前列腺影像报告和数据系统2.1版与2版对前列腺癌的诊断价值比较

Comparison the Diagnostic Value of Prostate Imaging Reporting and Data System Version 2.1 and Version 2

目的探讨前列腺影像报告和数据系统(PI-RADS)2.1版(V2.1)与2版(V2)对前列腺癌(PCa)的诊断价值和阅片者之间的一致性比较。方法搜集临床怀疑PCa行3.0 T多参数MRI检查的患者442例。两名医师(R1和R2)分别按照V2.1与V2标准对移形带和外周带病灶进行评分。运用Kappa检验评估两名医师评价结果的一致性。运用受试者工作特征曲线(ROC)评估2个版本对PCa及临床显著前列腺癌(csPCa)的检出效能,并运用Z检验分别评估2个版本曲线下面积(AUC)有无差异。结果442例连续的患者纳入本研究,其中PCa患者245例,良性病灶患者197例。V2.1在所有病灶(包括PCa和良性病灶)、PCa、csPCa、移行带病灶组一致性(k=0.626~0.732)均高于V2(k=0.544~0.678)。在不区分位置时(混合组),两名医师诊断PCa、csPCa时使用V2.1的AUC均高于V2。但2个版本AUC之间的差异无统计学意义。结论PI-RADS V2.1和V2对PCa及csPCa均具有较高的诊断较能,但V2.1阅片者间的一致性更高,值得推广使用。

Objective To explore the difference in diagnostic efficacy between Prostate Imaging reporting and Data System Version 2.1(PI-RADS V2.1)and Version 2(V2)in detecting prostate cancer(PCa)and to evaluate the consistency of image interpretation between two readers.Methods 442 patients with pathologically confirmed and clinical suspicion of PCa who underwent 3.0 T Mp-MRI,were retrospectively analyzed.Two radiologists scored according to V2.1 and V2 stratified by location(Transitional Zone,TZ,Peripheral Zone,PZ).Kappa test was used to assess the consistency of the results interpreted by the two radiologists.The receiver operating characteristic(ROC)curve was used to evaluate the efficiency of the two scoring schemes in detecting PCa and cs PCa,and with Z test to investigate whether there was any difference in detection efficiency between the two schemes.Results 442 consecutive patients were included in the study,of which 245(55.4%)were PCa and 197(44.6%)were benign lesions.For all lesions,PCa,cs PCa,and transitional zone lesions in V2.1,the consistency(k=0.626~0.732)is higher than V2(k=0.544~0.678).Study data from both TZ and PZ,the ROC analysis showed that the area under the curve(AUC)of PCa and cs PCa detected by V2.1 were higher than V2(s PcaR1:V2.1=0.942,R2:V2.1=0.928;R1:V2=0.937,R2:V2=0.918;PCa R1:V2.1=0.908,R2:V2.1=0.897;R1:V2=0.897,R2:V2=0.885),respectively.In addition,there was no statistically significant difference between the AUCs(Z:0.29、0.62、0.54、0.58,P:0.771、0.606、0.59、0.564).Conclusion Both PI-RADS V2.1 and V2 showed good results on the diagnostic accuracy of PCa and cs PCa.However,the consistency was better with V2.1 than with V2.