Transrektal ultrason eşliğinde çoklu prostat biyopsilerinin etkinliğini arttırmada endorektal sarmal kullanılmadan yapılan difüzyon ağırlıklı manyetik rezonans görüntülemenin yeri

Abstract

Amaç: İlk defa prostat biyopsisi endikasyonu konmuş hastalarda endorektal sarmal kullanılmadan biyopsi öncesi uygulanan difüzyon ağırlıklı manyetik rezonans görüntüleme DAMRG bulgularının biyopsi sonuçları ile korelasyonu araştırılmıştır. DA-MRG’nin transrektal ultrason TRUSG eşliğinde yapılacak prostat çoklu biyopsisine yol gösterip gösteremeyeceği araştırılmak istenmiştir.Gereç ve Yöntemler: Temmuz 2010 Ağustos 2011 tarihleri arasında hastanemiz üroloji polikliniğine başvuran, ilk defa prostat biyopsisi endikasyonu konulmuş, rektal muayenede pozitif bulgusu olmayan 34 hastaya DAMRG incelemesi yapıldı. PSA alt sınırı 2,5 ng/ml olarak alındı. Prostat biyopsisi alanları; sağ taraf: “a ”, sol taraf: “b ” olarak adlandırıldı. Her bir alandan alınan 2’şer kor biyopsi aynı tüpte olacak şekilde toplam 12 tüp halinde patolojik incelemeye ayrı ayrı gönderildi. Takiben hastaların patolojik bulguları ile TRUSG biyopsi öncesi DA-MRG bulguları karşılaştırıldı ve aradaki korelasyona bakıldı.Bulgular: Prostat kanseri PK tespit edilen hastaların ortalama PSA değeri 7,0 ± 2,6 idi. Toplamdaki 34 hastanın 9 tanesinde PK saptandı %26 . Biyopsi sonucu PK olan 9 hastanın 6 tanesinde DA-MRG’nde şüpheli olarak rapor edilen alanlar ile patolojik veriler uyumlu bulundu %67 . Organa özgül uyumluluk ise 9 hastanın 8’inde vardı %88.8 . Pozitif yorum gücü 8/20 %40 , negatif yorum gücü 13/14 %92,8 , genel doğruluk oranı 21/34 %61,8 olarak bulunmuştur. Sonuç: İdeale yakın bir prostat örneklemesi için endorektal sarmal kullanılmadan yapılan DA-MRG’nin henüz kat etmesi gereken yol olduğunu düşünmekteyiz. Hastalara en az zarar vererek, tümör odaklarını en yüksek verimlilikle saptayacak ideal yöntemin bulunması için bu ve benzeri çalışmaların daha geniş kapsamlı ve geliştirilerek yapılması gereğine inanmaktayız

Keywords

• Prostat kanseri,tanı,radyoloji,MRG

The role of diffusion weighted magnetic resonance imaging without endorectal coil in increasing the efficiency of transrectal ultrasound guided prostate biopsies

Abstract

Objective: To study the effectiveness of diffusion weighted magnetic resonance imaging DW-MRI without the use an endorectal coil on detecting prostate zones with malignancy prior to prostate biopsies and to see whether the method can serve as a guide prior to transrectal ultrasound guided prostate biopsies. Materials and Methods: Between July 2010-August 2011, 34 patients with an indication for a prostate biopsy with no positive findings on digital rectal examination underwent DW-MRI. The lowest limit for PSA was 2,5ng/ ml. The zones of biopsy were marked as: “a 1- 6 ” for the right side and “b 1-6 ” for the left side. 2 biopsy cores were taken from every zone and the specimens for every zone were sent to pathology separately in 12 tubes. Pathologic findings were matched with the prebiopsy DWMRI findings for a possible correlation. Results: The mean PSA value for patients with prostate cancer PCa was 7,0 ± 2,6. PCa was detected in 9/34 patients 26% . Out of the 9 patients with a malignant biopsy, 6 had positive correlation in terms of Pca findings on DW-MRI 67% , whereas 8/9 88,8% patients were only organ specific. Positive predictive value was 8/20 40% and negative predictive value was 13/14 92,8% with an overall predictive value of 21/34 61,8% .Conclusion: DW-MRI without endorectal coil needs more development before acting as a guide for TRUSG guided prostate biopsies. We believe that, in order to find the ideal method to diagnose the tumors most efficiently and with the least complication rates, more expanded studies with larger series have to be done

