Оценка потенциала измеряемого коэффициента диффузии мультипараметрической магнитно-резонансной томографии в определении низкой степени злокачественности рака предстательной железы после радикальной простатэктомии

Гончарук Д.А., Велиев Е.И., Соколов Е.А. и др. Оценка потенциала измеряемого коэффициента диффузии мультипараметрической магнитно-резонансной томографии в определении низкой степени злокачественности рака предстательной железы после радикальной простатэктомии. Consilium Medicum. 2018; 20 (7): 15–19. DOI: 10.26442/2075-1753_2018.7.15-19

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Goncharuk D.A., Veliev E.I., Sokolov E.A. et al. Assessment of measured in multiparametric magnetic resonance imaging diffusion coefficient potential for low malignancy score determination in PC after radical prostatectomy. Consilium Medicum. 2018; 20 (7): 15–19. DOI: 10.26442/2075-1753_2018.7.15-19

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Аннотация

Цель – оценка корреляции измеряемого коэффициента диффузии – ИКД (ИКД опухоли и отношения ИКД) с финальной степенью злокачественности после радикальной простатэктомии (РПЭ).

Материалы и методы. В исследование были включены 118 пациентов с раком предстательной железы (РПЖ), которым была выполнена РПЭ в период с 2012 по 2017 г. с предварительно выполненной мультипараметрической магнитно-резонансной томографией (мпМРТ) 3 Тесла с контрастированием в одном центре. После анализа всех МР-исследований на основании карт ИКД были определены средние значения ИКД из опухолевой (ИКД опухоли) и доброкачественной ткани (ИКД доброкачественной ткани) и рассчитан ИКД отношения (деление ИКД опухоли на ИКД доброкачественной ткани).
Результаты. Между измерениями ИКД опухоли и послеоперационной степенью дифференцировки опухоли по Глисону обнаружена статистически значимая отрицательная корреляционная связь умеренной силы (коэффициент корреляции Спирмена = -0,733, p=0,000). При этом схожая корреляция была выявлена и для ИКД отношения с несколько более высоким коэффициентом Спирмена = -0,802, p=0,000. В ROC-анализе дискриминации РПЖ Глисон 6 от Глисон ≥7 площадь под ROC-кривой (AUC) для ИКД опухоли составила 0,898 (95% доверительный интервал – ДИ 0,835–0,961) и для ИКД отношения – 0,950 (95% ДИ 0,909–0,992). При использовании в качестве критерия определения Глисон 6 (грейд-группы 1) значения ИКД опухоли 0,78 и более чувствительность составила 78%, специфичность – 98%. При использовании значения отношения ИКД≥0,4501 чувствительность и специфичность составили 92 и 93% соответственно.
Заключение. Измерения ИКД опухоли имеют статистически значимую отрицательную корреляционную связь с финальной степенью злокачественности РПЖ Глисон 6 (грейд-группа 1) при послеоперационном патоморфологическом исследовании. ИКД отношения имел несколько более сильную корреляцию, что имеет большую точность при разделении степени Глисона 6 (3+3) от ≥(3+4).

Ключевые слова: рак предстательной железы, шкала Глисона, мультипараметрическая магнитно-резонансная томография, измеряемый коэффициент диффузии.

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Objective. To evaluate correlation of measured diffusion coefficient – MDC (tumor MDC and MDS ratio) with final malignancy degree after radical prostatectomy (RP).

Materials and methods. The study included 118 patients with prostate cancer in whom RP was performed between 2012 and 2017 after 3 Tesla contrast-enhanced multiparametric magnetic resonance imaging (mpMRI) in one medical center. After MRI results analysis mean MDC of tumor tissue (tumor MDC) and normal tissue (normal tissue MDC) were determined according to MDC records and MDC ratio was calculated (division of tumor MDC by normal tissue MDC).
Results. A significant negative moderate correlation (Spearman correlation coefficient = -0.733, p=0.000) was found between tumor MDC and postoperative tumor cells differentiation degree. Similar correlation was also found for MDS ratio with higher Spearman correlation coefficient = -0.802, p=0.000. In ROC-analysis of PC discrimination Gleason 6 from Gleason ≥7 area under ROC-curve (AUC) for tumor MDC was 0.898 (95% confidence interval – CI 0.835–0.961) and for MDC ratio – 0.950 (95% CI 0.909–0.992). When tumor MDC≥0,78 was used as a criteria for Gleason 6 (grade group 1) sensitivity was 78% and specificity – 98%. When MDC rate ≥0.4501 was used sensitivity and specificity comprised 92 and 93%, respectively.
Conclusion. When measured in postoperative pathomorphological study tumor MDC measurement has significant negative correlation with final malignancy rate of PC Gleason 6 (grade group 1). MDS ratio had somewhat stronger correlation that is more precise after Gleason score division 6 (3+3) from ≥(3+4).

Key words: prostate cancer, Gleason scale, multiparametric magnetic resonance imaging, measured diffusion coefficient.

