| Objective:Using magnetic resonance spectroscopy (1H-MRS) to quantitative analysis the metabolism changes in cancerous regions of T3N0M0prostate cancer before and after cryotherapy. Comparing to the pathology to analysis the correlation of the1H-MRS and recurrence cancer. To evaluate the clinical usefulness of magnetic resonance spectroscopy imaging in detecting local recurrence of T3N0M0prostate cancer in patients after cryotherapy.Materials and Methods:In a retrospective study, sixty-five patients who was T3N0M0prostate cancer underwent cryosurgery as primary treatment. All the patients had undergone conventional digital rectal examination (DRE),prostate specific antigen (PSA), transrectal ultrasound (TRUS), transrectal ultrasound-guided biopsy, MRI,’H-MRS. After cryotherapy, the patients were detected prostate specific antigen (PSA) monthly. In the study, when the patients with an elevated PSA level (PSA>5μg/L), they should be examined MRI.1H-MRS and TRUS-guided biopsy in a week. The patients without a detectable PSA were examined MRI.1H-MRS, and TRUS-guided biopsy in the12and24months after cryotherapy. The signal-to-noise ratio (S/N) of choline (Cho), citrate (Cit) and the ratios of (choline+creatine)/citrate ((Cho+Cre)/Cit) were measured on each region of cancerous and noncancerous by1H-MRS in preoperative and postoperative. According to the TRUS-guided biopsy in the6regions of prostate, the cancerous and noncancerous were marked.Result:1. The S/N of Cho, Cit and the ratios of (Cho+Cre)/Cit in the cancerous and noncancerous regions before cryotherapy in the sixty-five patients were (25±9) and (11±5),(18±5) and (39±12),(2.33±0.60) and (0.53±0.19). There have significant difference between them (t is11.36,9.81and13.39, P=0.00).2. In the group patients of non-recurrence, The S/N of Cho Cit in the cancerous and noncancerous regions were (4±2) and (3±2)(t=1.432, P=0.314),(2±2) and (4±3) (t=1.174, P=0.187). There have no difference between them. The S/N of Cho (t=25.22, P=0.00) and the S/N Cit (t=32.06, P=0.00) in the regions of cancerous are significant difference before and after the cryotherapy.There were a large number of necrotic area in regions of the cancer and noncancerous, where the S/N of Cho and Cit is very low, so the ratios of (Cho+Cre)/Cit can not be calculated.3. In the group patients of local recurrence, The S/N of Cho and Cit in the cancerous and noncancerous regions after cryotherapy were (17±3) and (3±2)(t=17.24, P=0.00),(9±2) and (3±3)(t=23.66, P=0.00). There have significant difference between them. The S/N of Cho (t=9.58, P=0.00), the S/N of Cit (t=12.13, P=0.00), the ratio of (Cho+Cre)/Cit (t=1.214, P=0.256) in the recurrent area is no significant difference compared to preoperative.4.16patients were confirmed local recurrence by systemic biopsy in the24months after cryotherapy, corresponding to the1H-MRS examination can be seen high Cho peak and low Cit peak.49patients were without local recurrence by systemic biopsy, corresponding to the1H-MRS examination can not be seen Cho peak and Cit peak. After cryotherapy, in the tumor partitions the S/N of Cit were decreased to the noise level, but the S/N of Cho were still significantly higher, the S/N of Cho can be used for evaluation of tumor recurrence. So, the S/N of Cho and tumor recurrence has a significant correlation(r=0.861).Conclusion:1H-MRS can faithfully demonstrate the process of change of prostate cancer after cryotherapy.1H-MRS can be used to evaluate the changes of the S/N of Cho and Cit and (Cho+Cre)/Cit before and after cryotherapy, to help diagnosing local recurrence, and timely adjustment treatment programs. |
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