(AJ) The three aims of the work were as follows: 1. Comparison of prostate magnetic resonance (MR) examination results from 1.5 T and 3 T scanners in patients with prostate carcinoma (PCa). MR findings of 103 patients (ages 44-72 years) were compared with histopathological results after radical prostatectomy. The work was focused on the accuracy of predicting local cancer staging and determining prostate tumour location. Patients were divided into three groups (A, B and C) based on the type of MR scanner and protocol used. Patient groups A and B were examined in 1.5T and 3T MR scanners equipped with surface coils in the identical multiparametric MR imaging protocol included dynamic contrast examination (DCE). Patient group C was examined in a 3T MR scanner without DCE. The highest accuracy of predicting the stage of PCa was seen in patients examined in 3 T MR scanner with DCE included in the protocol, however, no significant differences were seen between results from 1.5 T and 3.T MR scanners. No significant difference was also found in the accuracy of determining the location of prostate tumour between 1.5 T and 3T MR examinations, however, there were significant differences between sequences used, with the highest accuracy attained by using a combination of T2 weighted sequences and diffusion...

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23567号 / 医博第4781号 / 新制||医||1054(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 花川 隆, 教授 永井 純正, 教授 渡邊 直樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

OBJETIVO: Avaliar a relação entre mensurações de gordura (subcutânea e periprostática) realizadas em ressonância magnética, com o prognóstico do paciente portador de câncer de próstata. MATERIAIS E MÉTODOS: A mensuração da gordura periprostática e subcutânea com exame de ressonância magnética com ênfase na próstata foram realizadas em 58 pacientes com o diagnóstico histopatológico de câncer de próstata. Dados demográficos, clínicos e patológicos dos pacientes foram coletados e a correlação com o prognóstico, realizada. RESULTADOS: Na análise univariada, as gorduras periprostática e a subcutânea indicaram serem preditores de evolução desfavorável com significância estatística para o observador 1, no caso da gordura periprostática e para o observador 2 no caso da gordura subcutânea. Na análise multivariada, não houve associação com significância estatística. CONCLUSÃO: A associação entre obesidade e o câncer de próstata é complexa. Os dados obtidos neste estudo indicam que a medida da gordura periprostática, pelas imagens em T2, na RM, podem ser um preditor independente, da evolução desfavorável de pacientes com neoplasia de próstata / PURPOSE: Evaluate the relationship between fat measurements (subcutaneous and periprostatic) performed on MRI, with the prognosis of the patient with prostate cancer. MATERIALS AND METHODS: Measurements of periprostatic and subcutaneous fat with magnetic resonance imaging with emphasis on the prostate were performed in 58 patients with the histopathological diagnosis of prostate cancer. Demographic, clinical and pathological data of the patients were collected and the correlation with the prognosis was performed. RESULTS: In the univariate analysis, the periprostatic and subcutaneous fat were predictors of unfavorable evolution with statistical significance for the observer 1, in the case of the periprostatic fat and for the observer 2 in the case of the subcutaneous fat. In the multivariate analysis, there was no association with statistical significance. CONCLUSION: The association between obesity and prostate cancer is complex. The data obtained in this study indicate that the measurement of periprostatic fat by T2-weighted images in MRI may be an independent predictor of the unfavorable evolution of patients with prostate neoplasia

