Purpose:This study investigates whether quantitative MRI and histology of the prostate reveal differences between races, specifically African Americans (AAs) and Caucasian Americans (CAs), that can affect diagnosis.Materials and Methods:Patients (98 CAs, 47 AAs) with known or suspected prostate cancer (PCa) underwent 3T MRI (T2W, DWI, and DCE-MRI) prior to biopsy or prostatectomy. Quantitative mpMRI metrics: ADC, T2, and DCE empirical mathematical model parameters were calculated.Results:AAs had a greater percentage of higher Gleason-grade lesions compared to CAs. There were no significant differences in the quantitative ADC and T2 values between AAs and CAs. The cancer signal enhancement rate (α) on DCE-MRI was significantly higher for AAs compared to CAs (AAs: 13.3 ± 9.3 vs. CAs: 6.1 ± 4.7 s−1,p< 0.001). The DCE signal washout rate (β) was significantly lower in benign tissue of AAs (AAs: 0.01 ± 0.09 s−1vs. CAs: 0.07 ± 0.07 s−1,p< 0.001) and significantly elevated in cancer tissue in AAs (AAs: 0.12 ± 0.07 s−1vs. CAs: 0.07 ± 0.08 s−1,p= 0.02). DCE significantly improves the differentiation of PCa from benign in AAs (α: 52%, β: 62% more effective in AAs compared to CAs). Histologic analysis showed cancers have a greater proportion (p= 0.04) of epithelium (50.9 ± 12.3 vs. 44.7 ± 12.8%) and lower lumen (10.5 ± 6.9 vs. 16.2 ± 6.8%) in CAs compared to AAs.Conclusions:This study shows that AAs have different quantitative DCE-MRI values for benign prostate and prostate cancer and different histologic makeup in PCa compared to CAs. Quantitative DCE-MRI can significantly improve the performance of MRI for PCa diagnosis in African Americans but is much less effective for Caucasian Americans.
目的：本研究旨在探讨前列腺定量磁共振成像（MRI）与组织学检查是否揭示非裔美国人（AAs）与高加索裔美国人（CAs）之间存在可能影响诊断的种族差异。 材料与方法：对已知或疑似前列腺癌（PCa）的患者（98例CAs，47例AAs）在活检或前列腺切除术前进行3T MRI检查（包括T2加权成像、扩散加权成像及动态对比增强MRI）。计算多参数MRI定量指标：表观扩散系数、T2值及动态对比增强经验数学模型参数。 结果：与CAs相比，AAs中更高格里森分级病灶的比例更高。两组间定量表观扩散系数和T2值无显著差异。动态对比增强MRI显示，AAs的癌症信号增强率（α）显著高于CAs（AAs：13.3 ± 9.3 s⁻¹ vs. CAs：6.1 ± 4.7 s⁻¹，p < 0.001）。在良性组织中，AAs的动态对比增强信号清除率（β）显著较低（AAs：0.01 ± 0.09 s⁻¹ vs. CAs：0.07 ± 0.07 s⁻¹，p < 0.001）；而在癌组织中，AAs的β值显著升高（AAs：0.12 ± 0.07 s⁻¹ vs. CAs：0.07 ± 0.08 s⁻¹，p = 0.02）。动态对比增强在区分AAs前列腺癌与良性组织方面效果显著提升（与CAs相比，α区分效能提高52%，β提高62%）。组织学分析显示，与AAs相比，CAs的前列腺癌组织中上皮比例更高（50.9 ± 12.3% vs. 44.7 ± 12.8%，p = 0.04），腺腔比例更低（10.5 ± 6.9% vs. 16.2 ± 6.8%）。 结论：本研究表明，与CAs相比，AAs在良性前列腺组织和前列腺癌的定量动态对比增强MRI值存在差异，且前列腺癌的组织学构成也不同。定量动态对比增强MRI能显著提升MRI对非裔美国人前列腺癌的诊断效能，但对高加索裔美国人的诊断效果提升有限。
Quantitative Multi-Parametric MRI of the Prostate Reveals Racial Differences
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