Valor De La Secuencia De Difusión en El Estudio De Cáncer De Próstata en Pacientes Con Antígeno Prostático Específico Elevado

Abstract

In prostatic carcinoma, the glandular architecture is replaced by cancer cells producing barriers to water motion, anomaly that can be studied through diffusion-enhanced MRI technique. To assess the contribution of these sequences in the prostate cancer exploration, we conducted a descriptive and inferential study using diffusion-enhanced MRI technique in 26 patients with abnormal digital rectal examination (DRE) and increased prostate specific antigen (PSA) values. We analyzed sensitivity, specificity and ROC curves based on apparent diffusion coefficient (ADC). Seven out of 14 biopsies were positive in patients undergoing prostate biopsy. When applying ADC <1000 _m2/se, high sensitivity with low specificity levels, as well as moderate predictive values were obtained. By incorporating T2-weighted images, improved diagnostic accuracy, specificity and predictive values were achieved. When comparing ADC values in tissues with and without cancer, average and minimum ADC appeared to exhibit different values. ROC curves depicted increased and significant values, suggesting cutoff values of 1059 µm 2 /s and 969 µm 2 /s for healthy and malignant tissues, respectively; LR (+) for cutoff value: 6.97 and 5.23, respectively. Our results enable us to propose that improved diagnostic outcomes are attained through combined interpretation of T2-weighted images and diffusion-weighted sequences and that the ADC permits discrimination between normal and malignant tissues. Therefore, we strongly support that these criteria should be taken into account when performing prostate explorations.

Resonancia magnética biparamétrica en la biopsia de precisión prostática por ultrasonido endorrectal

“…Una característica que hemos encontrado es que el tejido inflamatorio o no neoplásico tiende a restringir en valores DWI bajos (b 0), a diferencia del tejido neoplásico que lo hace casi exclusivamente en valores altos. Estos hallazgos que son concordantes con publicaciones y comunicados recientes [9][10][11] .…”

“…45%[4][5][6][7][8][9][10][11] . El uso como protocolo de otros parámetros en IRM, como son la espectroscopia y medios de contraste, a nosotros no nos ha sido útil, principalmente por concepto de tiempo de magneto y costo.…”