本研究的目的是评估使用T1FLASH磁共振成像技术进行前列腺病变评估的MRI T1映射的临床可行性。所有临床怀疑患有前列腺癌（PCa）者均在2021年10月至2022年4月期间进行多参数前列腺MRI（mpMRI），并使用单次矫正恢复、径向欠采样和迭代重构的T1FLASH技术完成T1映射。在放射学鉴定的前列腺病变和转移带（TZ）、良性前列腺增生结节和周边带（PZ）代表性参考区域上手动放置感兴趣区（ROI）。测量每个ROI的平均T1弛豫时间和表观扩散系数（ADC）值（b = 50/b = 1400 s/mm2）。如果患者进行超声/ MRI融合引导前列腺穿刺活检，则被纳入本研究。活检切片的组织学评估作为参考标准，并根据国际泌尿学病理协会（ISUP）对PCa进行分级。在本研究的范围内，ISUP 2级及以上被视为临床意义的PCa。前列腺穿刺活检的组织学结果被解剖映射到相应的mpMRI ROI上。在整个前列腺区域和ISUP组之间比较T1弛豫时间、ADC值和诊断准确性（曲线下面积[AUC]）时，采用可以处理集群数据的统计方法进行比较。在67位合格参与者中，共有40位进行超声/ MRI融合引导前列腺穿刺活检的患者被纳入研究。在所有参与者中成功进行了多层T1映射，中位获得时间仅为2:10分钟，且没有明显的图像伪影。在影像学上鉴定出71个前列腺病变（TZ 49; PZ 22），其中22个被组织学诊断为PCa（ISUP组1/2/3/4分别为3/15/3/1例）。在TZ中，PCa的T1弛豫时间与参考区域（P = 0.029）和良性前列腺增生结节（P < 0.001）相比显著降低。同样，在PZ中，PCa表现出较短的T1弛豫时间与参考区域（P < 0.001）相比。与放射学疑似良性病变的组织学结果相比，PCa也表现出趋向较短的T1弛豫时间（中位数为1.40秒，中位数为1.47秒），尽管未达到统计学意义（P = 0.066）。为了区分PCa和不良性前列腺病变或参考区域，T1弛豫时间和ADC值的AUC分别为0.80和0.83（P = 0.519）。为了区分具有放射学怀疑良性组织学结果的病变和PCa，T1弛豫时间和ADC值的AUC分别为0.69和0.62（P = 0.446）。基于T1FLASH的T1映射可在短时间内进行，并且可以提供有助于区分显著和不显著PCa的T1弛豫时间信息。有必要进行进一步研究，以在更大的患者群中确认这些结果，在深度学习设置中评估T1FLASH图谱与mpMRI序列的额外优势，并评估T1FLASH图谱与可能存在伪影的扩散加权成像序列相比的鲁棒性。 版权所有 © 2022 Wolters Kluwer Health, Inc.保留所有权利。

The aim of this study was to assess the clinical feasibility of magnetic resonance imaging (MRI) T1 mapping using T1FLASH for assessment of prostate lesions.Participants with clinical suspicion for prostate cancer (PCa) were prospectively enrolled between October 2021 and April 2022 with multiparametric prostate MRI (mpMRI) acquired on a 3 T scanner. In addition, T1 mapping was accomplished using a single-shot T1FLASH technique with inversion recovery, radial undersampling, and iterative reconstruction. Regions of interest (ROIs) were manually placed on radiologically identified prostate lesions and representative reference regions of the transitional zone (TZ), benign prostate hyperplasia nodules, and peripheral zone (PZ). Mean T1 relaxation times and apparent diffusion coefficient (ADC) values (b = 50/b = 1400 s/mm2) were measured for each ROI. Participants were included in the study if they underwent ultrasound/MRI fusion-guided prostate biopsy for radiologically or clinically suspected PCa. Histological evaluation of biopsy cores served as reference standard, with grading of PCa according to the International Society of Urological Pathology (ISUP). ISUP grades 2 and above were considered clinically significant PCa for the scope of this study. Histological results of prostate biopsy cores were anatomically mapped to corresponding mpMRI ROIs using biopsy plans. T1 relaxation times and ADC values were compared across prostate regions and ISUP groups. Across different strata, T1 relaxation time, ADC values, and diagnostic accuracy (area under the curve [AUC]) were compared using statistical methods accounting for clustered data.Of 67 eligible participants, a total of 40 participants undergoing ultrasound/MRI fusion-guided prostate biopsy were included. Multislice T1 mapping was successfully performed in all participants at a median acquisition time of 2:10 minutes without evident image artifacts. A total of 71 prostate lesions was radiologically identified (TZ 49; PZ 22). Among those, 22 were histologically diagnosed with PCa (ISUP groups 1/2/3/4 in n = 3/15/3/1 cases, respectively). In the TZ, T1 relaxation time was statistically significantly lower for PCa compared with reference regions (P = 0.029) and benign prostate hyperplasia nodules (P < 0.001). Similarly, in the PZ, PCa demonstrated shorter T1 relaxation times versus reference regions (P < 0.001). PCa also showed a trend toward shorter T1 relaxation times (median, 1.40 seconds) compared with radiologically suspicious lesions with benign histology (median, 1.47 seconds), although statistical significance was not reached (P = 0.066). For discrimination of PCa from reference regions and benign prostate lesions, T1 relaxation times and ADC values demonstrated AUC = 0.80 and AUC = 0.83, respectively (P = 0.519). Discriminating PCa from radiologically suspicious lesions with benign histology, T1 relaxation times and ADC values showed AUC = 0.69 and AUC = 0.62, respectively (P = 0.446).T1FLASH-based T1 mapping yields robust results for quantification of prostate T1 relaxation time at a short examination time of 2:10 minutes without evident image artifacts. Associated T1 relaxation times could aid in discrimination of significant and nonsignificant PCa. Further studies are warranted to confirm these results in a larger patient cohort, to assess the additional benefit of T1FLASH maps in conjunction with mpMRI sequences in the setting of deep learning, and to evaluate the robustness of T1FLASH maps compared with potentially artifact-prone diffusion-weighted imaging sequences.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.