前列腺影像报告与数据系统2.0版与2.1版对移行带前列腺癌的诊断价值研究

Diagnostic Value of Prostate Imaging Reporting and Data System Version 2.0 and Version 2.1 for Detection of Prostate Cancer in Transition Zone

目的比较前列腺影像报告与数据系统2.0版(PI-RADS v2.0)与2.1版(PI-RADS v2.1)的评分一致性及对移行带前列腺癌(PCa)的诊断价值。方法回顾性分析经病理证实的137例移行带前列腺疾病患者MRI资料,其中移行带PCa 28例和前列腺增生(BPH)109例。由两位阅片者在不知病理结果的情况下,根据PI-RADS v2.0与PI-RADS v2.1对移行带可疑结节进行盲法阅片及评分。两位阅片者的评分一致性采用Kappa检验进行分析。以病理结果为标准,绘制ROC曲线获得PI-RADS v2.0与PI-RADS v2.1诊断移行带PCa的最佳诊断阈值及曲线下面积。结果两位阅片者使用PI-RADS v2.0与PI-RADS v2.1的评分一致性Kappa值分别为0.724和0.762。根据ROC曲线分析,PI-RADS v2.0与PI-RADS v2.1诊断移行带PCa的最佳阈值均为≥4分,相应曲线下面积分别为0.910与0.939,敏感性分别为75.0%与78.6%,特异性分别为94.5%与96.3%。结论PI-RADS v2.0与PI-RADS v2.1对移行带PCa均有较高的诊断价值,且PI-RADS v2.1在低分值(1~3分)对移行带结节的风险分层较PI-RADS v2.0更加合理。

Objective To compare the inter-observer agreement and diagnosis value of PI-RADS v2.0 and PI-RADS v2.1 for detection of prostate cancer(PCa)in the transition zone(TZ).Methods The MRI data of 137 consecutive patients histologically proven prostate lesions between 2016 January and 2018 April were retrospectively analyzed.Among them,28 patients were confirmed PCa in TZ and 109 patients were confirmed benign prostatic hyperplasia(BPH).The MRI images were reviewed according to PI-RADS v2.0 and PI-RADS v2.1 by two radiologists with blind method.Inter-observer agreement was assessed by using Kappa test.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnosis value of PI-RADS v2.0 and PI-RADS v2.1.Results The Kappa value of PI-RADS v2.0 and PI-RADS v2.1 were 0.724 and 0.762,respectively.With a cutoff value of score 4,the AUC of PI-RADS v2.0 and PI-RADS v2.1 for diagnosing PCa in TZ were 0.910 and 0.939.Diagnostic sensitivity was 75.0%and 78.6%,specificity was 94.5%and 96.3%,respectively.Conclusion Both PI-RADS v2.0 and PI-RADS v2.1 show good accuracy in diagnosing PCa in TZ.At low scores(score 1 to 3),PI-RADS v2.1 perform better than PI-RADS v2.0 for risk stratification of nodules in TZ.