Східноукраїнський медичний журнал (Oct 2020)
DIAGNOSTIC SIGNIFICANCE OF MAGNETIC RESONANCE IMAGING IN PROSTATE INTRAEPITHELIAL NEOPLASIA
Abstract
Introduction. Multiparametric magnetic resonance imaging (mpMRI) is routinely used in prostate cancer diagnostics. In order to improve sensitiveness of MRI such additional parameters were developed as T2 weighted images, diffuse weighted images, dynamic contrast enhancement. In last decade a lot of investigations are directed at studying MRI role in prostate intraepithelial neoplasia (PIN) diagnostics. Previous investigations had controversial results due to different approaches and the number of patients. The article is about prostate intraepithelial neoplasia (PIN) diagnostics through PSA test. Purpose. To determine role and significance of mpMRI in prostate intraepithelial neoplasia diagnostics. Materials and methods. The results of examination of 52 patients with PIN were assessed using PIRADS criteria. The total number of samples with PIN amounted 166. According to PIRADS MRI assessment of central and peripherial zones was made separately. The use of T2WI, DWI, DCE in patients with high grade and low grade PIN was studied. PIN was diagnosed through prostate biopsy guided by transrectal ultrasound. MRI was performed before prostate biopsy (MRI cognitive fusion biopsy). Discussion. There was a difference in values of PIRADS characteristics between PIN and benign prostatic tissue. The mean of PIRADS gradation in samples with PIN was 2.1. Among them 47 (28.3 %) PIN samples had gradation 3 (the presence of clinically significant cancer is equivocal), in 8 (4.8 %) cases – gradation 4 (clinically significant cancer is likely to be present). Compared with low grade PIN, high grade PIN had 30.4 % larger mean PIRADS value, 2,3. This is an evidence of high diagnostic value of MRI parameters in PIN detection. MRI parameters in high grade PIN cases differ a lot from those of low grade PIN and normal prostate. It was determined that high grade PIN has similar properties on MRI as prostate cancer. Further study is required to stratify all PIN patients into groups of high malignization risk in order to perform detailed examination and treatment. MpMRI gives an opportunity to assess the peculiarities of precancerous diseases in order to perform precise biopsy with minimal amount of samples.
