前列腺癌的直腸內磁振造影診斷－初期報告

Prostate Cancer: Local Tumor Staging with Endorectal MR Imaging: Preliminary Report

許明輝(Ming-Huei Sheu) ； 王家槐(Jia-Hwia Wang) ； 李潤川(Rheun-Chuan Lee) ； 曾修山(Hsiuo-Shan Tseng) ； 鄧木火(Michael Mu-Huo Teng) ； 邱文祥(Allen Wen-Hsiang Chiu) ； 徐慧興(Hueih-Shing Hsu) ； 張延驊(Yen-Hwa Chang) ； 林登龍(Alex Tong-Long Lin) ； 陳光

《中華放射線醫學雜誌》 22卷1期 (1997/02) Pp. 11-18

摘要

本報告的目的在於評估運用直腸內置線圈的磁振造影對前列腺癌局部腫瘤定期的診斷效果。自1995無7月至1996無6月，10位病患經直腸穿刺生檢證實為前列腺癌，在接受磁振造影檢查後，進一步接受根除性前列腺切除術。將磁振造影判讀結果與病理結果做詳細對照後發現：(1)磁振造影對腫瘤的定位（包括位置與分佈範圍）之準確率為40%，6例有低估現象。(2)在病理證實有包膜外侵犯（7例）、神經血管束侵犯（4例）、儲精囊侵犯（5例）之病例中，磁振造影診斷之敏感率、特異率、陽性預測率與準確率分別為：71%、33.3%、71%、60%；75%、83%、75%、80%；60%、80%、75%、70%。(3)對腫瘤局部定期之評估，正確者6例，定期過高與過低者各2例，準確率為60%。對區別局限性（B期）與侵犯性（C期）腫瘤之診斷準確率為90%。本報告顯示，在我們初期的經驗中，磁振造影不能準確地偵測腫瘤實際的分佈範圍，對局部腫瘤定期評估之準確率則差強人意。但如就區別局限性與侵犯性前列腺癌而言，磁振造影為理想的診斷工具。

關鍵字

磁振造影，表面線圈 ； 腫瘤，分期 ； 前列腺，磁振造影 ； 前列腺，腫瘤

並列摘要

The purpose of this study is to assess the accuracy of magnetic resonance (MR) imaging, using the endorectal coil, in the evaluation of localization and local staging of prostate cancer. From July 1995 to June 1996, 10 consecutive patients with biopsy-proven prostate cancer were encountered. Radical prostatectomy had been performed on all of them, about 2 weeks after endorectal MR imaging. A correlation between the MR images and histopathologic findings of whole-mount specimens revealed: (1) The diagnostic accuracy of MR imaging for cancer localization (including lateralization and volume estimation) was 40%, underestimation occurred in 6 cases. (2) Histopathology showed extracapsular extension in 7 cases, neurovascular bundle involvement in 4 cases and seminal vesicle invasion in 5 cases. Sensitivity, specificity, positive predictive value and accuracy of MR imaging were 71%, 33.3%, 71%, 60%; 75%, 83%, 75%, 80%; 60%, 80%, 75%, 70%, respectively. (3) The diagnostic accuracy of MR imaging for local tumor staging was 60%, over-and under- staging occurred in 2 cases, respectively. Accuracy for differentiating a localized (stage B) from an invasive (stage C) cancer was 90%.
Results from our preliminary experience show that the accuracy of endorectal MR imaging was not satisfactory for tumor localization and local staging. However, with its high accuracy in differentiation between localized and invasive cancer, MR imaging still plays a useful role in the patient selection for surgical intervention.

並列關鍵字

Magnetic resonance MR, surface coil ； Neoplasms, staging ； Prostate, MR ； Prostate, neoplasms