全身磁共振成像，用于分期患有前列腺癌的患者
Whole-body magnetic resonance imaging for staging patients with high-risk prostate cancer
影响因子:5.80000
发表日期:2024 Sep 17
作者:
Andrew M Fang, Brian F Chapin, Charles W Shi, Jia Sun, Aliya Qayyum, Vikas Kundra, Paul G Corn, Deborah A Kuban, Gregory C Ravizzini, Devaki Shilpa S Surasi, Jingfei Ma, Tharakeswara K Bathala
摘要
分期分期患有高危前列腺癌（HRPCA），其计算机断层扫描（CT）和骨闪烁显像（BS）的常规成像是次优的。因此，我们旨在比较全身磁共振成像（WBMRI）与常规成像与患有HRPCA的患者的准确性。我们前瞻性地招募了新诊断为HRPCA的患者（前列腺特异性抗原≥20ng/ml和/ml和/或/或级组≥4）。在评估后30天内，患者接受了BS，腹部和骨盆的CT和WBMRI。主要终点是检测到WBMRI和常规成像的淋巴结转移性疾病的诊断性能。参考标准是通过组织病理学或随访6个月的所有可用临床信息定义的。为了比较诊断测试，利用了接收器操作特征曲线的曲线（AUC）下的确切MCNEMAR的测试和面积。在招收的92例患者中，发现15例（16.3％）和8名（8.7％）患者分别患有淋巴和骨转移。 WBMRI在检测淋巴转移酶中的敏感性，特异性和准确性分别为0.60（95％置信区间0.32-0.84），0.84（0.74-0.92）和0.80（0.74-0.92）和0.80（0.71-0.88），而CT为0.20（0.20 （0.71-0.88）。 WBMRI对检测骨转移的敏感性，特异性和准确性分别为0.25（0.03-0.65），0.94（0.87-0.98）和0.88（0.80-0.94），而CT和BS则为0.12（0-0.53），0.94（0.94（0.94（0.87-0.94），以及0.87-0.98-0.98-0.98-0.98-0.98-0.98） （0.78-0.93）。为了评估淋巴转移，与CT相比，WBMRI表现出更高的敏感性（P = 0.031）和辨别力（0.72对0.56，P = 0.019）。对于HRPCA分期，WBMRI在淋巴传递中均优于淋巴传递和bone and CT和BS的bone and and and CT和BS bons and ct and cts and cts and ct and ct and cts and cts and ct and ct and cts and和bs bons和bs bons和bs bons and和bs。需要进一步的研究来评估WBMRI的成本效益以及联合PSMA PET和WBMRI的实用性。
Abstract
Staging patients with high-risk prostate cancer (HRPCa) with conventional imaging of computed tomography (CT) and bone scintigraphy (BS) is suboptimal. Therefore, we aimed to compare the accuracy of whole-body magnetic resonance imaging (WBMRI) with conventional imaging to stage patients with HRPCa.We prospectively enrolled patients with newly diagnosed HRPCa (prostate-specific antigen ≥20 ng/ml and/or Grade Group ≥4). Patients underwent BS, CT of the abdomen and pelvis, and WBMRI within 30 days of evaluation. The primary endpoint was the diagnostic performances of detecting metastatic disease to the lymph nodes and bone for WBMRI and conventional imaging. The reference standard was defined by histopathology or by all available clinical information at 6 months of follow-up. To compare diagnostic tests, Exact McNemar's test and area under the curve (AUC) of the receiver operating characteristics curves were utilized.Among 92 patients enrolled, 15 (16.3%) and 8 (8.7%) patients were found to have lymphatic and bone metastases, respectively. The sensitivity, specificity, and accuracy of WBMRI in detecting lymphatic metastases were 0.60 (95% confidence interval 0.32-0.84), 0.84 (0.74-0.92), and 0.80 (0.71-0.88), respectively, while CT were 0.20 (0.04-0.48), 0.92 (0.84-0.97), and 0.80 (0.71-0.88). The sensitivity, specificity, and accuracy of WBMRI to detect bone metastases were 0.25 (0.03-0.65), 0.94 (0.87-0.98), and 0.88 (0.80-0.94), respectively, while CT and BS were 0.12 (0-0.53), 0.94 (0.87-0.98), and 0.87 (0.78-0.93). For evaluating lymphatic metastases, WBMRI demonstrated a higher sensitivity (p = 0.031) and discrimination compared to CT (0.72 versus 0.56, p = 0.019).For staging patients with HRPCa, WBMRI outperforms CT in the detection of lymphatic metastases and performs as well as CT and BS in the detection of bone metastases. Further studies are needed to assess the cost effectiveness of WBMRI and the utility of combined PSMA PET and WBMRI.