Pharmakokinetische MRT der Prostata: Parameter zur Unterscheidung von Low-grade- und High-grade-Prostatakarzinomen

Zusammenfassung

Ziel: Es sollte geprüft werden, ob die pharmakokinetischen MRT-Parameter Perfusion, Blutvolumen, mittlere Transit Zeit (MTT), interstitielles Volumen, Permeabilität, Extraktionskoeffizient, Verzögerungszeit und Dispersion für die Unterscheidung von Low-grade (Gleason-Score ≤ 6) und High-grade Prostatakarzinomen (Gleason-Score ≥ 7) geeignet sind. Material und Methoden: 42 Patienten mit stanzbioptisch gesichertem Prostatakarzinom (PSA: 2,7 bis 31,4 ng/ml) wurden vor geplanter Prostatektomie mit der dynamischen kontrastmittelgestützten inversionspräparierten Dual-Contrast-Gradienten-Echo-Sequenz (zeitliche Auflösung: 1,65 s) bei 1,5 Tesla mit der kombinierten Endorektal-Body-Phased-Array-Spule untersucht. Die Berechnung der Parameterkarten erfolgte mit einem sequenziellen 3-Kompartiment-Modell und entsprechenden Nachverarbeitungsalgorithmen. Bei 32 Patienten konnten 41 Prostatakarzinomareale (15 × low-grade, 26 × high-grade) nach Korrelation mit den Prostatektomiepräparaten ausgewertet werden. Ergebnisse: Low-grade Prostatakarzinome zeigten im Mittel ein größeres Blutvolumen (1,76 % vs. 1,64 %, p = 0,039), eine längere MTT (6,39 s vs. 3,25 s, p < 0,001) und eine geringere Permeabilität (2,57 min^-1 vs. 3,86 min^-1, p = 0,011) als High-grade Prostatakarzinome. Kein statistisch signifikanter Unterschied fand sich für die Perfusion (p = 0,069), für das interstitielle Volumen (p = 0,849), für den Extraktionskoeffzienten (p = 0,615), für die Verzögerungszeit (p = 0,489) und die Dispersion (p = 0,306). Schlussfolgerungen: Blutvolumen, MTT und Permeabilität sind für eine Unterscheidung von Low-grade und High-grade Prostatakarzinomen geeignet. Im Rahmen des Therapieansatzes der „active surveillance” könnten diese Parameter dazu dienen, einen Progress im MRT nachzuweisen.

Abstract

Purpose: To investigate whether pharmacokinetic MRI parameters ”perfusion, blood volume, mean transit time (MTT), interstitial volume, permeability, extraction coefficient, delay, and dispersion” allow the differentiation of low-grade (Gleason score ≤ 6) and high-grade (Gleason score ≥ 7) prostate cancer. Materials and Method: Forty-two patients with prostate cancer verified by biopsy (PSA 2.7 to 31.4 ng/ml) and scheduled for prostatectomy underwent MRI at 1.5 Tesla using the dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (temporal resolution, 1.65 s) and a combined endorectal body phased array coil. Parametric maps were computed using a sequential 3-compartment model and the corresponding post-processing algorithms. A total of 41 areas of prostate cancer (15 low-grade, 26 high-grade cancers) in 32 patients were able to be correlated with the prostatectomy specimens and were included in the analysis. Results: Low-grade prostate cancers had a higher mean blood volume (1.76 % vs. 1.64 %, p = 0.039), longer MTT (6.39 s vs. 3.25 s, p < 0.001), and lower mean permeability (2.57 min^-1 vs. 3.86 min^-1, p = 0.011) than high-grade cancers. No statistically significant difference was found for perfusion (p = 0.069), interstitial volume (p = 0.849), extraction coefficient (p = 0.615), delay (p = 0.489), and dispersion (p = 0.306). Conclusions: Blood volume, MTT, and permeability allow the differentiation of low-grade and high-grade prostate cancer. They may be used to detect cancer progression by MRI in patients managed by active surveillance.

Key words

prostate - MR diffusion/perfusion - MR functional imaging

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