Introduction: [<sup>18</sup>F]-fluoro-methylcholine (FCH) PET/CT and MRI with diffusion-weighted MRI (DW-MRI) have insufficient performance in lymph node staging of primary prostate cancer by themselves, b...Introduction: [<sup>18</sup>F]-fluoro-methylcholine (FCH) PET/CT and MRI with diffusion-weighted MRI (DW-MRI) have insufficient performance in lymph node staging of primary prostate cancer by themselves, but the combination may perform better. We aim to prospectively determine the diagnostic performance of combined FCH PET and MRI for lymph node staging. Methods: This was a single site study of diagnostic accuracy in a well-defined group of 21 consecutive high-risk primary prostate cancer patients (>30% chance of lymph node metastases) in a large community hospital. We performed FCH PET/CT and MRI with DW-MRI prior to endoscopic extended pelvic lymph node dissection (EPLND). PET was fused and interpreted together with various MRI image sets (T1, T2, DWIBS) and was only scored positive when a lymph node seen on MRI coincided with increased focal FCH uptake on PET. Findings were compared with detailed histological evaluation, on a per-patient and per-region level. We calculated sensitivity, specificity, positive and negative predictive value of combined PET-MRI. Results: 14 out of 21 patients had metastatic lymph nodes with 37 out of 164 evaluable regions harboring metastases. On a per-patient analysis, PET-MRI had a sensitivity/specificity of 79/100% with a PPV/NPV of 100/77%. On a per-region analysis (n = 164) these figure were 65/99% and 96/91%, respectively. Conclusions: Combined DW-MRI and FCH PET/CT has a very high positive predictive value in high risk prostate cancer patients. If confirmed in larger series a positive combined scan may safely allow cancellation of surgical staging in selected patients, depending on local protocols in N1 M0 patients.展开更多
目的探讨基于磁共振测量肢体的二维径线数据在评估单侧原发性下肢淋巴水肿(PLEL)临床分期的价值。方法回顾性搜集132例经确诊为PLEL患者,所有患者均行下肢MRI检查。采用短时反转恢复(STIR)序列测量双侧小腿软组织纵向及横向的总径线(TD...目的探讨基于磁共振测量肢体的二维径线数据在评估单侧原发性下肢淋巴水肿(PLEL)临床分期的价值。方法回顾性搜集132例经确诊为PLEL患者,所有患者均行下肢MRI检查。采用短时反转恢复(STIR)序列测量双侧小腿软组织纵向及横向的总径线(TD)、肌骨径线(MD)和皮下软组织径线(SD),分别计算患侧与健侧TD及SD的差值(DTD、DSD)。依据2020年国际淋巴协会(International Society of Lymphology,ISL)临床分期标准对患者进行相关分期。对所有测量数据进行统计分析,以确定MRI径线测量方法在PLEL临床分期中的可行性。结果横径TD(R=0.492)、SD(R=0.596)、DTD(R=0.608)、DSD(R=0.620)与临床分期的相关性明显大于纵径的TD(R=0.430)、SD(R=0.532)、DTD(R=0.547)和DSD(R=0.519),横径DSD与临床分期相关性最高。无论横径或纵径,淋巴水肿Ⅰ期患者TD、SD、DTD及DSD的值明显小于Ⅱ期及Ⅲ期(P<0.05),而Ⅱ期与Ⅲ期之间各测量值差异均无统计学意义(P>0.05)。横径鉴别临床分期的曲线下面积(AUC)大于纵径,其中横径DSD(AUC=0.930)鉴别Ⅰ期与Ⅱ期的AUC值最高。结论基于MRI测量软组织径线可以作为一种单侧PLEL临床分期的定量方法,推荐横径的皮下软组织差值DSD作为鉴别Ⅰ期与Ⅱ期淋巴水肿的最佳评估指标。展开更多
文摘Introduction: [<sup>18</sup>F]-fluoro-methylcholine (FCH) PET/CT and MRI with diffusion-weighted MRI (DW-MRI) have insufficient performance in lymph node staging of primary prostate cancer by themselves, but the combination may perform better. We aim to prospectively determine the diagnostic performance of combined FCH PET and MRI for lymph node staging. Methods: This was a single site study of diagnostic accuracy in a well-defined group of 21 consecutive high-risk primary prostate cancer patients (>30% chance of lymph node metastases) in a large community hospital. We performed FCH PET/CT and MRI with DW-MRI prior to endoscopic extended pelvic lymph node dissection (EPLND). PET was fused and interpreted together with various MRI image sets (T1, T2, DWIBS) and was only scored positive when a lymph node seen on MRI coincided with increased focal FCH uptake on PET. Findings were compared with detailed histological evaluation, on a per-patient and per-region level. We calculated sensitivity, specificity, positive and negative predictive value of combined PET-MRI. Results: 14 out of 21 patients had metastatic lymph nodes with 37 out of 164 evaluable regions harboring metastases. On a per-patient analysis, PET-MRI had a sensitivity/specificity of 79/100% with a PPV/NPV of 100/77%. On a per-region analysis (n = 164) these figure were 65/99% and 96/91%, respectively. Conclusions: Combined DW-MRI and FCH PET/CT has a very high positive predictive value in high risk prostate cancer patients. If confirmed in larger series a positive combined scan may safely allow cancellation of surgical staging in selected patients, depending on local protocols in N1 M0 patients.
文摘目的探讨基于磁共振测量肢体的二维径线数据在评估单侧原发性下肢淋巴水肿(PLEL)临床分期的价值。方法回顾性搜集132例经确诊为PLEL患者,所有患者均行下肢MRI检查。采用短时反转恢复(STIR)序列测量双侧小腿软组织纵向及横向的总径线(TD)、肌骨径线(MD)和皮下软组织径线(SD),分别计算患侧与健侧TD及SD的差值(DTD、DSD)。依据2020年国际淋巴协会(International Society of Lymphology,ISL)临床分期标准对患者进行相关分期。对所有测量数据进行统计分析,以确定MRI径线测量方法在PLEL临床分期中的可行性。结果横径TD(R=0.492)、SD(R=0.596)、DTD(R=0.608)、DSD(R=0.620)与临床分期的相关性明显大于纵径的TD(R=0.430)、SD(R=0.532)、DTD(R=0.547)和DSD(R=0.519),横径DSD与临床分期相关性最高。无论横径或纵径,淋巴水肿Ⅰ期患者TD、SD、DTD及DSD的值明显小于Ⅱ期及Ⅲ期(P<0.05),而Ⅱ期与Ⅲ期之间各测量值差异均无统计学意义(P>0.05)。横径鉴别临床分期的曲线下面积(AUC)大于纵径,其中横径DSD(AUC=0.930)鉴别Ⅰ期与Ⅱ期的AUC值最高。结论基于MRI测量软组织径线可以作为一种单侧PLEL临床分期的定量方法,推荐横径的皮下软组织差值DSD作为鉴别Ⅰ期与Ⅱ期淋巴水肿的最佳评估指标。
