Ciel'. Posúdiť přínos MR zobrazovania v stagingu karcinomu prostaty, porovnat' predoperačné a pooperačné histologické nálezy s MR nálezom so zretelom detekcie extra-kapsulárneho šírenia nádoru. Metoda. V rokoch 2004-2007 bolo zarade-ných 75 pacientov s novodiagnostikovaným karcinómom prostaty na základe transrektálnej biopsie prostaty pod TRUS (transrektálnej ultrasonografie). Porovnali sme predoperačné a pooperačné histologické nálezy a s MR nálezmi. Všetci pacienti boli vyšetření na MR přístroji 1,5 T, s použitím pelvic phased-array cievky, bez použitia kontrastnej látky, T2 FRFSE váž. obrazy v 3 rovinách, axiálna T1 FSE váž. obraz na posúdenie lymfatických uzlin. Kontrastná látka sa použila len v případe recidívy a duplicitnej malignity použitím DCE MRI (dynamic contrast enhanced MRI). Hodnotenie MR nálezu vychádzalo z TNM klasifikácie rovnako aj hodnotenie patologa. Výsledky. Zo 75 pacientov s novodiagnostikovaným karcinómom prostaty - 19 pacientov (25,3 %) pre pokročilost' MR nálezu nebolo operovaných po absolvovaní MR vyšetrenia (PSA od 10-188 ng/ml, Gleason scóre 6-8, T2a-T2c), po MR vyšetření hodnotené ako T3a-c. 5 pacientov (6,7%) absolvovalo TURP (transuretrálna resekcia prostaty) - 3 pre pokročilost' nálezu, 2 odmietli RAPE (radikálna prostatektomia). 34 (45,3 %) pacientov absolovovalo RAPE (T1c--T2c, PSA od 3-10 ng/ml, Gleason skóre 3-7). V 5 prípadoch (6,7 % z 75 pacientov) sme podhodnotili T stupeň (T2a-c, pooperačné T3 a-b), 4 pacienti čakajú na RAPE (5,3 %). V sledovanom období v skupině po RAPE nebola zaznamenaná recidíva, v pokročilom stádiu (T3, duplicita) nezomrel nikto. 13 pacientov (17,3 %) neboli manažovaní cez našu onkourologickú ambulanciu - nevieme porovnat naše výsledky s pooperačnými nálezmi. Záver. Staging karcinomu prostaty aj s použitím MR zobrazovania má jednoznačný význam. Jeho prínosom je určenie prognózy pacienta a optimálnej liečebnej strategie.

Aim. To review the efficacy of MR imaging in prostate cancer staging, to compare preoperative and postoperative histologie findings with MRI findings with regard to detection of extracapsular tumourous extension. Method. Between 2004 and July 2007, seventy five patients with newly diagnosed prostate cancer confirmed by transrectal biopsy under TRUS (transrectal ultrasonography) guidance were enrolled. We compared pre-operative and postoperative histologie findings with MRI findings. All patients were examined on 1.5T MR system, using pelvic phased-array coil, by using T2-weighted FSE images in three planes and Tl-weighted FSE in axial plane for lymphonode detection. Contrast medium was used only in cases of suspected tumourous recurrence or other malignancy using DCE (dynamic contrast enhanced) MR imaging. Both MRI and histological findings were reported in terms of TNM classification. Results. Of 75 patients with newly diagnosed prostate cancer, 19 patients (25.3%) did not undergo surgery due to advanced MRI findings (pT3a-c), originally reported as pT2a-c (PSA ranging from 10 to 188 ng/ml, Gleason score 6-8. Five patients (6.7%) underwent TURP (transurethral prostate resection) because of advanced disease, two patients refused RAPE (radical prostatectomy). Thirty four (45.3%) patients underwent RAPE (T1c-T2c, PSA from 3 to 10 ng/ml, Gleason score 3-7). Five cases (6.7%) were underdiagnosed in T classification (T2a-c before and T3a-b after surgery), four patients are waiting for RAPE (5.3%). During the follow-up of subjects after RAPE, there was no tumourous recurrence noted, in the group of advanced disease (pT3, concomitant malignancy) nobody died. Thirteen patients (17.3%) were not operated/followed-up at our institution after MRI examination, therefore we were not able to compare our results with postoperative findings. Conclusion. Staging of prostate carcinoma using MR imaging has unambiguous value. It contributes to proper determination of the patients prognosis and selection of the optimal therapeutical strategy.

Rádiologické oddelenie FNsP F D R Banská Bystrica

MRI staging prostate carcinoma - our experience

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