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-07-20T19:52:55Z No. of bitstreams: 1 M?RCIA_CRISTINA_GON?ALVES_DE_OLIVEIRA_MARAES.pdf: 3458644 bytes, checksum: 005c22fed45246220ed1f2e0de9490a9 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-30T12:47:18Z (GMT) No. of bitstreams: 1 M?RCIA_CRISTINA_GON?ALVES_DE_OLIVEIRA_MARAES.pdf: 3458644 bytes, checksum: 005c22fed45246220ed1f2e0de9490a9 (MD5) / Made available in DSpace on 2018-07-30T12:58:07Z (GMT). No. of bitstreams: 1 M?RCIA_CRISTINA_GON?ALVES_DE_OLIVEIRA_MARAES.pdf: 3458644 bytes, checksum: 005c22fed45246220ed1f2e0de9490a9 (MD5) Previous issue date: 2017-08-30 / Abstract: Today, the incidence of prostate cancer is considered high, however, unlike other malignant tumours, there is an expressive number of cases in which prostate cancer does not progress to clinical disease. The management of patients with prostate cancer should be individually fitted due to the broad behaviour spectrum of this cancer, ranging from low grade tumours with low aggressive biological characteristics to high grade tumours with metastatic capacity. The possibility of predicting the future behavior of the disease allows the selection of the most appropriate conduct for each case. Studies have shown that mpMRI (multiparametric Magnetic Resonance Imaging) has a high negative predictive value for clinically significant prostate cancer, indicating that its application as a screening method and as assessment method of disease progression is promising. To standardize the protocols and reports of prostate mpMRI, the PI-RADS v2 (Prostate Imaging Reporting and Data System version 2) was launched in 2015. Multiparametric Magnetic Resonance Imaging standardized by PI-RADSv2 has been taking a prominent place in the management of prostate cancer, but the specificity and positive predictive value still need to be improved. Purpose: To assess whether the ADC (Apparent diffusion coefficient) value and tumour ADC ratio associated with PI-RADS v2 may increase accuracy in predicting clinically significant prostate cancer. Materials and methods: 91 individuals with suspected prostate cancer were retrospectively studied through mpMRI imaging standardized by PI-RADS v2, obtaining the ADC value from the tumour and the contralateral tissue. The findings were correlated to anatomopathological study (biopsy, prostatectomy or transurethral resection). Results: Accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the consensus between the two reviewers using PI-RADS v2, category 3 associated with categories 4 and 5 for the detection of clinically significant cancer were 70.3%, 97.4%, 50.9%, 58.7% and 96.4% (p <0.001), respectively. The association of the ADC value (<0.795x10-3) to categories 3, 4 and 5 of the PI-RADSv2, in turn, demonstrated accuracy, specificity and positive predictive value of 78.9%, 84.9% and 76.5%; and the association with the tumour ADC ratio (<0.62) presented 77.5%, 86.5% and 77.4% of accuracy, specificity and positive predictive value, respectively. Conclusion: The association of the ADC value and the tumour ADC ratio to the PI-RADS v2 in mpMRI increases the accuracy, specificity and positive predictive value in the detection of aggressive prostate cancer, and may help in the screening of individuals who would undergo invasive procedures and radical therapy, or conservative management, as active surveillance or watchful waiting. / Introdu??o: ? considerada alta a incid?ncia de c?ncer de pr?stata na atualidade, contudo, diferentemente de outras neoplasias, existe um n?mero expressivo de casos em que o c?ncer de pr?stata n?o evolui para a doen?a cl?nica. Por este motivo, o manejo dos pacientes com neoplasia prost?tica deve ser moldado individualmente face ao amplo espectro que varia desde tumores de baixo grau, com caracter?sticas biol?gicas de baixa agressividade, a tumores de alto grau, com capacidade metast?tica. A possibilidade de prever o comportamento futuro da doen?a permite a sele??o da conduta mais adequada para cada caso. Estudos vem comprovando que a Resson?ncia Magn?tica multiparam?trica (RMmp) apresenta um alto valor preditivo negativo para o c?ncer de pr?stata com signific?ncia cl?nica, indicando que sua aplica??o como m?todo de triagem e na avalia??o da progress?o da doen?a ? promissora. Para padronizar os protocolos e os relat?rios da RMmp da pr?stata foi lan?ado em 2015 o PI-RADS v2 (?Prostate Imaging Reporting and Data System? vers?o 2). A RMmp padronizada pelo PI-RADS v2 vem assumindo um lugar de destaque no manejo do c?ncer de pr?stata, contudo, ainda s?o considerados baixos a Especificidade e o Valor Preditivo Positivo. Objetivos: Avaliar se o valor de ADC (?Apparent diffusion coefficient? = Coeficiente de Difus?o Aparente) e a raz?o tumoral do ADC associados ao PI-RADS v2 podem aumentar a acur?cia da RMmp na predi??o do c?ncer de pr?stata com signific?ncia clinica. Materiais e m?todos: Foram estudados retrospectivamente 91 indiv?duos com suspeita de c?ncer de pr?stata, submetidos a RMmp padronizada pelo PI-RADS v2, obtendo-se o ADC quantitativo da les?o e do tecido contralateral. Os achados foram correlacionados ao estudo anatomopatol?gico (bi?psia, prostatectomia ou ressec??o transuretral). Resultados: A acur?cia, sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para o consenso entre os dois avaliadores utilizando a RMmp padronizada pelo PI-RADS v2, com a categoria 3 associada as categorias 4 e 5 para a detec??o do c?ncer com signific?ncia cl?nica foram 70,3%; 97,4%; 50,9%; 58,7% e 96,4% (p<0,001), respectivamente. A associa??o do valor do ADC (<0,795x10-3) ?s categorias 3, 4 e 5 do PI-RADS v2, por sua vez, demonstrou acur?cia, especificidade e valor preditivo positivo de 78,9%; 84,9% e 76,5%; e a associa??o com a raz?o tumoral do ADC (< 0,62), apresentou 77,5%; 86,5% e 77,4% de acur?cia, especificidade e valor preditivo positivo, respectivamente. Conclus?o: A associa??o do valor do ADC e da raz?o tumoral do ADC ao PI-RADS v2 na RMmp aumenta a acur?cia, especificidade e valor preditivo positivo na detec??o do c?ncer agressivo da pr?stata, podendo auxiliar na triagem dos indiv?duos e na decis?o entre a conduta agressiva, com procedimentos invasivos e terapia radical, ou a conduta conservadora, com vigil?ncia ativa ou observa??o.