检查对肛瘘诊断及分型的价值.方法 回顾性分析经手术证实的36例肛瘘患者的临床资料及MRI表现,并与手术结果对照分析,总结肛瘘的MRI表现特点及应用价值.结果 36例肛瘘手术显示内口42个,主瘘管45条、瘘管分支15条,外口42个,脓肿16个.与手术结果对照,MRI显示肛瘘内口的准确率为90.5%(38/42个),显示瘘管分支的准确率为80%(12/15条),显示主瘘管、外口及脓肿的准确率均为100%.按照Parks分型,MRI分型符合率为88.9%(32/36例).结论 MRI能准确显示肛瘘内、外口的位置,瘘管的数量及走行,能够对肛瘘进行准确分型.     

前列腺外周带癌T 2 WI影像特征的多因素分析

目的：探讨前列腺外周带癌 T2 WI 影像特征的诊断价值。方法回顾性分析经病理证实的56例外周带前列腺癌的T2 WI图像,另选取75例前列腺增生、7例前列腺炎作为对照组,应用χ2检验对各影像特征进行筛选,再采用多因素Logistic回归分析。结果 T2 WI上病灶的信号强度、形态、均匀度、患侧外周带体积、患侧外周带与移行区分界、前列腺包膜在外周带前列腺癌与对照组的差异均有统计学意义(P<0.05),病灶的边界、包膜在2组间的差异无统计学意义(P>0.05)。多因素Logistic回归发现影响外周带前列腺癌的危险因素为病灶的形态、患侧外周带体积、前列腺包膜、外周带与移行区分界。结论 T2 WI 上病灶的形态、患侧外周带体积及前列腺包膜是诊断外周带前列腺癌的独立危险因素。     

3.0T MRI在直肠癌术前评估中的应用研究

目的 探讨3.0T MRI在直肠癌术前评估中的应用价值.方法 对41例经病理活检证实为直肠癌的患者进行常规MRI、高分辨MRI及扩散加权成像(DWI)扫描,测量肿瘤最下缘离肛缘的距离及累及环周百分比,评估肿瘤的TN分期、环周切缘(CRM)、系膜血管受侵(EMVI)的状态,与肠镜和手术结果比较.结果 MRI对判断肿瘤下缘距肛缘的距离具有很好的预测价值(P>0.05);T1~T2期、T3期肿瘤累及环周百分比的平均值分别是61%、83%(P>0.05);T、N分期诊断的总准确率分别为80.5%、75.6%,与病理诊断的一致性较好(Kappa值=0.564、0.634);CRM、EMVI诊断的总准确性分别是90.2%、73.2%,与病理诊断的一致性分别是较好、中度一致(Kappa值=0.765、0.461).     

MRI扩散加权成像在前列腺癌及其邻近器官侵犯诊断中的价值

目的探讨MRI扩散加权成像(DWI)和ADC图在前列腺癌及其邻近器官侵犯诊断与鉴别诊断中的价值。方法回顾性分析经穿刺活检或手术病理证实的前列腺癌30例。所有患者均进行MRI常规扫描和DWI扫描,DWI序列取b值为0、100、800及200、1000两组分别扫描,分析DWI表现和表观扩散系数(ADC)图,并测量癌肿区及周围侵犯区的ADC值。结果前列腺癌病灶和邻近组织侵犯的病灶在两组扫描中5个序列DWI图上均呈高信号,ADC图呈低信号。所有病例的ADC值均低于(897.4±67.5)×10-6。结论 DWI成像检查在前列腺癌及其周围侵犯的诊断中具有特征性表现,在临床上有较高的应用价值。     

1.5T MR超高b值DWI对前列腺癌的诊断价值

目的 探讨1.5T MR 超高b值扩散加权成像(DWI)对前列腺癌(PCa)的诊断价值.方法 收集分析行常规MRI和DWI(b值为400、800、1 400 s/mm2)扫描,并经临床病理证实的PCa 12例,前列腺增生(BPH)17例,分别测量各b值DWI上感兴趣区(ROI)的信号强度,对ROI的可视化程度进行分级,比较其间是否存在差异.结果 超高b值与高b值DWI PCa病灶的信号强度差异有统计学意义(χ2=220.957,P=0.000<0.05);b值越高,DWI上PCa癌灶亮度对比越高,可视化程度差异有统计学意义(χ2=11.378,P=0.003<0.05).超高b值DWI上PCa癌灶与BPH和正常外周带信号强度有统计学意义(χ2=25.913,P=0.000<0.05),超高b值DWI PCa病灶亮度主要是亮和灰亮(占71.4%),BPH和正常外周带的亮度以暗和灰暗为主(BPH组占63.0%,正常外周带组占73.3%);可视化程度差异都有统计学意义(Z=-6.908、-6.110,P值均为0.000<0.017).b=1 400 s/mm2的DWI信号强度和可视化程度诊断效能最高.结论 1.5T MR超高b值DWI能提高PCa癌灶的显示率,易于观察和诊断.     

Accuracy of MRI for predicting the circumferential resection margin,mesorectal fascia invasion,and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer

Purpose

To evaluate the diagnostic accuracy of MRI for predicting the circumferential resection margin (CRM), mesorectal fascia (MRF) invasion, and the tumor response to neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer.

