Prostat Kanseri Tanı ve Lokal İnvazyon Değerlendirmesinde Multiparametrik Manyetik Rezonans Görüntülemenin Önemi

Year 2021, , 73 - 83, 11.03.2021

Hüseyin Aydın , Mustafa Balcı

https://doi.org/10.17343/sdutfd.811682

Abstract

Amaç: Prostat kanseri (PCa) tanısı ve kanser dışı prostat hastalıklarından (KDPH) ayırımında multiparametrik manyetik rezonans görüntülemenin (mpMRG) önemi değerlendirilmiştir.
Materyal Metod: Aralık 2017 ile Ocak 2020 tarihleri arasında, prostat kanseri (PCa) ön tanısı ile mpMRG yapılan 99 hastanın görüntüleri retrospektif olarak değerlendirildi. Standart MpMRG çekim protokolü T2A TSE (aksiyel-koronal-sagital), T1A TSE (axial-koronal-sagital), difüzyon ağırlıklı görüntüleme (DAG) ve T1A dinamik kontrastlı inceleme (DKİ) sekanslarından oluştu. Lezyonların lokasyonu, morfolojisi, ekstraprostatik yayılımı (EPY), T2A sinyal intensite (T2SI) değerleri, difüzyon kısıtlılığı, kontrastlanma eğri paternleri, maksimum kontrastlanma değeri (Cmax), maksimum kontrastlanmaya ulaşması için geçen süre (akselerasyon zaman: AZ) değerlendirildi. Bulgular arasındaki ilişki SPSS 20.0 programı ile değerlendirildi.
Bulgular: Değerlendirilen 99 olgunun 75’inin Prostat Ca (PCa), 24’ünün KDPH histopatolojik tanısı vardı. Tüm hastaların yaş ortalaması 66.5±7.4 idi. Periferal zon yerleşimli lezyonlarda “apparent diffusion coefficient” (ADC) (p<0,001), Cmax ve AZ (p<0.005) değerleri, PCa ve KDPH grupları arasında anlamlı farklılık saptandı. Transizyonel zon yerleşimli lezyon T2SI değerleri, hasta grupları arasında anlamlı farklılık gösterdi (p<0.001). PCa için Tip1 eğri ve KDPH için Tip 3 eğri paterni, ayırıcı tanı açısından anlamlı (p<0,002) bulundu. Tranzisyonel zon yerleşimli lezyonlarda eğri tipi malign tarafa kaydıkça T2SI’nde azalma görüldü. EPY derecesi arttıkça yakın invazyon oranlarında da artış saptandı (p<0,001).
Sonuç: Multiparametrik prostat MRG, PCa’yı KDPD’dan ayırmada ve lokal invazyon durumunu ortaya koymada son derece değerli bir radyolojik tanı yöntemidir. ADC, T2SI ve DCE kantitatif değerleri, benign-malign lezyon tahmininde önemli rol oynamaktadır.

Keywords

Prostat kanseri, prostatit, multiparametrik MRG, dinamik kontrastlı MR, difüzyon ağırlıklı görüntüleme

Supporting Institution

YOK

Thanks

Makalenin hazırlanmasında yaptığı teknik yardımlardan dolayı, Sayın Dr.Öğretim Üyesi Veysel Atilla Ayyıldız’a çok teşekkür ederiz.

Importance of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Diagnosis and Local Invasion Assessment

Abstract

Objective: The importance of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer (PCa) and in its differentiation from non-cancerous prostate diseases (NCPD) was evaluated.
Material Method: Images of 99 patients who underwent mpMRI with a pre-diagnosis of PCa between December 2017 and January 2020 were retrospectively evaluated. The MpMRG acquisition protocol consisted of T2W TSE (axial-coronal-sagittal), T1W TSE (axial-coronal-sagittal), diffusion-weighted imaging (DWI) and T1W dynamic contrast imaging (DCI) sequences. The location, morphology, extraprostatic spread (EPY) of the lesions, T2W signal intensity (T2SI) values, diffusion restriction, enhancement curve patterns, maximum enhancement value (Cmax), time to reach maximum enhancement (acceleration time: AZ) were evaluated. The relationship between the findings was evaluated using the SPSS 20.0 program.
Results: 75 of 99 cases were diagnosed as Prostate Ca (PCa), 24 of them had NCPD hitopathological diagnosis. The age ratio of all patients was 66.5 ± 7.4. A significant difference was found between the apparent diffusion coefficient (ADC) (p <0.001), Cmax and AT (p <0.005) values, PCa and KDPH groups in lesions located in the peripheral zone. T2SI values of lesions in the transitional zone differed significantly between patient groups (p <0.001). The Type 1 curve for PCa and the Type 3 curve for NCPD were found to be significant in terms of differential diagnosis (p <0.002). In transitional zone lesions, T2SI decreased as the curve type shifted to the malignant side. As the degree of EPY increased, an increase was found in the near invasion rates (p <0.001).
Conclusion: Multiparametric prostate MRI is an extremely valuable radiological diagnostic method in distinguishing PCa from NCPD and revealing the local invasion status. ADC, T2SI and DCE quantitative values play an important role in the prediction of benign-malignant lesions.

