前列腺癌症的扩散MRI微结构成像

摘要(中文译文)

前列腺癌仍然是全球男性中最常见的恶性肿瘤之一，早期发现、准确表征和分期对于优化患者管理至关重要。扩散磁共振成像（dMRI）已成为一种强大的组织微结构无创在体成像技术，有望为了解前列腺癌的病理生理学提供前所未有的见解。在本综述中，我们探讨了dMRI技术在前列腺癌微结构MRI应用中的现状和未来方向。我们描述了前列腺成像的技术挑战及可能的解决方案，以及超越测量传统表观扩散系数的技术。这些包括更复杂的表示和模型，如体素内不相干运动（IVIM）、扩散峰度成像（DKI）、基于张量值扩散编码的方法如q空间轨迹成像（QTI），以及时间依赖性dMRI。VERDICT（肿瘤细胞计量中的血管、细胞外和受限扩散）和IMPULSED（使用有限频谱编辑扩散的微结构参数成像）等模型因其在临床环境中量化前列腺组织组成的能力而受到关注。本综述强调了微结构MRI在前列腺癌中的变革潜力，同时确定了实现其临床影响所需的关键研究重点和技术发展。未来方向包括采用高性能MRI系统、改进图像读出和处理技术、整合多参数和多维方法、开发简约方案，以及标准化稳健的生物标志物以实现个性化治疗分层。尽管关于微结构MRI应如何部署尚未达成共识，但现有证据表明，与传统测量相比，它可以提供更优越的诊断性能，与肿瘤侵袭性的相关性更好，并在前列腺癌诊断和治疗监测方面具有潜在的下游优势。

Abstract

Prostate cancer remains one of the most prevalent malignancies in men worldwide, and early detection, accurate characterization, and staging are critical for optimal patient management. Diffusion magnetic resonance imaging (dMRI) has emerged as a powerful technique for non-invasive in vivo imaging of tissue microstructure, promising to enable unprecedented insights into the pathophysiology of prostate cancer. In this review, we examine the current state and future directions of dMRI techniques for microstructure MRI in prostate cancer applications. We describe the technical challenges of prostate imaging along with potential remedies, as well as techniques that go beyond measuring the conventional apparent diffusion coefficient. These include more sophisticated representations and models, such as intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), methods based on tensor-valued diffusion encoding such as q-space trajectory imaging (QTI), as well as time-dependent dMRI. Models, such as VERDICT (vascular, extracellular, and restricted diffusion for cytometry in tumors) and IMPULSED (imaging microstructural parameters using limited spectrally edited diffusion), are highlighted for their ability to quantify the composition of prostatic tissues in the clinical setting. This review highlights the transformative potential of microstructure MRI in prostate cancer, while identifying key research priorities and technical developments needed to realize its clinical impact. Future directions include the adoption of high-performance MRI systems, improved image readout and processing techniques, integration of multiparametric and multidimensional approaches, development of parsimonious protocols, and standardization of robust biomarkers for personalized treatment stratification. Although there is yet to be a consensus of how microstructure MRI should be deployed, current evidence suggests that it can provide superior diagnostic performance compared to conventional measurements, with improved correlation to tumor aggressiveness and potential downstream advantages for prostate cancer diagnostics and treatment monitoring.

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