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前列腺癌(prostate cancer,PCa)的全球发病率约为4.0%,位居全球男性恶性肿瘤的第二位,其侵袭性位居第五位[1]。随着人口老龄化进程的加快,PCa的发病率和病死率也在逐年上升。因此,早期检测、诊断PCa及评估其复发、转移尤为重要。多参数MRI(multiparametric MRI,mpMRI)是评估PCa的常用影像学方法,其在常规T1加权成像(T1-weighted imaging,T1WI)、T2加权成像(T2-weighted imaging,T2WI)序列的基础上结合扩散加权成像(diffusion weighted imaging,DWI)、动态对比增强磁共振成像(dynamic contrast enhanced MRI, DCE-MRI)和(或)MRI波谱等功能成像序列来反应前列腺组织的功能、生化代谢等方面的改变[2]。笔者主要就mpMRI的主要序列、评分的新规范及其在PCa中的应用展开综述。
多参数磁共振成像在前列腺癌中的应用进展
Progress in the application of multiparameter magnetic resonance imaging in prostate cancer
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摘要: 前列腺癌(PCa)的发病率位居全球男性恶性肿瘤的第二位,随着人口老龄化进程的加快,其发病率和病死率也在逐年上升。若PCa不被及早发现、检测、诊断,将严重危害老年男性的健康。自前列腺影像报告与数据系统V2.1版指南更新了多参数磁共振成像(mpMRI)序列及评分新规范以后,mpMRI在PCa中的应用前景更为广泛。多项研究报道了mpMRI在PCa活检前及指导靶向活检、主动监测、根治性前列腺切除术后局部复发及转移中的应用价值,但mpMRI评估PCa仍然存在局限性。笔者主要就mpMRI关键序列及评分的新规范、mpMRI评估PCa的应用进展、当前的局限性及潜在的解决方案展开综述。
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关键词:
- 前列腺肿瘤 /
- 多参数磁共振成像 /
- 扩散加权成像 /
- 动态对比增强磁共振成像
Abstract: The incidence of prostate cancer (PCa) ranks second among male malignancies worldwide. With the quickening growth of population aging, the incidence and case fatality rate of PCa are also increasing year by year. Failure to detect, test, and diagnose PCa early will seriously harm the health of elderly men. Since the new specification of multiparameter magnetic resonance imaging (mpMRI) sequence and score were updated in the prostate imaging reporting and data system V2.1, the application prospect of mpMRI in PCa has became more extensive. A number of studies have reported the application value of mpMRI in PCa before biopsy and in guiding prostate-targeted biopsy, active surveillance, local recurrence, and metastasis after radical prostatectomy. However, mpMRI still has limitations in the evaluation of PCa. This article mainly focuses on the new criteria of mpMRI key sequences and scores as well as the application progress of mpMRI in the evaluation of PCa and its current limitations and potential solutions. -
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