不同版本 PI-RADS(v1与v2)对前列腺癌诊断的一致性分析

The agreement research of two physicians for PI-RADS (v1/v2) diagnostic scoring at 1.5T MR equipment

目的:评价PI-RADS v1与PI-RADS v2在不同诊断经验医师间的评分结果一致性。方法:回顾性分析175例在1.5T MR设备行前列腺T 2WI、DWI和DCEI扫描并获得穿刺病理结果的前列腺癌患者影像资料。由两位具有不同诊断经验的医师分别应用PI-RADS v1和v2评分标准独立分析患者mp-MRI图像,记录两位医师PI-RADS评分结果。采用加权Kappa检验比较不同医师PI-RADS评分结果的一致性,并绘制Bland-Altman法画散点图作进一步对比分析。结果:在移行带病灶中,两位医师采用PI-RADS v1评分结果间的一致性为一般水平(二次加权k值为0.337,95%可信区间0.105~0.568),采用PI-RADS v2评分结果间的一致性处于中等水平(二次加权0.498,95%可信区间0.273~0.723);外周带病灶中,两位医师采用PI-RADS v1评分结果间的一致性为中等水平(二次加权k值0.417,95%可信区间为0.252~0.582),采用PI-RADS v2评分结果间的一致性处于良好水平(二次加权k值0.658,95%可信区间0.521~0.795);在不区分外周带及移行带病灶的综合评价中,两位医师PI-RADS v1评分结果一致性为中等水平(二次加权k值0.398,95%的可信区间为0.261~0.535),而两位医师PI-RADS v2评分结果一致性达到良好水平(二次加权k值0.632,95%的可信区间为 0.510~ 0.755)。不同区域病灶的Bland-Altman散点图均表明在不同医师评分差值的平均值中,PI-RADS v2较 PI-RADS v1更接近于代表差值为零的线,提示无论在外周带还是移行带病灶的评价中,不同医师PI-RADS v2评分结果的一致性均高于PI-RADS v1。结论:在1.5T MR设备和非直肠内线圈条件下,两位不同诊断经验医师采用PI-RADS v2对前列腺癌进行诊断评分的一致性高于PI-RADS v1。

Objective: To preliminarily evaluate the inter-observer agreement between two physicians for diagnostic scoring of prostate cancer by applying PI-RADS v1 and PI-RADS v2. Methods: A total of 175 patients with biopsy confirmed prostate cancer were retrospectively included.T 2WI,DWI and DCE mp-MRI scans from 1.5T MRI scanner were reviewed and analyzed by two independent physicians according to the PI-RADS v1 and PI-RADS v2 scoring standard,and scored accordingly.The inter-observer agreement was tested by weighted Kappa method and the Bland-Altman plot. Results: In lesions of transition zone,the agreement of PI-RADS v1 score in different physicians was just fair (quadratic weighted k value was 0.337,95%CI:0.105~0.568);the agreement of PI-RADS v2 score in different physicians was moderate (quadratic weighted k value was 0.498,95%CI:0.273~0.723).In the peripheral zone,the agreement of PI-RADS v1 score in different physicians was moderate (quadratic weighted k value was 0.417,95%CI:0.252~0.582),the agreement of PI-RADS v2 score in different physicians was good (quadratic weighted k value was 0.658,95%CI:0.521~0.795).In all lesions,the agreement of PI-RADS v1 score in different physicians was just moderate (quadratic weighted k value was 0.398,95%CI:0.261~0.535);the agreement of PI-RADS v2 score in different physicians was good (quadratic weighted k value was 0.632,95%CI:0.510~0.755).Draw the Bland-Altman scatter plot of the two physicians in diagnostic scoring of peripheral and transition zone cancer by using the PI-RADS v1 and PI-RADS v2 respectively,the results show that the mean of difference values in different physicians,PI-RADS v2 is closer to represent difference of zero line than PI-RADS v1,also revealed that considering the inter-reader agreement of PI-RADS score results in peripheral and transition zone cancer,PI-RADS v2 were higher than PI-RADS v1. Conclusion: At 1.5T MR scanner without the rectum coil.The inter-observer agreement of the two physicians by using PI-RADS v2 in prostate cancer was higher than PI-RADS v1.