Keywords

Prostate cancer, prostatitis, multiparametric MRI, dynamic contrast MRI, diffusion weighted imaging

References

• 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49. 2. Johnson LM, Turkbey B, Figg WD, Choyke PL. Multiparametric MRI in prostate cancer management. Nat Rev Clin Oncol. 2014;11(6):346–53.
• 3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.
• 4. Hubanks JM, Boorjian SA, Frank I, Gettman MT, Thompson RH, Rangel LJ, et al. The presence of extracapsular extension is associated with an increased risk of death from prostate cancer after radical prostatectomy for patients with seminal vesicle invasion and negative lymph nodes. In: Urologic Oncology: Seminars and Original Investigations. Elsevier; 2014. p. 26-e1.
• 5. Mustafa S, Isil B, Canan A. Multiparametric MR in Prostate Cancer: General Practical Application Advices. UROONKOLOJI Bul UROONCOLOGY. 2015;14(2):136–43.
• 6. Rosenkrantz AB, Taneja SS. Radiologist, be aware: ten pitfalls that confound the interpretation of multiparametric prostate MRI. Am J Roentgenol. 2014;202(1):109–20.
• 7. Coşkun M, Türkbey B. PIRADS v2: Tuzaklar. Trd Sem 2017;5:429-39.
• 8. Eri LM, Thomassen H, Brennhovd B, Håheim LL. Accuracy and repeatability of prostate volume measurements by transrectal ultrasound. Prostate Cancer Prostatic Dis. 2002;5(4):273–8.
• 9. Verma S, Turkbey B, Muradyan N, Rajesh A, Cornud F, Haider MA, et al. Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. Am J Roentgenol. 2012;198(6):1277–88.
• 10. Requena-López AA, Mata-Samperio BK, Cuadra-Reyes LA, Casillas-Vargas R. Wilkie’s syndrome as a cause of bowel obstruction in adults: A case report. Cir Cir. 2020;88(2):185–8.
• 11. Uysal A, Özmen M. Prostat Kanseri Tanı ve Yönetiminde Dinamik Kontrastlı MRG. 2017;
• 12. Al-Khalil S, Boothe D, Durdin T, Sunkara S, Watkins P, Yang S, et al. Interactions between benign prostatic hyperplasia (BPH) and prostate cancer in large prostates: a retrospective data review. Int Urol Nephrol. 2016;48(1):91–7.
• 13. Chen ME, Troncoso P, Johnston D, Tang K, Babaian RJ. Prostate cancer detection: relationship to prostate size. Urology. 1999;53(4):764–8.
• 14. de Gorski A, Rouprêt M, Peyronnet B, Le Cossec C, Granger B, Comperat E, et al. Accuracy of magnetic resonance imaging/ultrasound fusion targeted biopsies to diagnose clinically significant prostate cancer in enlarged compared to smaller prostates. J Urol. 2015;194(3):669–73.
• 15. Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of prostate anatomy, histology, and pathology. Endocrinol Metab Clin. 2011;40(3):565–75.
• 16. Kantarcı M, Tonkaz G. Prostat Kanserinin Değerlendirilmesinde 3 T Difüzyon Ağırlıklı MR Görüntüleme. Trd Sem 2017;5:412-28. 17. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS prostate imaging–reporting and data system: 2015, version 2. Eur Urol. 2016;69(1):16–40.
• 18. Henderson DR, de Souza NM, Thomas K, Riches SF, Morgan VA, Sohaib SA, et al. Nine-year follow-up for a study of diffusion-weighted magnetic resonance imaging in a prospective prostate cancer active surveillance cohort. Eur Urol. 2016;69(6):1028–33.
• 19. Jordan EJ, Fiske C, Zagoria R, Westphalen AC. PI-RADS v2 and ADC values: is there room for improvement? Abdom Radiol. 2018;43(11):3109–16. 20. Fütterer JJ, Barentsz JO, Heijmink SW. Value of 3-T magnetic resonance imaging in local staging of prostate cancer. Top Magn Reson Imaging. 2008;19(6):285–9.
