Online Journal
IF値: 0.966(2018年)→0.898(2019年)


Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 領域横断
パネルディスカッション 領域横断 Joint(JSUM・AFSUMB Joint Session)(English) 超音波治療の効果判定とその臨床経過観察



Multi-parametric magnetic resonance imaging to evaluate and monitor prostate cancer after high-intensity focused ultrasound

小路 直1, 2, 夏山 雄揮1, 2, 小川 貴博1, 2, 川上 正能1, 2, 中野 まゆら1, 2, 寺地 敏郎2, 内田 豊昭1

Sunao SHOJI1, 2, Yuki NATSUYAMA1, 2, Takahiro OGAWA1, 2, Masayoshi KAWAKAMI1, 2, Mayura NAKANO1, 2, Toshiro TERACHI2, Toyoaki UCHIDA1

1東海大学医学部付属八王子病院泌尿器科, 2東海大学医学部外科学系泌尿器科学

1Department of Urology, Tokai University Hachioji Hospital, 2Department of Urology, Tokai University School of Medicine

キーワード :

High-intensity focused ultrasound(HIFU)-treated areas of the prostate on contrast-enhanced T1-weighted MRI appear as non-enhanced areas, and subsequent transrectal biopsies have been able to remove homogenous necrotic tissue sections from the non-enhanced area(Rouviere et al. 2001). However, time-dependent changes in blood flow within the prostate treated with HIFU were observed on contrast-enhanced MRI between postoperative days 1 and 14(Shoji et al. 2014)(Fig.a). Pathological analysis showed vessel damage with coagulative degeneration and detachment of vascular endothelial cells in HIFU-treated prostate tissue(Shoji et al. 2014)(Fig.b). Previous studies(Poliachik et al. 2001,Wu et al. 2001)have shown that these time-dependent changes in blood flow within the prostate are likely due to the primary thermal effects induced on the tissue and vessel damage by coagulative degeneration in the prostate and that cavitation rapidly induces the detachment of vascular endothelial cells, gradually decreasing blood flow secondary to vessel obstruction. Future large-scale studies should investigate the most appropriate timing of contrast-enhanced MRI for precise feedback regarding the effectiveness of HIFU.
We evaluated the usefulness of multi-parametric MRI(mpMRI)in monitoring recurrence of prostate cancer after HIFU. We recruited patients in whom biochemical failures were detected(Phoenix Astro definition)in follow-up after whole-gland HIFU(Sonablate 500®; SonaCare Medical, Indianapolis, IN, USA)using mpMRI from 2013 to 2015. Patients suspected of having local recurrence lesions(per mpMRI)received MRI-TRUS fusion image-guided target biopsies of suspicious lesions using BioJet®(D&K Technologies GmbH, Barum, Germany)and 12-core trans-perineal systematic biopsies. For patients with no suspicious lesions, systematic biopsies were performed. We analyzed relationships between pathological biopsy findings and longitudinal changes in mpMRI. In 35 patients with biochemical failure, mpMRI detected 25 patients with suspected local recurrences. The cancer detection rates of these 25 patients with suspected local recurrences was 92%(23/25), compared with 0%of the 10 patients in whom recurrence was not suspected(P<0.0001). PSA velocity significantly differed between these two patient groups(median 1.12 vs. 0.42 ng/ml/year, P=0.034). In the suspected local recurrence group, cancer detection rates of target biopsy cores(median: 87%)and systematic biopsies(3.3%)significantly differed(P<0.0001). In longitudinal changes in mpMRI, all local recurrences were detected in the area with retained blood flow after HIFU. In conclusion, mpMRI can effectively evaluate recurrence of prostate cancer after HIFU. Retained blood flow in cancerous lesions after HIFU indicates insufficiently treated lesions that require re-treatment. Our results should contribute to the management of the HIFU treatment for the prostate cancer.