A utilidade da quantificação do coeficiente aparente de difusão na estratificação de risco do cancro da próstata por ressonância magnética em 1,5T sem sonda endorretal
DOI:
https://doi.org/10.24915/aup.33.3.33Palavras-chave:
Ressonância magnética multiparamétrica, Cancro da próstata, Coeficiente aparente de difusão, Score de Gleason, Estratificação de riscoResumo
Objetivo
Avaliar a relação entre os valores de coeficiente aparente de difusão (ADC) e os scores de Gleason (SG) pós-cirúrgicos e determinar a acuidade diagnóstica da ressonância magnética multiparamétrica (RM-Mp) 1.5T sem sonda endorretal na distinção de carcinomas da próstata de baixo, intermédio e alto grau.
Material e métodos
Estudo retrospetivo, científica e eticamente aprovado, incluindo 30 doentes (idade média: 60 anos) submetidos a RM-Mp pré-prostatectomia. Utilizando os relatórios histológicos como guia, os tumores foram localizados nos mapas de ADC, com vista a quantificar os coeficientes. Dois doentes apresentaram 2 focos mensuráveis, pelo que foram estudados 32 tumores. A relação entre os valores de ADC e o SG foi analisada através do coeficiente de correlação de Spearman. Para avaliar a acuidade diagnóstica dos valores ADC, foram obtidas receiver operating characteristic curves (curvas ROC).
Resultados
Os valores de ADC mostraram uma correlação negativa significativa com o SG. Na diferenciação de tumores com SG de 6 e SG≥7, obteve-se AUC de 0,76 (intervalo de confiança 95%: 0,59; 0,93). Na diferenciação de tumores com SG de 6 ou 7 e SG≥8, obteve-se AUC de 0,94 (intervalo de confiança 95%: 0,86; 1,00).
Conclusão
A medição dos valores de ADC num aparelho de 1,5T sem sonda endorretal é útil na estratificação de risco do cancro da próstata.
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Referências
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Eur J Radiol, 82 (2013), pp. 1219-1226 http://dx.doi.org/10.1016/j.ejrad.2013.02.021
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18 G. Ravizzini,B. Turkbey,K. Kurdziel,P.L. Choyke New horizons in prostate cancer imaging Eur J Radiol, 70 (2009), pp. 212-226 http://dx.doi.org/10.1016/j.ejrad.2008.09.019
19 H. Hricak,P. Choyke,S.C. Eberhardt,S.A. Leibel,P.T. Scardino Imaging prostate cancer: a multidisciplinary perspective Radiology, 243 (2007), pp. 28-53 http://dx.doi.org/10.1148/radiol.2431030580
20 C.A. Ben,N. Girouin,M. Colombel,J.M. Maréchal,A. Gelet,A. Bissery Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy Eur Radiol, 19 (2009), pp. 770-778 http://dx.doi.org/10.1007/s00330-008-1190-8
21 S. Heijmink,J.J. Fütterer,T. Hambrock,S. Takahashi,T.W. Scheenen,H.J. Huisman Prostate cancer: body-array versus endorectal coil MR imaging at 3T – comparison of image quality, localization, and staging performance
Radiology, 244 (2007), pp. 184-195 http://dx.doi.org/10.1148/radiol.2441060425
2 B. Turkbey,P.S. Albert,K. Kurdziel,P.L. Choyke Imaging localized prostate cancer: current approaches and new developments Am J Roentgenol, 192 (2009), pp. 1471-1480
3 J.O. Barentsz,J. Richenberg,R. Clements,P. Choyke,S. Verma,G. Villeirs ESUR prostate MR guidelines 2012
Eur Radiol, 22 (2012), pp. 746-757 http://dx.doi.org/10.1007/s00330-011-2377-y
4 B. Turkbey,H. Mani,O. Aras,J. Ho,A. Hoang,A.R. Rastinehad Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology, 268 (2013), pp. 144-152 http://dx.doi.org/10.1148/radiol.13121325
5 H.A. Vargas,O. Akin,T. Franiel,Y. Mazaheri,J. Zheng,C. Moskowitz Diffusion-weighted endorectal MR imaging at 3T for prostate cancer: tumor detection and assessment of aggressiveness Radiology, 259 (2011), pp. 775-784 http://dx.doi.org/10.1148/radiol.11102066
