全身磁共振成像在高危前列腺癌患者分期中的应用

Whole-body magnetic resonance imaging for staging patients with high-risk prostate cancer

PROSTATE CANCER AND PROSTATIC DISEASES

影响因子:5.8

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

DOI: 10.1038/s41391-024-00893-1

摘要

传统的计算机断层扫描（CT）和骨扫描（BS）在高危前列腺癌（HRPCa）患者的分期中效果有限。因此，本研究旨在比较全身磁共振成像（WBMRI）与常规影像在高危前列腺癌患者分期中的准确性。我们前瞻性招募了新诊断的高危前列腺癌患者（前列腺特异性抗原≥20 ng/ml和/或分级组≥4），患者在评估前30天内接受了BS、腹盆部CT和WBMRI。主要终点为WBMRI和常规影像在检测淋巴结和骨转移方面的诊断性能。以组织学或随访6个月的全部临床资料作为金标准。采用Exact McNemar检验和受试者工作特征曲线（ROC）下面积（AUC）进行比较。在92名入组患者中，15人（16.3%）检测到淋巴结转移，8人（8.7%）检测到骨转移。WBMRI检测淋巴结转移的敏感性、特异性和准确率分别为0.60（95% CI：0.32-0.84）、0.84（0.74-0.92）和0.80（0.71-0.88），而CT分别为0.20（0.04-0.48）、0.92（0.84-0.97）和0.80（0.71-0.88）。WBMRI检测骨转移的敏感性、特异性和准确率为0.25（0.03-0.65）、0.94（0.87-0.98）和0.88（0.80-0.94），而CT和BS分别为0.12（0-0.53）、0.94（0.87-0.98）和0.87（0.78-0.93）。在淋巴结转移的评估中，WBMRI表现出更高的敏感性（p=0.031）和鉴别能力（0.72对比0.56，p=0.019）。在高危前列腺癌患者的分期中，WBMRI优于CT用于淋巴结转移的检测，与CT和BS在骨转移检测中表现相当。未来需要进一步研究WBMRI的成本效益以及PSMA PET与WBMRI的联合应用价值。

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.