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Список литературы

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19. Lebovici A, Sfrangeu SA, Feier D et al. Evaluation of the normal-todiseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness. BMC Med Imaging 2014; 14: 15.
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21. Langer DL, van der Kwast TH, Evans AJ et al. Intermixed normal tissue within prostate cancer: effect on MR imaging measurements of apparent diffusion coefficient and T2-sparse versus dense cancers. Radiology 2008; 249: 900–8.
22. Merret C et al. Magnet before the Needle: Commentary on MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis (PRECISION Trial). Urology 2018.

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2. Ahmed HU, Arya M, Freeman A et al. Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol 2012; 13 (11): e509–17.
3. Musunuru HB, Yamamoto T, Klotz L et al. Active surveillance for intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J Urol 2016; 196 (6): 1651–8.
4. Epstein JI, Zelefsky MJ, Sjoberg DD et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 2016; 69 (3): 428–35.
5. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 2012; 61: 1019–24.
6. Oto A, Kayhan A, Jiang Y et al. Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 2010; 257: 715–23.
7. Litjens GJS, Hambrock T, Hulsbergen-van de Kaa C et al. Interpatient variation in normal peripheral zone apparent diffusion coefficient: effect on the prediction of prostate cancer aggressiveness. Radiology 2012; 265: 260–6.
8. Verma S, Rajesh A, Morales H et al. Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy. AJR Am J Roentgenol 2011; 196: 374–81.
9. Hambrock T, Somford DM, Huisman HJ et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason gradein peripheral zone prostate cancer. Radiology 2011; 259: 453–61.
10. Vargas HA, Akin O, Franiel T et al. Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Radiology 2011; 259: 775–84.
11. Jung S, Donati OF, Vargas HA et al. Transition zone prostate cancer: incremental value of diffusion-weighted endorectal MR imaging in tumor detection and assessment of aggressiveness. Radiology 2013; 269: 493–503.
12. Barentsz JO, Richenberg J, Clements R et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746–57.
13. Kim CK, Park BK, Kim B. High-b-value diffusion-weighted imaging at 3 T to detect prostate cancer: comparisons between b values of 1,000 and 2,000 s/mm2. AJR Am J Roentgenol 2010; 194: W33–37.
14. Zelhof B, Pickles M, Liney G et al. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer. BJU Int 2009; 103: 883–88.
15. Gibbs P, Liney GP, Pickles MD et al. Correlation of ADC and T2measurements with cell density in prostate cancer at 3.0 Tesla. Invest Radiol 2009; 44: 572–6.
16. Simpkin CJ, Morgan VA, Giles SL et al. Relationship between T2 relaxation andapparent diffusion coefficient in malignant and non-malignant prostate regions and the effect ofperipheral zone fractional volume. Br J Radiol 2013; 86: 20120469.
17. Kim JH, Kim JK, Park B-W et al. Apparent diffusion coefficient: prostate cancer versus noncancerous tissue according to anatomical region. J Magn Reson Imaging 2008; 28: 1173–9.
18. Thormer G, Otto J, Horn L-C et al. Non-invasive estimation of prostate cancer aggressiveness using diffusion-weighted MRI and 3D proton MR spectroscopy at 3.0 T. Acta Radiol 2014 [Epub ahead of print].
19. Lebovici A, Sfrangeu SA, Feier D et al. Evaluation of the normal-todiseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness. BMC Med Imaging 2014; 14: 15.
20. Rosenkrantz AB, Kopec M, Kong X et al. Prostate cancer vs. postbiopsy hemorrhage: diagnosis with T2- and diffusion-weighted imaging. J Magn Reson Imaging 2010; 31: 1387–94.
21. Langer DL, van der Kwast TH, Evans AJ et al. Intermixed normal tissue within prostate cancer: effect on MR imaging measurements of apparent diffusion coefficient and T2-sparse versus dense cancers. Radiology 2008; 249: 900–8.
22. Merret C et al. Magnet before the Needle: Commentary on MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis (PRECISION Trial). Urology 2018.

Авторы

Д.А.Гончарук*1, Е.И.Велиев1,2, Е.А.Соколов1,2, И.В.Шабунин3, О.В.Паклина2, Г.Р.Сетдикова2

1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;

2 ГБУЗ «Городская клиническая больница им. С.П.Боткина» Департамента здравоохранения города Москвы. 125284, Россия, Москва, 2-й Боткинский пр-д, д. 5;
3 Лечебно-диагностический центр «Патеро-клиник». 129226, Россия, Москва, пр. Мира, д. 211, к. 2
*gonch.urology@yandex.ru

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D.A.Goncharuk*1, E.I.Veliev1,2, E.A.Sokolov1,2, I.V.Shabunin3, O.V.Paklina2, G.R.Setdikova2

1 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;

2 S.P.Botkin City Сlinical Hospital of the Department of Health of Moscow. 125284, Russian Federation, Moscow, 2-i Botkinskii pr-d, d. 5;
3 Medical and diagnostic center “Patero-Clinic”. 129226, Russian Federation, Moscow, pr. Mira, d. 211, k. 2
*gonch.urology@yandex.ru

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