磁共振成像预测前列腺癌囊外侵犯的方法学 演进及临床意义

Methodological Evolution and Clinical Significance of Magnetic Resonance Imaging in Predicting Extraprostatic Extension of Prostate Cancer

摘要: 前列腺癌囊外侵犯(extraprostatic extension, EPE)是影响前列腺癌局部分期、手术策略制定及预后评估的关键因素。随着多参数磁共振成像(mpMRI)在前列腺癌诊疗中的广泛应用，其在术前评估EPE中的作用不断深化。既往研究显示，MRI对EPE的评估方法经历了由基于整体印象的主观判断，向定性影像征象、连续定量测量指标，再到结构化评分体系的逐步演进。定性征象提高了影像评估的可解释性，定量指标增强了客观性与可重复性，而结构化评分体系通过整合多源影像信息，在准确性、一致性及临床可交流性之间实现了相对平衡。现有证据表明，MRI在识别侵袭范围较大的EPE方面具有稳定表现，其评估结果与术前手术决策、切缘阳性风险及部分肿瘤学结局存在明确关联。然而，MRI对局灶性或轻度EPE的敏感性仍有限，在前部、移行带及前列腺尖部等特定解剖区域的评估中持续面临挑战。未来研究需在充分认识这些局限的基础上，通过标准化评估流程和问题导向的研究设计，进一步明确MRI评估EPE的适用边界与临床定位。

Abstract: Extraprostatic extension (EPE) is a pivotal determinant in local staging, surgical planning, and prognostic assessment of prostate cancer. With the widespread adoption of multiparametric magnetic resonance imaging (MRI) in prostate cancer management, its role in the preoperative evaluation of EPE has become increasingly prominent. Over the past decades, MRI-based assessment of EPE has evolved from subjective, impression-based interpretation to the use of qualitative imaging features, continuous quantitative metrics, and, more recently, structured scoring systems. Qualitative features enhance interpretability, quantitative measurements improve objectivity and reproducibility, and structured scoring systems integrate multidimensional imaging information to achieve a balance between diagnostic accuracy, interobserver consistency, and clinical communicability. Current evidence indicates that MRI demonstrates relatively stable performance in identifying EPE with more extensive invasion, and MRI-derived EPE assessments show reproducible associations with surgical decision-making, positive surgical margin risk, and selected oncologic outcomes. However, MRI remains limited in sensitivity for focal or subtle EPE and continues to face challenges in specific anatomic regions, including the anterior prostate, transition zone, and apical area. Future research should build upon these well-recognized limitations, emphasizing standardized assessment workflows and problem-oriented study designs to better define the appropriate clinical role and boundaries of MRI in EPE evaluation.