4.6 Article

Assessment of Prostate Cancer Aggressiveness Using Dynamic Contrast-enhanced Magnetic Resonance Imaging at 3 T

期刊

EUROPEAN UROLOGY
卷 64, 期 3, 页码 448-455

出版社

ELSEVIER
DOI: 10.1016/j.eururo.2013.05.045

关键词

Dynamic contrast-enhanced MRI; Pharmacokinetic modeling; Prostate cancer; Prostate cancer aggressiveness; Validation study

资金

  1. European Research Council/ERC [243115]
  2. Dutch Cancer Society [KWF: KUN 2007/3971]
  3. European Research Council (ERC) [243115] Funding Source: European Research Council (ERC)

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Background: A challenge in the diagnosis of prostate cancer (PCa) is the accurate assessment of aggressiveness. Objective: To validate the performance of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate at 3 tesla (T) for the assessment of PCa aggressiveness, with prostatectomy specimens as the reference standard. Design, settings, and participants: A total of 45 patients with PCa scheduled for prostatectomy were included. This study was approved by the institutional review board; the need for informed consent was waived. Outcome measurements and statistical analysis: Subjects underwent a clinical MRI protocol including DCE-MRI. Blinded to DCE-images, PCa was indicated on T2-weighted images based on histopathology results from prostatectomy specimens with the use of anatomical landmarks for the precise localization of the tumor. PCa was classified as low-, intermediate-, or high-grade, according to Gleason score. DCE-images were used as an overlay on T2-weighted images; mean and quartile values from semi-quantitative and pharmacokinetic model parameters were extracted per tumor region. Statistical analysis included Spearman's rho, the Kruskal-Wallis test, and a receiver operating characteristics (ROC) analysis. Results and limitations: Significant differences were seen for the mean and 75th percentile (p75) values of wash-in (p = 0.024 and p = 0.017, respectively), mean wash-out (p = 0.044), and p75 of transfer constant (K-trans) (p = 0.035), all between low-grade and high-grade PCa in the peripheral zone. ROC analysis revealed the best discriminating performance between low-grade versus intermediate-grade plus high-grade PCa in the peripheral zone for p75 of wash-in, K-trans, and rate constant (K-ep) (area under the curve: 0.72). Due to a limited number of tumors in the transition zone, a definitive conclusion for this region of the prostate could not be drawn. Conclusions: Quantitative parameters (K-trans and K-ep) and semi-quantitative parameters (wash-in and wash-out) derived from DCE-MRI at 3 T have the potential to assess the aggressiveness of PCa in the peripheral zone. P75 of wash-in, K-trans, and K-ep offer the best possibility to discriminate low-grade from intermediate-grade plus high-grade PCa. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

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