Multiparametrik MRG ile prostat kanseri teşhisinde perfüzyon MRG'nin tanıya katkısının değerlendirilmesi
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Prostat kanseri açısından şüpheli bulguları olan hastalarda multiparametrik prostat manyetik rezonans görüntüleme (MpPMRG) tetkiki ile Prostate Imaging Reporting and Data System versiyon 2 (PIRADS v2) kılavuzuna göre saptanan lezyonlarda, kantitatif perfüzyon MR verilerinin elde edilmesi ve bu verilerin prostat kanseri tanısına katkısının değerlendirilmesi Materyal ve Metod: Bu prospektif çalışma Malatya İnönü Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulu'nun 2018/66 protokol no'lu izni ile gerçekleştirildi. Ocak 2018 ile Mart 2019 tarihleri arasında klinik bulguları ve Prostat Spesifik Antijen (PSA) değeri prostat kanseri açısından şüpheli olan 56 hastanın,76 lezyonu çalışmaya dahil edildi. Tüm hastalara tıbbi endikasyon dahilinde multiparametrik prostat manyetik rezonans görüntüleme (MpPMRG) yapıldı. Çalışmaya dahil edilen hastaların görüntüleri histopatoloji sonuçları bilinmeden iki radyolog tarafından Prostate Imaging Reporting and Data System versiyon 2 (PIRADS v2) kılavuzuna uygun şekilde değerlendirildi. Yüksek b değerleri ile elde edilen ADC görüntülerde intensite ölçümü yapıldı. Dinamik kontrastlı manyetik rezonans (DkMR) görüntülerden tofts modeline göre perfüzyon MR haritaları oluşturuldu. Haritalar üzerinde lezyon alanlarından ve radyolojik olarak benign kabul edilen alandan referans ölçüm yapıldı. Hastalardan yapılan histopatolojik örnekleme ile Gleason skorları belirlendi. Perfüzyon MR görüntülerden elde edilen Ktrans, Kep, Ve, iAUC ve ADC sinyalinin Gleason ve Prostate Imaging Reporting and Data System (PIRADS) skoru ile korelasyonu incelendi. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 64,02 (44-86), tPSA değer ortalaması 20,11 (2,21-517,61) ng/ml, prostat volüm ortalaması 68,79 (18-186) ml'dir. Periferal zon yerleşimli lezyonların yüksek b değeri ile elde edilen ADC sinyal intensite, perfüzyon MR haritalarında belirlenen volüm of interest (VOI)'lerden elde edilen Ktrans, Kep, Ve ve iAUC değerlerinin histopatoloji sonucu benign ve kanser saptanan hastalar arasındaki farkı istatistiksel olarak anlamlı bulundu (p<0,05). Yapılan analizlerde periferal zon lezyonlarının Ktrans cut-off değeri 0,218, spesifitesi %52, sensitivitesi %75; iAUC cut-off değeri 0,209, spesifitesi %81,3, sensitivitesi %85,7 saptandı. Sonuç: DkMR görüntülerden elde edilen perfüzyon MR parametreleri, PIRADS skoru ile birlikte değerlendirildiğinde lezyonların histopatoloji sonuçları ile uyumunu artırmaktadır. Çalışmamız perfüzyon MR parametrelerinin, prostat gland periferal zon lezyonlarını benign-malign olarak karakterize etmede kullanılabilecek kantitatif ölçütler olduğunu göstermektedir. Bu verilerin kesinleşmesi için daha geniş hasta serileri ve prostatektomi veya MR füzyon biyopsi gibi daha güvenilir histopatolojik sonuçların elde edildiği ileri çalışmalara ihtiyaç duyulmaktadır. Anahtar kelimeler: Multiparametrik Prostat MRG, Perfüzyon MR, Ktrans, Prostat kanseri, PIRADS
Purpose: To obtain the quantitative perfusion MR data in the lesions determined according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual and to evaluate the contribution of these data in the diagnosis of cancer in patients with suspected prostate cancer. Materials and Methods: This prospective study was carried out with the permission of the protocol of Malatya İnönü University Scientific Research and Publication Ethics Board 2018/66. Between January 2018 and March 2019, 76 lesions of 56 patients with clinical findings and PSA were suspected for prostate cancer were included in the study. All patients underwent multiparametric prostate magnetic resonance imaging (MPPMRG) for medical indication. Images of the patients were evaluated according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual by 2 radiologists who did not know the histopathology results. Intensity measurements were performed on ADC images obtained with high b values. Perfusion MR maps were created from tkms images according to tofts model. On the maps, reference measurements