Abstract

Purpose

To analyze routine preoperative prostate MRI to predict erectile function (EF) before and after radical prostatectomy (RP).

Methods

Patients who underwent RP with an existing preoperative MRI including dynamic contrast-enhanced images and completed International Index of Erectile Function (IIEF-5) questionnaires at baseline and 12 months postoperative. They were divided into four erectile dysfunction (ED) groups according to preoperative IIEF-5 score. The perfusion quality was measured in the peripheral zone of the prostate by the ratio of signal increase 120 s after wash-in of contrast agent (Ratio120) in preoperative MRI and compared between the ED groups.

Results

Ratio120 showed differences among the preoperative ED groups (p = .020) in 97 patients. According to IIEF-5 at 12 months postoperative, 43 patients were dichotomized into “no to mild” (≥17 points) and “moderate to severe” (≤16) ED groups. Ratio120 revealed differences among the postoperative ED groups (128.84% vs. 101.95%; p = .029) and stayed an independent predictor for ED in the multivariable regression analysis (adjusted for age, nerve-sparing and preoperative IIEF-5). ROC curves demonstrated an additional diagnostic benefit.

Conclusions

Preoperative MRI of the prostate may be used for the prediction of EF and postsurgical recovery after RP. This may serve as important tool in preoperative patient counseling and management of expectations.

中文翻译：

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前列腺 MRI 动态对比增强作为根治性前列腺切除术后勃起功能和恢复的预测指标

摘要

目的

分析常规术前前列腺 MRI 以预测根治性前列腺切除术 (RP) 前后的勃起功能 (EF)。

方法

在基线和术后 12 个月接受 RP 并使用现有术前 MRI 包括动态对比增强图像和完成国际勃起功能指数 (IIEF-5) 问卷调查的患者。根据术前IIEF-5评分将他们分为四个勃起功能障碍（ED）组。通过术前MRI中造影剂冲洗后120 s信号增加的比率（Ratio120）测量前列腺外周区的灌注质量，并在ED组之间进行比较。

结果

Ratio120 显示 97 名患者术前 ED 组之间存在差异 ( p  = .020)。根据术后 12 个月的 IIEF-5，将 43 名患者分为“无至轻度”（≥17 分）和“中度至重度”（≤16）ED 组。Ratio120 揭示了术后 ED 组之间的差异（128.84% 对 101.95%；p  = .029），并且在多变量回归分析中仍然是 ED 的独立预测因子（根据年龄、神经保留和术前 IIEF-5 进行调整）。ROC 曲线显示了额外的诊断益处。

结论

前列腺术前 MRI 可用于预测 EF 和 RP 术后恢复情况。这可以作为术前患者咨询和期望管理的重要工具。