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Diffusionsgewichtete MRT der Prostata

Diffusion-weighted MRI of the prostate

Der Radiologe volume 51, pages 205–214 (2011)Cite this article

Zusammenfassung

Die diffusionsgewichtete MRT („diffusion-weighted imaging“, DWI) kann die MRT der Prostata bei der Erkennung und Lokalisation von Prostatakarzinomen besonders nach vorangehender, negativer Stanzbiopsie ergänzen. In 13 klinischen Original- und 2 Übersichtsarbeiten des Jahres 2010 zeigt sich, dass die DWI Prostatakarzinome an Einschränkungen der freien Teilchenbeweglichkeit bei erhöhter Zelldichte qualitativ im Bild oder quantitativ an Hand des „apparent diffusion coefficient“ (ADC) nachweist. Den ADC in der Prostata beeinflussen Stärke der Diffusionsgewichtung, Lokalisation (periphere Zone, Transitionalzone), Vorliegen von Prostatitis oder Einblutung sowie Streudichte und Differenzierung von Prostatakarzinomzellen. Unterschiede zwischen gesundem Prostatagewebe in der peripheren Zone und Prostatakarzinom sind für den ADC im Mittel offenbar geringer als für das (Cholin + Kreatin)/Zitrat-Verhältnis bei der MR-Spektroskopie. Die Testgüteparameter liegen etwas besser für MRT mit DWI als für MRT der Prostata allein, zeigen aber deutliche Unterschiede zwischen verschiedenen Studien. Die klinische Bewertung der DWI der Prostata erfordert verfahrenstechnische Vereinheitlichungen und Studien mit hohen Patientenzahlen.

Abstract

Diffusion-weighted magnetic resonance imaging (DWI) can complement MRI of the prostate in the detection and localization of prostate cancer, particularly after previous negative biopsy. A total of 13 original reports and 2 reviews published in 2010 demonstrate that prostate cancer can be detected by DWI due to its increased cell density and decreased diffusiveness, either qualitatively in DWI images or quantitatively by means of the apparent diffusion coefficient (ADC). In the prostate, the ADC is influenced by the strength of diffusion weighting, localization (peripheral or transitional zone), presence of prostatitis or hemorrhage and density and differentiation of prostate cancer cells. Mean differences between healthy tissue of the peripheral zone and prostate cancer appear to be smaller for ADC than for the (choline + creatine)/citrate ratio in MR spectroscopy. Test quality parameters vary greatly between different studies but appear to be slightly better for combined MRI and DWI than for MRI of the prostate alone. Clinical validation of DWI of the prostate requires both increased technical conformity and increased numbers of patients in clinical studies.

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Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 1, 80336, München, Deutschland

    U.G. Mueller-Lisse M.B.A & M.K. Scherr

  2. Klinik und Poliklinik für Urologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, München, Deutschland

    U.L. Mueller-Lisse

  3. Abteilung für Radiologische Diagnostik, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

    P. Zamecnik & H.-P.W. Schlemmer

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  1. U.G. Mueller-Lisse M.B.A
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  2. U.L. Mueller-Lisse
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  3. P. Zamecnik
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  4. H.-P.W. Schlemmer
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  5. M.K. Scherr
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Correspondence to U.G. Mueller-Lisse M.B.A.

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Mueller-Lisse, U., Mueller-Lisse, U., Zamecnik, P. et al. Diffusionsgewichtete MRT der Prostata. Radiologe 51, 205–214 (2011). https://doi.org/10.1007/s00117-010-2061-2

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Schlüsselwörter

  • Prostata
  • Prostatakarzinom
  • Magnetresonanztomographie (MRT)
  • Diffusion
  • „Diffusion-weighted imaging“ (DWI)

Keywords

  • Prostate
  • Prostate cancer
  • Magnetic resonance imaging (MRI)
  • Diffusion
  • Diffusion-weighted imaging (DWI)