Keywords

• Prostate cancer,diagnosis,radiology,MRI

References

1. Siegel R, Naishadham D, Jemal A. Cancer Statistics: 2013. Ca Cancer J Clin 2013; 63:11-30.
2. Hodge KK, McNeal JE, Terris MK, et al. Random systemic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989;142:71-4.
3. Matlaga BR, Eskew LA, McCollough DL. Prostate biopsy: indications and technique. J Urol 2003;169:12-9.
4. Stamey TA. Making of the most out of six systemic sextant biopsies. Urology 1996;45:2-12.
5. Presti Jc JR. Prostate biopsy strategies. Nat Clin Pract Urol 2007;4:505-11.
6. Somford DM, Fütterer JJ, Hambrock T, et al. Diffusion and perfusion MR imaging of the prostate. Magn Res Imaging Clin N Am 2008;16:685-95.
7. Issa B. In vivo measurement of the apparent diffusion co- efficient in normal and malignant prostatic tissues using echo-planar imaging. J Magn Res Imaging 2002;16:196-200.
8. Reinsberg SA, Payne GS, Riches SF, et al. Combined use of diffusion-weighted MRI and 1H MR spectroscopy to inc- rease accuracy in detection prostate cancer detection. AJR Am J Roentgenol 2007;188:91-8.

