摘要
背景与目的:随着前列腺多参数MR成像技术的发展,影像学在前列腺病灶诊断、恶性度评估及疗效评估等方面均表现出一定的临床意义。但扫描序列增多,且在前列腺不同区域、不同序列所占的权重并不一样,给临床工作带来了一定的负担,基于此基础上的第二版前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System version 2,PI-RADS V2)应运而生。为推广PI-RADS V2,本研究就其对前列腺病灶评估的一致性及准确性进行探究。方法:回顾性分析98例符合PI-RADS V2评估要求并有病理资料的患者,共141个病灶。邀请两位不同年资的影像学医师独立评估病灶。采用kappa系数评估两名医师PI-RADS V2分类评分的一致性。利用受试者工作特征(receiver operating characteristic,ROC)曲线方法来分析两名医师诊断出Gleason score≥7的病灶的准确性,并分别计算出各ROC曲线的cut-off值来确定PI-RADS V2评分的最佳界值。结果:对于PI-RADS V2≥3分的病灶,两名医师对外周带病灶评估一致性较好(非外周带和外周带kappa值分别为0.668和0.769)。对于PI-RADS V2≥4分的病灶,其评估一致性更好(非外周带和外周带kappa值分别为0.710和0.843)。影像学医师1、2诊断出Gleason score≥7的病灶的ROC曲线的曲线下面积(area under curve,AUC)分别为0.816、0.792,且非外周带的AUC均比外周带的高(AUC1:0.886 vs 0.791;AUC2:0.791 vs 0.730)。另外,两名医师在评估外周带及非外周带病灶良恶性的最佳PI-RADS V2评分界值均为3分。结论:PI-RADS V2评价前列腺病灶具有较好的一致性及准确性。PI-RADS V2可能更适合非外周带病灶的评估,尚需进一步验证。
Background and purpose: With the development of multi-parametric MR imaging techniques for detection of prostate carcinoma, medical imaging has shown the promising value in diagnosis, prediction of aggressiveness and evaluation of responses to different treatments. However, the increase of scanning sequences and the different weight of sequences in different regions of prostate put additional burden on diagnosticians, and thus the Prostate Imaging Reporting and Data System version 2(PI-RADS V2) is generated. For popularizing PI-RADS V2, we performed this study to investigate interobserver agreement and accuracy in diagnosing prostate lesions. Methods: We retrospectively analyzed 98 patients with 141 prostate carcinoma lesions confirmed by biopsy and/or surgery who met the conditions of PI-RADS V2 assessment. Two readers independently assigned a PI-RADS V2 assessment category to the lesions. The Cohen's kappa statistic was used to quantify interobserver agreement. The area under the receiver operating characteristic(ROC) curve(AUC) was calculated to determine reader accuracy for the detection of clinically significant prostate cancer(Gleason score ≥7). Simultaneously, the cutoff value of all ROCs were calculated, which would be regarded as the optimal value to define the prostate lesions as benign or malignant foci. Results: When a PI-RADS V2 assessment category ≥3 was considered positive, the agreement between readers was good for nonperipheral zone lesions(kappa=0.668) and peripheral zone lesions(kappa=0.769). When a PI-RADS V2 assessment category ≥4 was considered positive, the agreement was better for non-peripheral zone lesions(kappa=0.710) and excellent for peripheral zone lesions(kappa=0.843). The AUCs for readers 1 and 2 were 0.816 and 0.792, and had no significant difference. The AUCs were greater for non-peripheral zone lesions than for peripheral zone lesions(AUC1: 0.886 vs 0.791; AUC2: 0.791 vs 0.730). Additionally, the cutoff value of all ROC curves was 3. Conclusion: Two experienced readers were able to accurately identify patients with clinically significant prostate cancer using PI-RADS V2 with good interobserver agreement. PI-RADS V2 may be more suitable for non-peripheral zone lesions, which need further investigation.
作者
刘伟
刘晓航
汤伟
高洪波
周良平
LIU Wei;LIU Xiaohang;TANG Wei;GAO Hongbo;ZHOU Liangping(Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China;Shanghai Institute of Medical Imaging, Shanghai 200032, China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2018年第3期197-202,共6页
China Oncology
关键词
第二版前列腺影像报告和数据系统
前列腺癌
准确性
一致性
Prostate Imaging Reporting and Date System version 2
Prostate carcinoma
Accuracy
Interobserver agreement