6 L.K. Bittencourt,J.O. Barentsz,L.C.D. de Miranda,E.L. Gasparetto Prostate MRI: diffusion-weighted imaging at 1.5T correlates better with prostatectomy Gleason Grades than TRUS-guided biopsies in peripheral zone tumours
Eur Radiol, 22 (2012), pp. 468-475 http://dx.doi.org/10.1007/s00330-011-2269-1
7 M. Chen,H.D. Dang,J.Y. Wang,C. Zhou,S.Y. Li,W.C. Wang Prostate cancer detection: comparison of T2-weighted imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopic imaging, and the three techniques combined Acta Radiol, 49 (2008), pp. 602-610 http://dx.doi.org/10.1080/02841850802004983
8 A. Qayyum Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications Radiographics, 29 (2009), pp. 1797-1810 http://dx.doi.org/10.1148/rg.296095521
9 R. Shimofusa,H. Fujimoto,H. Akamata,K. Motoori,S. Yamamoto,T. Ueda Diffusion-weighted imaging of prostate cancer J Comput Assist Tomogr, 29 (2005), pp. 149-153
10 B. Turkbey,V.P. Shah,Y. Pang,M. Bernardo,S. Xu,J. Kruecker Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? Radiology, 258 (2010), pp. 488-495 http://dx.doi.org/10.1148/radiol.10100667
11 K. Kitajima,S. Takahashi,Y. Ueno,H. Miyake,M. Fujisawa,F. Kawakami Do apparent diffusion coefficient (ADC) values obtained using high b-values with a 3-T MRI correlate better than a transrectal ultrasound (TRUS)-guided biopsy with true Gleason scores obtained from radical prostatectomy specimens for patients with prostat
Eur J Radiol, 82 (2013), pp. 1219-1226 http://dx.doi.org/10.1016/j.ejrad.2013.02.021
12 S. Verma,A. Rajesh,H. Morales,L. Lemen,G. Bills,M. Delworth Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy Am J Roentgenol, 196 (2011), pp. 374-381
13 D. Koh,A. Sohaib Diffusion-weighted imaging of the male pelvis Radiol Clin N Am, 50 (2012), pp. 1127-1144 http://dx.doi.org/10.1016/j.rcl.2012.08.008
14 G. Giannarini,G. Petralia,H.C. Thoeny Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature Eur Urol, 61 (2012), pp. 326-340 http://dx.doi.org/10.1016/j.eururo.2011.09.019
15 M. Sadinski,M. Medved,I. Karademir,S. Wang,Y. Peng,Y. Jiang Short-term reproducibility of apparent diffusion coefficient estimated from diffusion-weighted MRI of the prostate Abdom Imaging, 40 (2015), pp. 2523-2528 http://dx.doi.org/10.1007/s00261-015-0396-x
16 N. Lawrentschuk,L. Klotz Active surveillance for low-risk prostate cancer: an update Nat Rev Urol, 8 (2011), pp. 312-320 http://dx.doi.org/10.1038/nrurol.2011.50
17 M. Large,S. Eggener Active surveillance for low-risk localized prostate cancer Oncol Willist Park, 23 (2009), pp. 974-979
18 G. Ravizzini,B. Turkbey,K. Kurdziel,P.L. Choyke New horizons in prostate cancer imaging Eur J Radiol, 70 (2009), pp. 212-226 http://dx.doi.org/10.1016/j.ejrad.2008.09.019
19 H. Hricak,P. Choyke,S.C. Eberhardt,S.A. Leibel,P.T. Scardino Imaging prostate cancer: a multidisciplinary perspective Radiology, 243 (2007), pp. 28-53 http://dx.doi.org/10.1148/radiol.2431030580
20 C.A. Ben,N. Girouin,M. Colombel,J.M. Maréchal,A. Gelet,A. Bissery Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy Eur Radiol, 19 (2009), pp. 770-778 http://dx.doi.org/10.1007/s00330-008-1190-8
21 S. Heijmink,J.J. Fütterer,T. Hambrock,S. Takahashi,T.W. Scheenen,H.J. Huisman Prostate cancer: body-array versus endorectal coil MR imaging at 3T – comparison of image quality, localization, and staging performance
Radiology, 244 (2007), pp. 184-195 http://dx.doi.org/10.1148/radiol.2441060425
Publicado
2017-04-10
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