• 21. Baur ADJ, Maxeiner A, Franiel T, Kilic E, Huppertz A, Schwenke C, et al. Evaluation of the prostate imaging reporting and data system for the detection of prostate cancer by the results of targeted biopsy of the prostate. Invest Radiol. 2014;49(6):411–20.
• 22. Liu W, Turkbey B, Sénégas J, Remmele S, Xu S, Kruecker J, et al. Accelerated T2 mapping for characterization of prostate cancer. Magn Reson Med. 2011;65(5):1400–6.
• 23. Gibbs P, Liney GP, Pickles MD, Zelhof B, Rodrigues G, Turnbull LW. Correlation of ADC and T2 measurements with cell density in prostate cancer at 3.0 Tesla. Invest Radiol. 2009;44(9):572–6.
• 24. Hötker AM, Dappa E, Mazaheri Y, Ehdaie B, Zheng J, Capanu M, et al. The influence of background signal intensity changes on cancer detection in prostate MRI. Am J Roentgenol. 2019;212(4):823–9.
• 25. Wang L, Mazaheri Y, Zhang J, Ishill NM, Kuroiwa K, Hricak H. Assessment of biologic aggressiveness of prostate cancer: correlation of MR signal intensity with Gleason grade after radical prostatectomy. Radiology. 2008;246(1):168–76.
• 26. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol. 2019;76(3):340–51.
• 27. Padhani AR, Weinreb J, Rosenkrantz AB, Villeirs G, Turkbey B, Barentsz J. Prostate imaging-reporting and data system steering committee: PI-RADS v2 status update and future directions. Eur Urol. 2019;75(3):385–96. 28. Kim SH, Choi MS, Kim MJ, Kim YH, Cho SH. Role of semi–quantitative dynamic contrast–enhanced MR imaging in characterization and grading of prostate cancer. Eur J Radiol. 2017;94:154–9.
• 29. Dewhirst MW, Tso CY, Oliver R, Gustafson CS, Secomb TW, Gross JF. Morphologic and hemodynamic comparison of tumor and healing normal tissue microvasculature. Int J Radiat Oncol Biol Phys. 1989;17(1):91–9.
• 30. Ren J, Huan Y, Wang H, Chang Y-J, Zhao H-T, Ge Y-L, et al. Dynamic contrast-enhanced MRI of benign prostatic hyperplasia and prostatic carcinoma: correlation with angiogenesis. Clin Radiol. 2008;63(2):153–9.
• 31. Hansford BG, Peng Y, Jiang Y, Vannier MW, Antic T, Thomas S, et al. Dynamic contrast-enhanced MR imaging curve-type analysis: is it helpful in the differentiation of prostate cancer from healthy peripheral zone? Radiology. 2015;275(2):448–57.
• 32. Cristel G, Esposito A, Briganti A, Damascelli A, Brembilla G, Freschi M, et al. MpMRI of the prostate: is there a role for semi-quantitative analysis of DCE-MRI and late gadolinium enhancement in the characterisation of prostate cancer? Clin Radiol. 2019;74(4):259–67.
• 33. Pesapane F, Standaert C, De Visschere P, Villeirs G. T-staging of prostate cancer: identification of useful signs to standardize detection of posterolateral extraprostatic extension on prostate MRI. Clin Imaging. 2020;59(1):1–7.
• 34. de Rooij M, Hamoen EHJ, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol. 2016;70(2):233–45.
• 35. Salerno J, Finelli A, Morash C, Morgan SC, Power N, Schieda N, et al. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline. Can Urol Assoc J. 2016;10(9–10):E332.
• 36. Soylu FN, Eggener S, Oto A. Local staging of prostate cancer with MRI. Diagnostic Interv Radiol. 2012;18(4):365.