9. Mazaheri Y, Shukla-Dave A, Hricak H, et al. Prostate cancer:identification with combined diffusion-weighted MR imaging and 3D 1H MR spectroscopic imaging-correlation with pathologic findings. Radiology 2008;246:480-8.
10. Kirkham APS, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol 2006;50:1163–75, discussion 1175.
11. Futterer JJ, Heijmink SW, Scheenen TW, et al. Prostate can- cer localization with dynamic contrast-enhanced MR ima- ging and proton MR spectroscopic imaging. Radiology 2006;241:449–58.
12. Hosseinzadeh K, Schwarz SD. Endorectal diffusionweigh- ted imaging in prostate cancer to differentiate malignant and benign peripheral zone tissue. J Magn Reson Imaging 2004;20:654–61.
13. Singh AK, Krieger A, Lattouf JB, et al. Patient selection determines the prostate cancer yield of dynamic contrast- enhanced magnetic resonance imaging-guided transrectal biopsies in a closed 3-Tesla scanner. BJU Int 2008;101:181– 5.
14. Pondman KM, Fütterer JJ, Haken BT, et al. MR-Guided Biopsy of the Prostate: An Overview of Techniques and a Systematic Review Eur Urol 2008;54:517-27.
15. Eichler K, Hempel S, Wilby J, et al. Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systemic review. J Urol 2006;175:1605- 12.
16. de la Taille A, Antiphon P, Salomon L, et al. Prospective evaluation of a 21-sample needle biopsy procedure desig- ned to improve the prostate cancer detection rate. Urology 2003;61:1181-6.
17. Uzzo RG, Wei JT, Waldbaum RS, et al. The influence of pros- tate size on cancer detection. Urology 1995;46:46:831-6.
18. Nava L, Montorsi F, Consonni P, et al. Results of a prospec- tive randomized study comparing 6, 12, 18 transrectal ult- rasound guided sextant biopsies in patients with elevated PSA, normal DRE and normal prostatic ultrasound. J Urol 1997;157(supll):59A.
19. de la Rosette MCH, Jean J, Wink MH, et al. Optimizing prostate cancer detection: 8 versus12-core biopsy protocol. J Urol 2009;182:1329-36.
20. Abd TT, Goodman M, Hall J, et al. Comparison of 12-core versus 8-core prostate biopsy: Multivariate analysis of large series of US veterans. Urology 2011;77:542-7.
21. Sedelaar JP, Goossen TE, Wijkstra H, et al. Reproducibility of contrast-enhanced transrectal ultrasound of the prostate. Ultrasoud Med Biol 2001;27:595-602.
22. Sedelaar JP, Vijverberg PL, De Reijke TM, et al. Transrectal ultrasound in the diagnosis of prostate cancer: state of the art and future perspectives. Eur Urol 2001;40:275-84.
23. Leventis AK, Shariat SF, Utsunomia T, et al. Characteristics of normal prostate vascular anatomy as displayed by power Doppler. Prostate 2001;46:281-8.
24. Halpern EJ, Frauscher F, Forsberg F, et al. High-frequency Doppler US of the prostate: effect of patient position. Radi- ology 2002;222:634-9.
25. Keener TS, Winter TC, Berger R, et al. Prostate vascular flow: the effect of ejaculation as revealed on transrectal po- wer Doppler sonography. Am J Roentgenol 2000;175:1169- 72.
26. Kılıçkesmez Ö, Cimili T, İnci E, et al. Diffusion-weighted MRI of urinary bladder and prostate cancers. Diagn Interv Radiol 2009;15:104-10.
27. Kitajima K, Kaji Y, Kuroda K, et al. High b-value diffusion- weighted imaging in normal and malignant peripheral zone tissue of the prostate:effect of signal to-noise ratio. Mag Re- son Med Sci 2008;7:93-9.
28. Gibbs P, Liney GP, Pickles MD, et al. Correlation of ADC and T2 measurements with cell density in prostate cancer at 3.0 Tesla. Invest Radiol 2009;44:572-6.
29. Choi YJ, Kim JK, Kim N, et al. Functional MR imaging of prostate cancer. Radiographics 2007;27:63-75.
30. Courtney A. Woodfield CA, Tung GA, et al. Diffusion-Weighted MRI of Peripheral Zone Prostate Cancer:Comparison of Tumor Apparent Diffusion Coeffi- cient with Gleason Score and Percentage of Tumor on Core Biopsy. AJR 2010 April;194:316-22.
31. Yoshimitsu K, Kiyoshima K, Irie H, et al. Usefulness of ap- parent diffusion coefficient map in diagnosing prostate car- cinoma: correlation with stepwise histopathology. J Magn Reson Imaging 2008; 27:132–139.
32. Tanimoto A, Nakashima J, Kohno H, et al. Prostate can- cer screening: the clinical value of diffusion-weighted ima- ging and dynamic MR imaging in combination with T2- weighted imaging. J Magn Reson Imaging 2007;25:146-152.
33. Lim HK, Kim JK, Kim KA, et al. Prostate cancer: apparent diffusion coefficient map with T2-weighted images for de- tection- a multieader study. Radiology 2009;250:145-51.
34. Haider MA, van der Kwast TH, Tanguay J, et al. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 2007;189:323-328.
35. Zelhof B, Pickles M, Liney G, et al. Correlation of diffusion- weighted magnetic resonance data with cellularity in pros- tate cancer. BJU Int 2009;103:883-8.
36. Tamada T, Sone T, Jo Y, et al. Apparent diffusion coeffici- ent values in peripheral and transition zones of the prostate: comparison between normal and malignant prostatic tissu- es and correlation with histologic grade. J Magn Reson Ima- ging 2008;28:720-6.
37. de Souza NM, Riches SF, VanAs NJ, et al. Diffusion- weighhted magnetic resonance imaging: a potential non- invasive marker of tumor aggressiveness in localized pros- tate cancer. Clin Radiol 2008;63:774-82.