ADC值联合PI-RADS v2提高临床显著前列腺癌诊断效能的价值评估

Combination of ADC values with PI-RADS v2 in Improment of Diagnostic Efficacy for Clinically Significant Prostate Cancer

目的评估表观扩散系数(ADC)联合第2版前列腺影像报告和数据系统(PI-RADS v2)在临床显著前列腺癌(CSPCa)中的诊断效能。方法回顾性分析苏州大学附属张家港医院2015年1月至2019年3月间104例前列腺特异性抗原(PSA)升高患者的MRI资料,包括T2WI、扩散加权成像(DWI)、动态对比增强(DCE)。根据病理结果分为CSPCa组和非CSPCa组。由2名阅片者共同根据PI-RADS v2评分标准对病灶进行评分,并测量病灶的ADC值。建立单独使用PI-RADS v2、ADC值(连续变量)联合PI-RADS v2、ADC值(分类变量)联合PI-RADS v2诊断CSPCa的Logistic回归模型,采用受试者工作特征曲线(ROC)评价其诊断效能。结果104例可疑病变,其中63例为CSPCa,41例为非CSPCa。PI-RADS v2、ADC值以及ADC值≤923是诊断CS PCa的独立预测因子(P<0.001)。ADC值联合PI-RADS v2以及ADC值≤923联合PI-RADS v2曲线下面积(AUC)分别为0.89、0.90,均高于单独使用PI-RADS v2(AUC 0.87),以ADC值≤923联合PI-RADS v2曲线下面积最大,但各组间AUC差异均无统计学意义(P﹥0.05)。结论ADC值联合PI-RADS v2是一个很好的诊断CSPCa的方法,但将ADC值引入PI-RADS v2并不能显著提高CSPCa的诊断效能。

Objective To evaluate the value of apparent diffusion coefficient(ADC)values combined with prostate imaging reporting and data system version 2(PI-RADS v 2)in the diagnosis of clinically significant prostate cancer(CSPCa).Methods We retrospectively analyzed the multiparametric prostate MR images of 104 patients with PSA elevation from January 2015 to March 2019 in Zhangjiagang Hospital affiliated to Suzhou University,including T2WI,diffusion-weighted imaging(DWI),and dynamic contrast enhancement(DCE).The lesions were divided into the CSPCa group and non-CSPCa group according to pathological results.Two readers scored the prostate lesions according to the PI-RADS v2 and measured the ADC value of the lesions.Logistic regression analyses were used to determine the ability of PIRADS v2 alone,ADC value(continuous variable)combined with PI-RADS v2 to predict CSPCa using the biopsy findings as a reference standard.An additional model with ADC value(categorical variable)was performed.ROC curve was used to evaluate its diagnostic efficacy.Results Of the 104 patients,CSPCa was found in 63 patients.PI-RADS V2,ADC values,and ADC value≤923 were independent predictors of CS-PCa(P<0.001).The area under the ROC curve(AUC)of the PI-RADS V2 combined with ADC values and ADC value≤923 were 0.89 and 0.90.The AUC of PIRADS v2 alone were 0.87.ADC value≤923 combined with PI-RADS V2 yielded the highest AUC for identification of CS-PCa;but the differences were not significant(P>0.05).Conclusion ADC combined with PI-RADS V2 may be a better predictor of CS-PCa than PI-RADS V2 alone,but addition of ADC did not significantly improve the diagnostic performance.