Materials and Methods

Sixty‐five consecutive patients with locally advanced rectal cancer (≥T3 or lymph node‐positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. Two blinded radiologists independently reviewed both the pre‐ and post‐CRT rectal MR images and measured the post‐CRT CRM; they recorded their confidence level with respect to the MRF invasion and tumor response using a 5‐point scale. The diagnostic accuracy of each reviewer was calculated using receiver operating characteristic curve (ROC) analysis.

Results

The measured CRM was not significantly different from the reference standard (mean difference, ?1.4 mm; 95% limits of agreement, ?8.3–5.4 mm; interclass correlation coefficient, 0.82). The diagnostic accuracy (A_z) for determining MRF invasion was 0.890 for reviewer 1 (95% confidence interval [CI], 0.788–0.954) and 0.829 for reviewer 2 (95% CI, 0.715–0.911). The A_z for predicting complete or near‐complete regression was 0.791 for reviewer 1 (95% CI, 0.672–0.882) and 0.735 for reviewer 2 (95% CI, 0.611–0.837).

Conclusion

MRI provides accurate information regarding the CRM of locally advanced rectal cancer after neoadjuvant CRT; it also shows relatively high accuracy for predicting MRF invasion and moderate accuracy for assessing tumor response. J. Magn. Reson. Imaging 2009;29:1093–1101. © 2009 Wiley‐Liss, Inc.

     

T2WI积分法对前列腺移行区癌诊断及鉴别诊断的价值

目的 探讨T2WI积分法对移行区前列腺癌(PCa)诊断及鉴别诊断的价值.方法 回顾性分析经病理证实的43例移行区PCa和91例前列腺增生(BPH)患者的T2WI图像,将T2WI影像征象分为主要征象和次要征象,并赋予不同积分,通过受试者工作特征(ROC)曲线评价不同积分对其诊断价值.结果 在-1~10共11个积分段中,移行区PCa的敏感度随着积分的增加而降低,特异度和阳性预测值逐渐增高.依据ROC曲线,积分≥4.5时为最佳诊断值,其敏感度为81%,特异度为73.3%,阴性预测值为90.9%,准确度为70.4%;积分≥8.5时,特异度和阳性预测值均为100%;在积分≥0.5和≥1.5时,阴性预测值均为100%.结论 T2WI积分能对移行区PCa进行量化分析,对提高临床诊断和指导治疗具有重要的价值.     

磁共振扩散加权成像对直肠癌术前分期的价值

目的:探讨MR扩散加权成像在直肠癌诊断中的临床应用价值.方法:回顾性分析43例直肠癌患者的MRI资料,所有患者均行常规序列T1 WI、T2 WI及DWI检查,将MRI诊断结果与手术病理结果进行对照分析.结果:常规序列T1分期的诊断符合率为60.0％(3/5),T2、T3、T4分期分别为80.0％(12/15)、66.7％(12/18)和80.0％(4/5);常规序列联合DWI的T1分期诊断符合率为100％(5/5),T2、T3、T4分期分别为100.0％(15/15)、83.3％(15/18)和100.0％(5/5).常规序列及常规序列联合DWI的直肠癌T分期总诊断符合率分别为72.1％和93.0％.结论:MR扩散加权成像结合常规序列能够对直肠癌T分期做出较准确的诊断.     

三阴性乳腺癌3 T磁共振表现及临床病理特征研究

目的:研究三阴性乳腺癌(TNBC)3 T磁共振表现和临床病理特征,并与非三阴性乳腺癌(NTNBC)进行比较。方法:回顾性分析经病理证实的TNBC和NTNBC患者的MRI表现及病理组织学分型、分级等临床病理特征,用t检验及χ~2检验分析差异有无统计学意义。结果:TNBC与NTNBC在形态、内部强化及病理分级方面差异具有统计学意义(P<0.05),而在患者年龄、病灶大小、边缘及时间-信号强度曲线上,差异无统计学意义(P>0.05)。结论:MRI影像表现及病理特征有助于诊断TNBC。     

1.5T磁共振动态增强 扩散成像在前列腺癌诊断中的应用

目的分析前列腺癌患者接受1.5T磁共振动态增强、扩散成像诊断的临床应用价值。方法选择2018年2月至2019年2月我院收治40例前列腺癌患者为观察组研究对象,选择同期来我院接受体检的健康者40名为对照组,均采取1.5T磁共振动态增强、扩散成像检查,记录并比较2组患者动态增强结果及扩散成像结果差异。结果观察组患者在0 s时信号强度(0.85±0.12)SI、30 s时信号强度(1.04±0.23)SI、60 s时信号强度(1.30±1.03)SI、90 s时信号强度(1.32±0.14)SI、120s时信号强度(1.35±0.21)SI、150 s时信号强度(1.44±0.31)SI均高于对照组(P<0.05)(按照0 s、30 s、60 s、90 s、120 s、150 s描述),另外观察组患者在不同b值下ADC值均明显低于对照组(P<0.05)。结论前列腺癌患者通过1.5T MR动态增强及扩散成像诊断准确性较高,值得临床应用与推广。