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首页> 外文期刊>Radiology >Prostate cancer managed with active surveillance: role of anatomic MR imaging and MR spectroscopic imaging.
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Prostate cancer managed with active surveillance: role of anatomic MR imaging and MR spectroscopic imaging.

机译：积极监测可治疗的前列腺癌：MR解剖学和MR光谱学成像的作用。

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PURPOSE: To determine the role that magnetic resonance (MR) imaging and MR spectroscopic imaging findings obtained at the time of diagnosis play in the progression of disease in patients whose prostate cancer is being managed with active surveillance and to compare the role of these findings with the role of transrectal ultrasonography (US) findings. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study, and informed consent was obtained from all patients whose records were to be entered into the research database. All patients who had prostate cancer managed with active surveillance and who had undergone both MR imaging and MR spectroscopic imaging of the prostate and transrectal US at time of diagnosis were identified. Two urologists blinded to the clinical outcome in these patients independently reviewed and dichotomized the MR imaging report and the MR spectroscopic imaging report as normal or suggestive of malignancy. One experienced urologist performed all US examinations that were then dichotomized similarly. Uni- and multivariate (with use of standard clinical variables) Cox models were fitted to assess time to cancer progression, defined as Gleason score upgrading, prostate-specific antigen velocity of more than 0.75 (microg x L(-1))/y, or initiation of treatment more than 6 months after diagnosis. RESULTS: The final cohort included 114 patients with a median follow-up of 59 months. Patients with a lesion that was suggestive of cancer at MR imaging had a greater risk of the Gleason score being upgraded at subsequent biopsy (hazard ratio, 4.0; 95% confidence interval: 1.1, 14.9) than did patients without such a lesion. Neither MR spectroscopic imaging nor transrectal US could be used to predict cancer progression. CONCLUSION: Abnormal prostate MR imaging results suggestive of cancer may confer an increased risk of Gleason score upgrade at subsequent biopsy. Although expensive, prostate MR imaging may help in counseling potential candidates about active surveillance.
机译：目的：确定在诊断时获得的磁共振（MR）成像和MR光谱成像发现在积极监测前列腺癌患者的疾病进展中的作用，并比较这些发现与经直肠超声检查（美国）发现的作用。材料与方法：机构审查委员会批准了这项符合HIPAA要求的回顾性研究，并从所有患者的记录中获得了知情同意，所有患者的记录都将输入到研究数据库中。确定所有患有前列腺癌的患者均进行了主动监测，并在诊断时对前列腺和经直肠US进行了MR成像和MR光谱成像。两名泌尿科医师对这些患者的临床结局不知情，将其独立检查，并将MR成像报告和MR光谱成像报告分为正常或提示恶性肿瘤。一位经验丰富的泌尿科医生进行了所有美国检查，然后将其类似地分为两部分。使用单变量和多元变量（使用标准临床变量）拟合Cox模型以评估癌症进展时间，定义为格里森评分提高，前列腺特异性抗原速度超过0.75（microg x L（-1））/ y，或在诊断后六个月以上开始治疗。结果：最后队列包括114例患者，中位随访期为59个月。与没有病变的患者相比，在MR影像学检查中提示癌灶的病变患者在随后的活检中格里森评分升高的风险更大（危险比，4.0; 95％置信区间：1.1，14.9）。 MR光谱成像或经直肠US均不能用于预测癌症进展。结论：前列腺MR成像异常提示癌症，可能在随后的活检中增加格里森评分升高的风险。尽管价格昂贵，但前列腺MR成像可能有助于为主动监测的潜在候选人提供咨询。

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