were made from the lesions and radiologically benign areas. Gleason scores were determined by histopathological sampling. Correlation between Ktrans, Kep, Ve, iAUC and ADC signals obtained from perfusion MR images with Gleason and PIRADS scores were evaluated. Findings: The mean age of the patients included in the study was 64.02 (44-86), the mean value of tPSA was 20.11 (2.21-517.61) ng / ml, and the mean prostate volume was 68.79 (18-186) ml. ADC signal intensity obtained by the high b value of the lesions located in the peripheral zone, the Ktrans, Kep, Ve and iAUC values obtained from the volume of interest (VOI) obtained in the perfusion MR maps were found to be statistically significant (p <0.05). In the analyzes, the Ktrans cut-off value of the peripheral zone lesions was 0.218, the specificity was 52%, and the sensitivity was 75%; iAUC cut-off value was 0.209, specificity was 81.3% and sensitivity was 85.7%. Result: Evaluation of The perfusion MR parameters obtained from DkMR images with PIRADS scores increase the coherence of the lesions with histopathology results. Our study shows that the perfusion MR parameters are quantitative criteria that can be used to characterize prostate gland peripheral zone lesions as benign or cancer. Further studies with larger patient series having prostatectomy or MR fusion biopsy are needed to obtain more accurete histopathological results to confirm these data. Keywords: Multiparametric MRI, Perfusion MRI, Ktrans, Prostate cancer, PIRAD
Purpose: To obtain the quantitative perfusion MR data in the lesions determined according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual and to evaluate the contribution of these data in the diagnosis of cancer in patients with suspected prostate cancer. Materials and Methods: This prospective study was carried out with the permission of the protocol of Malatya İnönü University Scientific Research and Publication Ethics Board 2018/66. Between January 2018 and March 2019, 76 lesions of 56 patients with clinical findings and PSA were suspected for prostate cancer were included in the study. All patients underwent multiparametric prostate magnetic resonance imaging (MPPMRG) for medical indication. Images of the patients were evaluated according to Prostate Imaging Reporting and Data System version 2 (PIRADS v2) manual by 2 radiologists who did not know the histopathology results. Intensity measurements were performed on ADC images obtained with high b values. Perfusion MR maps were created from tkms images according to tofts model. On the maps, reference measurements were made from the lesions and radiologically benign areas. Gleason scores were determined by histopathological sampling. Correlation between Ktrans, Kep, Ve, iAUC and ADC signals obtained from perfusion MR images with Gleason and PIRADS scores were evaluated. Findings: The mean age of the patients included in the study was 64.02 (44-86), the mean value of tPSA was 20.11 (2.21-517.61) ng / ml, and the mean prostate volume was 68.79 (18-186) ml. ADC signal intensity obtained by the high b value of the lesions located in the peripheral zone, the Ktrans, Kep, Ve and iAUC values obtained from the volume of interest (VOI) obtained in the perfusion MR maps were found to be statistically significant (p <0.05). In the analyzes, the Ktrans cut-off value of the peripheral zone lesions was 0.218, the specificity was 52%, and the sensitivity was 75%; iAUC cut-off value was 0.209, specificity was 81.3% and sensitivity was 85.7%. Result: Evaluation of The perfusion MR parameters obtained from DkMR images with PIRADS scores increase the coherence of the lesions with histopathology results. Our study shows that the perfusion MR parameters are quantitative criteria that can be used to characterize prostate gland peripheral zone lesions as benign or cancer. Further studies with larger patient series having prostatectomy or MR fusion biopsy are needed to obtain more accurete histopathological results to confirm these data. Keywords: Multiparametric MRI, Perfusion MRI, Ktrans, Prostate cancer, PIRAD
Açıklama
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
