ROLE OF MRI IN DIAGNOSIS AND GRADING OF PROSTATE CARCINOMA
Eman Farouk Foad Doula;
Abstract
Diagnosis of prostate cancer depend on elevated serum PSA level and confirmed with trans-rectal US–guided biopsy using sextant samples obtained from the peripheral zone (Yacoub et al, 2012).
Multiple limitation factors for this diag¬nostic paradigm include:
1. low specificity of serum PSA for the detection of cancer prostate and may leads to unnecessary biopsy.
2. Many prostatic condition (eg, benign prostatic hyperplasia, acute or chronic prostatitis) elevate serum PSA value.
3. The cut of value for serum PSA level is > 4 ng/mL shows major limitation as Clinically significant cancer could be present even with a lower PSA value (Yacoub et al, 2012).
4. TR US guided biopsy which usually does not allow the direct visualization and targeting of abnormal regions of the prostate, yet it can detect cancerous lesions in some cases. So, TRUS–guided biopsy has a low sensitivity (range, 39%–52%), yet with speci¬ficity of approximately 80% though, repeated biopsies were needed (Yacoub et al, 2012).
The cancer detection rate falls from 22%– 38% at the initial biopsy to 10%–17% at the second biopsy and 5%–15% at the third biopsy (Yacoub et al, 2012).
Functional MR imaging techniques combined with conventional imaging had provided improved cancer detection and localization, as well as information regarding the aggressiveness, volume, and staging of cancers for individualized therapy.
we proved that mp-MRI has sensitivity, specificity, validity, positive predictive value and negative predictive values of 100% compared to biopsy-proven pathological results which is only 82.1% sensitivity, specificity 100%, validity of 84.8% and negative predictive value 50% yet 100% positive predictive value.
We prove that the mean ADC for areas with negative biopsy findings is > 1.2 x 10-3 mm2/sec2 in PZ and mean ADC values in tumors with Gleason score 3+3 is 0.910 0 +/_ 0.18367 x 10-3 mm2/sec2 ranging from (o.63-1.2 x 10-3 mm2/sec2).
The mean ADC values in Gleason score 3+4 is 0.7829 +/_ 0.10095 x 10-3 mm2/sec2, Gleason 4+3 is 0.7829+/_0.11814 x 10-3 mm2/sec2, Gleason 4+4 is 0.5311 +/_ 0.09293 x 10-3 mm2/sec2 and Gleason 4+5 is 0.3883 +/_ 0.07333 x 10-3 mm2/sec2. Showing the following ranges respectively (0.70 - 0.97), (0.61 - 0.96), ( 0.41 - 0.72) and (0.30 - 0.50).
The significance between different Gleason scores are as following 3+3 to 4+3 is 0.586, 3+3 to 3+4 is 0.047, 3+3 to 4+4 is 0.0001, 3+3 to 4+5 is 0.0001, 3+4 to 4+3 is 0.173, 3+4 or 4+3 to 4+4 and 4+5 are 0.0001 and 4+4 to 4+5 is 0.0001.
They show overall significance between different Gleason scores 0.0001 (The mean difference is significant at the 0.05 level or less).
Multiple limitation factors for this diag¬nostic paradigm include:
1. low specificity of serum PSA for the detection of cancer prostate and may leads to unnecessary biopsy.
2. Many prostatic condition (eg, benign prostatic hyperplasia, acute or chronic prostatitis) elevate serum PSA value.
3. The cut of value for serum PSA level is > 4 ng/mL shows major limitation as Clinically significant cancer could be present even with a lower PSA value (Yacoub et al, 2012).
4. TR US guided biopsy which usually does not allow the direct visualization and targeting of abnormal regions of the prostate, yet it can detect cancerous lesions in some cases. So, TRUS–guided biopsy has a low sensitivity (range, 39%–52%), yet with speci¬ficity of approximately 80% though, repeated biopsies were needed (Yacoub et al, 2012).
The cancer detection rate falls from 22%– 38% at the initial biopsy to 10%–17% at the second biopsy and 5%–15% at the third biopsy (Yacoub et al, 2012).
Functional MR imaging techniques combined with conventional imaging had provided improved cancer detection and localization, as well as information regarding the aggressiveness, volume, and staging of cancers for individualized therapy.
we proved that mp-MRI has sensitivity, specificity, validity, positive predictive value and negative predictive values of 100% compared to biopsy-proven pathological results which is only 82.1% sensitivity, specificity 100%, validity of 84.8% and negative predictive value 50% yet 100% positive predictive value.
We prove that the mean ADC for areas with negative biopsy findings is > 1.2 x 10-3 mm2/sec2 in PZ and mean ADC values in tumors with Gleason score 3+3 is 0.910 0 +/_ 0.18367 x 10-3 mm2/sec2 ranging from (o.63-1.2 x 10-3 mm2/sec2).
The mean ADC values in Gleason score 3+4 is 0.7829 +/_ 0.10095 x 10-3 mm2/sec2, Gleason 4+3 is 0.7829+/_0.11814 x 10-3 mm2/sec2, Gleason 4+4 is 0.5311 +/_ 0.09293 x 10-3 mm2/sec2 and Gleason 4+5 is 0.3883 +/_ 0.07333 x 10-3 mm2/sec2. Showing the following ranges respectively (0.70 - 0.97), (0.61 - 0.96), ( 0.41 - 0.72) and (0.30 - 0.50).
The significance between different Gleason scores are as following 3+3 to 4+3 is 0.586, 3+3 to 3+4 is 0.047, 3+3 to 4+4 is 0.0001, 3+3 to 4+5 is 0.0001, 3+4 to 4+3 is 0.173, 3+4 or 4+3 to 4+4 and 4+5 are 0.0001 and 4+4 to 4+5 is 0.0001.
They show overall significance between different Gleason scores 0.0001 (The mean difference is significant at the 0.05 level or less).
Other data
| Title | ROLE OF MRI IN DIAGNOSIS AND GRADING OF PROSTATE CARCINOMA | Other Titles | دور الرنين المغناطيسي في تشخيص و تدريج ورم البروستاتا | Authors | Eman Farouk Foad Doula | Issue Date | 2011 |
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