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Impact of the integration of proton magnetic resonance
imaging spectroscopy to PI-RADS 2 for prediction of high
grade and high stage prostate cancer
Autor: Michael S. Leapman, Zhen J. Wang, Spencer C. Behr, John Kurhanewicz, Ronald J. Zagoria, Peter R. Carroll, Antonio C. Westphalen
A infecção pelo vírus Zika, apesar de conhecida desde 1942, apresentou destaque somente a partir de 2007, quando uma verdadeira
pandemia se espalhou pela África, Ásia e Américas. Durante este período, numerosas formas de acometimento do sistema
nervoso central têm sido descritas, principalmente as malformações relacionadas a infecção congênita. Apesar de os achados de
neuroimagem na síndrome congênita pelo vírus Zika não serem patognomônicos, muitos são bastante sugestivos, devendo o radiologista
estar preparado para saber interpretar e sugerir o diagnóstico. O objetivo deste artigo é revisar os achados de tomografia
computadorizada e ressonância magnética da síndrome congênita pelo vírus Zika.
Unitermos: Ressonância magnética; Tomografia computadorizada; Vírus Zika; Síndrome congênita pelo vírus Zika; Infecção congê-
nita.
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Objective: To compare the predictions of dominant Gleason pattern ≥ 4 or non-organ confined disease with Prostate Imaging Reporting
and Data System (PI-RADS v2) with or without proton magnetic resonance spectroscopic imaging (1
H-MRSI).
Materials and Methods: Thirty-nine men underwent 3-tesla endorectal multiparametric MRI including 1
H-MRSI and prostatectomy.
Two radiologists assigned PI-RADS v2 and 1
H-MRSI scores to index lesions. Statistical analyses used logistic regressions, receiver
operating characteristic (ROC) curves, and 2x2 tables for diagnostic accuracies.
Results: The sensitivity and specificity of 1
H-MRSI and PI-RADS v2 for high-grade prostate cancer (PCa) were 85.7% (57.1%) and
92.9% (100%), and 56% (68.0%) and 24.0% (24.0%). The sensitivity and specificity of 1
H-MRSI and PI-RADS v2 for extra-prostatic
extension (EPE) were 64.0% (40%) and 20.0% (48%), and 50.0% (57.1%) and 71.4% (64.3%). The area under the ROC curves (AUC)
for prediction of high-grade prostate cancer were 0.65 and 0.61 for PI-RADS v2 and 0.72 and 0.70 when combined with 1
H-MRSI
(readers 1 and 2, p = 0.04 and 0.21). For prediction of EPE the AUC were 0.54 and 0.60 for PI-RADS v2 and 0.55 and 0.61 when
combined with 1
H-MRSI (p > 0.05).
Conclusion: 1
H-MRSI might improve the discrimination of high-grade prostate cancer when combined to PI-RADS v2, particularly for
PI-RADS v2 score 4 lesions, but it does not affect the prediction of EPE.
Keywords: MRI; Spectroscopy; Diagnosis; Prostate cancer; Prostatectomy.
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