前列腺影像报告数据系统在前列腺癌诊断中的应用

Utility of prostate imaging reporting and data system for predicting prostate cancer

目的目的用磁共振引导靶向前列腺穿刺标本，评价前列腺影像报告数据系统（PI—RADS）对中国人群前列腺癌的诊断价值。方法自2014年7月至2015年6月，共43例患者行多参数核磁共振（mp—MRI）检查并行磁共振引导下靶向前列腺穿刺活检。PI—RADS评分由影像科医师严格按照欧洲泌尿放射学会（ESUR）标准对每个兴趣点（ROIs）分别进行评估；参考靶向穿刺病理，分析各项PI—RADS评分对前列腺癌诊断的敏感度和特异度。结果共穿刺ROIs71处，其中前列腺癌25处，前列腺增生46处。前列腺癌T2WI、DWI、PI—RADS评分明显高于前列腺增生，高级别前列腺癌ROIs评分高于低级别肿瘤（P〈0．05）。随着PI—RADS分级的提高，患者前列腺癌检出率逐步提高。以病理结果为对照行受试者工作特征（ROC）曲线分析，前列腺癌曲线下面积（AUC）分别为0．83、0．88、0．89。以≥4分为阈值，T2WI、DWI、PI—RADS对前列腺癌诊断敏感度分别为84％、80％、88％，特异度分别为80％、89％、87％；PI—RADS对高级别癌灶检测敏感度分别为80％、87％、93％，特异度分别为68％、79％、75％。结论PI—RADS评分与前列腺癌的风险有～定的相关性，可以在临床中作为前列腺癌诊断的辅助手段，以提高前列腺癌诊断的准确性。

Objective To evaluate the efficiency of prostate imaging reporting and data system （PI-RADS） for the diagnosis of prostate cancer in Chinese population. Methods The 43 patients received the multiparametric MRI （rap MRI） test followed by targeted prostate biopsy from July 2014 to June2015. The PI-RADS score of each region of interests （ROIs） was evaluated according to the European Society of Urological Radiology （ESUR） guideline. Receiver operating characteristics （ROC） curve was performed to test diagnostic efficacy of mp-MRI. Results The 71 ROIs were evaluated, of which 25 were prostate cancer and 46 were benign prostatic hyperplasia （BPH）. Compared with BPH, prostate cancer showed the higher score of T2WI （3.80 ±_ 0.50 vs. 3.13 0.54）, DWI （4.20±0.76 vs. 2.93±0.71） and PI-RADS （4.04±0.61 vs. 3.02±0.68） （all P〈 0.05）. The ROIs score was higher in high grade prostate cancer than in low grade cancer （P〈0.05）. The area under the curve （AUC） for the detection of prostate cancer was 0.83, 0.88 and 0.89 for T2WI, DWI and PI-RADS, with the sensitivity of 84%, 80%, 88% and specificity of 80%, 89%, 87%, respectively. As for high grade prostate cancer, the detection sensitivity was 80%, 87% and 93%, and the specificity was 68%, 79% and 75%. Conclusions The PI-RADS scoring system shows high relevance to prostate cancer, which is of great value for the diagnosis of prostate cancer in Chinese population.