MRT zur Problemlösung beim Nachweis des Prostatakarzinoms

Zusammenfassung

Das Prostatakarzinom ist der häufigste Tumor des Mannes. Zum Nachweis wird ab dem 50. Lebensjahr die jährliche digitale rektale Untersuchung und die Prostata-spezifische-Antigen-(PSA-)Bestimmung im Serum empfohlen. Bei einem großen Teil der Patienten findet sich jedoch trotz eines auf über 4 ng/ml erhöhten PSA-Wertes kein Prostatakarzinom in der durch den transrektalen Ultraschall (TRUS) gesteuerten Prostatabiopsie. Die MRT ist in der Lage, im T2-gewichteten Bild die Prostata mit ihrer zonalen Anatomie sowie tumorsuspekte signalarme Areale innerhalb der signalreichen peripheren Zone darzustellen. Bei Patienten mit erhöhtem PSA-Wert und negativer Stanzbiopsie erreicht die MRT für den Nachweis von Prostatakarzinomen eine höhere Sensitivität als die digitale rektale Untersuchung und der transrektale Ultraschall. Die Spezifität ist jedoch gering, da andere Befunde, wie Prostatische Intraepitheliale Neoplasie (PIN), Prostatitis, Narben oder Hämorrhagien ähnliche Veränderungen bewirken. Durch den Einsatz zusätzlicher Techniken wie der MR-Spektroskopie und der kontrastmittelunterstützten dynamischen MRT lässt sich die Sensitivität, jedoch insbesondere die Spezifität der Tumordetektion verbessern. Durch neu entwickelte Biopsievorrichtungen ist eine direkte Biopsie eines im MRT suspekten Areals möglich.

Abstract

Prostate cancer is the most common malignancy in males. Men aged 50 and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. However, prostate biopsies guided by transrectal ultrasound (TRUS) come up negative for cancer in many patients despite having PSA levels above 4ng/ml. T2-weighted Magnetic Resonance Imaging (MRI) is able to represent the prostate including the surrounding anatomy and depict suspicious areas of low intensity within a high-intensity peripheral zone. MRI has a higher sensitivity for detecting prostate carcinomas than DRE and TRUS in patients having an elevated PSA value and a negative core biopsy. However, its specificity is poor since other abnormalities such as prostatic intraepilthelial neoplasia (PIN), prostatitis, scars, or haemmorrhage have a similar MRI appearance. The use of additional techniques such as MR spectroscopy and contrast-enhanced dynamic MRI improves sensitivity, but in particular it improves the specificity of tumor detection. Newly developed biopsy devices enable the performance of targeted biopsies in areas that appear suspicious in the MRI.

Key words

MRI, prostate cancer, PSA, MR spectroscopy, dynamic MRI

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