Current multiparametric MRI (mp-MRI) in routine clinical practice has poor-to-moderate diagnostic performance for transition zone prostate cancer. The aim of this study was to evaluate the potential diagnostic performance of novel 1H magnetic resonance spectroscopic imaging (MRSI) using a semi-localized adiabatic selective refocusing (sLASER) sequence with gradient offset independent adiabaticity (GOIA) pulses in addition to the routine mp-MRI, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and quantitative dynamic contrast enhancement (DCE) for transition zone prostate cancer detection, localization and grading. Forty-one transition zone prostate cancer patients underwent mp-MRI with an external phased-array coil. Normal and cancer regions were delineated by two radiologists and divided into low-risk, intermediate-risk, and high-risk categories based on TRUS guided biopsy results. Support vector machine models were built using different clinically applicable combinations of T2WI, DWI, DCE, and MRSI. The diagnostic performance of each model in cancer detection was evaluated using the area under curve (AUC) of the receiver operating characteristic diagram. Then accuracy, sensitivity and specificity of each model were calculated. Furthermore, the correlation of mp-MRI parameters with low-risk, intermediate-risk and high-risk cancers were calculated using the Spearman correlation coefficient. The addition of MRSI to T2WI + DWI and T2WI + DWI + DCE improved the accuracy, sensitivity and specificity for cancer detection. The best performance was achieved with T2WI + DWI + MRSI where the addition of MRSI improved the AUC, accuracy, sensitivity and specificity from 0.86 to 0.99, 0.83 to 0.96, 0.80 to 0.95, and 0.85 to 0.97 respectively. The (choline + spermine + creatine)/citrate ratio of MRSI showed the highest correlation with cancer risk groups (r = 0.64, p < 0.01). The inclusion of GOIA-sLASER MRSI into conventional mp-MRI significantly improves the diagnostic accuracy of the detection and aggressiveness assessment of transition zone prostate cancer.

中文翻译：

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通过多参数 MRI 诊断移行区前列腺癌：使用 sLASER 体积选择的 MR 光谱成像的附加值

目前常规临床实践中的多参数 MRI (mp-MRI) 对过渡区前列腺癌的诊断性能较差至中等。本研究的目的是评估新型 1H 磁共振光谱成像 (MRSI) 的潜在诊断性能，除了常规 mp- MRI，包括 T2 加权成像 (T2WI)、弥散加权成像 (DWI) 和定量动态对比增强 (DCE)，用于前列腺癌的检测、定位和分级。41 名过渡区前列腺癌患者接受了带外部相控阵线圈的 mp-MRI。正常和癌症区域由两名放射科医师划定，分为低危、中危、和基于 TRUS 引导活检结果的高风险类别。支持向量机模型是使用 T2WI、DWI、DCE 和 MRSI 的不同临床适用组合构建的。使用受试者工作特征图的曲线下面积 (AUC) 评估每个模型在癌症检测中的诊断性能。然后计算每个模型的准确度、灵敏度和特异性。此外，使用 Spearman 相关系数计算了 mp-MRI 参数与低风险、中风险和高风险癌症的相关性。在 T2WI + DWI 和 T2WI + DWI + DCE 中加入 MRSI 提高了癌症检测的准确性、敏感性和特异性。T2WI + DWI + MRSI 实现了最佳性能，其中 MRSI 的添加将 AUC、准确性、灵敏度和特异性从 0 提高到 0。分别为 86 至 0.99、0.83 至 0.96、0.80 至 0.95 和 0.85 至 0.97。MRSI 的（胆碱 + 精胺 + 肌酸）/柠檬酸盐比率与癌症风险组的相关性最高（r = 0.64，p < 0.01）。将 GOIA-sLASER MRSI 纳入常规 mp-MRI 显着提高了过渡区前列腺癌的检测和侵袭性评估的诊断准确性。