Sessiz ve anlamlı prostat kanseri ayrımında kantitatif DCE-MRG faydalı mıdır?

Amaç: Prostat manyetik rezonans görüntülemede (MRG) dinamik kontrastlı inceleme (DKİ) için direk görsel değerlendirme önerilir. Kalitatif bir yaklaşım olarak bu okuyucular arası uyumsuzluğa neden olur. Bu çalışmada, tüm-spesimen histopatolojisini referans kabul ederek sessiz ve anlamlı prostat kanserlerinde kantitatif DKİ parametrelerinin karşılaştırılması amaçlanmıştır. Yöntemler: Multiparametrik MRG ve ardından radikal prostatektomi yapılan 76 olgu çalışmaya dahil edildi. İndeks tümörün yeri patoloji raporu kullanılarak tespit edildi. Bu bölgenin MRG bulguları başka bir radyolog tarafından prostat görüntüleme-raporlama ve bilgi sistemi versiyon 2.1 (PI-RADSv2.1) kullanılarak incelendi. Gleason 3+3 tümörler sessiz, Gleason ≥ 3+4 tümörler anlamlı kanser kabul edildi. İlgi alanı (ROI), lezyona ve normal periferal zona yerleştirildi. Ktrans, Kep, Ve, başlangıç eğrisinin altındaki alan (EAA) için lezyon değeri ve lezyon/normal oranı hesaplandı. Bu parametreler T testi kullanılarak sessiz ve anlamlı kanserlerde karşılaştırıldı. Bulgular: Olguların PI-RADSv2.1 skoru 2’den 5’e olgu sayısı sırasıyla 5, 4, 24 ve 43’tü. Sessiz kanserli olgu sayısı 13, anlamlı kanserli olgu sayısı 63 idi. Ktrans, Kep, Ve, EAA lezyon/normal oranları sessiz kanserler için sırasıyla 1.6, 1.59, 12, 2.1 iken, anlamlı kanserler için 3.1, 4.04, 1.39, 2.8 idi. Ktrans lezyon/normal oranı anlamlı kanserlerde yüksek iken, Ve lezyon/normal oranı sessiz kanserlerde yüksekti. Kep ve EAA için sessiz ve anlamlı kanserlerde anlamlı fark yoktu (P>0,05). Sonuç: Kantitatif değerlendirme, dinamik MRG’de daha objektif-kopyalanabilir sonuçlar sunar. Ktrans ve Ve lezyon/normal doku oranları, sessiz ve anlamlı kanserin ayrımında yardımcıdır.

Anahtar Kelimeler:

Dinamik MRG, Gleason, multiparametrik prostat MRG, perfüzyon MRG, prostat kanseri

Is quantitative DCE-MRI useful in differentiation of indolent and significant prostate cancers?

Aim: Direct visual assessment is recommended in prostate magnetic resonance imaging (MRI) for dynamic contrast enhancement (DCE), however, being a qualitative approach, it may cause inter-reader variability. The purpose of this study was to compare quantitative DCE parameters in the differentiation of clinically significant prostate cancer from indolent cancer using whole-mount histopathology. Methods: Seventy-six patients who underwent multiparametric MRI with suspicion of prostate cancer and subsequent radical prostatectomy were included. Index tumor location was determined with pathology reports. MRI findings of this location were evaluated by a different radiologist using prostate imaging-reporting and data system version 2.1 (PI-RADSv2.1) guideline. Gleason 3+3 tumors were considered indolent, and Gleason ≥ 3+4 tumors were considered significant cancers. Region-of-interests (ROI) were placed in the lesion and the normal peripheral zone. Lesion values and lesion/normal ratios of Ktrans, Kep, Ve, area under curve (iAUC) were calculated. T test was used in statistical analysis. Results: The numbers of cases with PI-RADSv2.1 scores of 2, 3, 4 and 5 were 5, 4, 24, and 43, respectively. There were 13 indolent cases and 63 patients with significant prostate cancer. Lesion/normal ratios of Ktrans, Kep, Ve, iAUC were 1.6, 1.59, 12, 2.1, respectively, in indolent cancers, and 3.1, 4.04, 1.39, 2.8, respectively, in significant cancers. Lesion/normal ratio of Ktrans was higher in significant cancers while lesion/normal ratio of Ve was higher in indolent cancers. Kep and iAUC were similar (P>0.05 for each). Conclusion: Quantitative DCE assessment may demonstrate more reproducible results. Lesion/normal tissue ratios of Ktrans and Ve were helpful in differentiation between indolent and significant prostate cancers.

Keywords:

dynamic mri, gleason, multiparametric prostate mri, perfusion mri, prostate cancer,

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