前列腺影像报告和数据系统第一版和第二版诊断前列腺癌的效能比较

Comparison of PI-RADS version 2 and version 1 regarding diagnostic accuracy for the detection of clinically significant prostate cancer

目的评估两位阅片者运用前列腺影像报告和数据系统第一版(PI-RADS v1)与第二版(PI-RADS v2)进行诊断评分的一致性,同时探讨PI-RADS v1与PI-RADS v2检出临床显著前列腺癌(csPCa)的效能差异。方法回顾性分析我院2015年1月~2018年4月行前列腺多参数MRI(Mp-MRI)检查患者的影像、病理及临床资料。由两名影像科医师分别运用基于PI-RADS v1和PI-RADS v2的两种5分制评分方案对图像进行视觉评估。运用Cohen′s Kappa检验对两位医师评分结果的一致性进行评估。运用受试者工作特性(ROC)曲线评估两个版本对外周带及移形带csPCa的诊断效能,并运用Z检验判断PI-RADS v1和PI-RADS v2的曲线下面积(AUC)有无差异。结果最终纳入169例患者。一致性评估结果显示两名医师运用PI-RADS v1与PI-RADS v2均具有较好的一致性,Kappa系数分别为0.618,0.817。ROC曲线分析结果显示PI-RADS v1和PI-RADS v2检出外周带csPCa的AUC值分别为0.881,0.939,两者间差异有统计学意义;PI-RADS v1和PI-RADS v2检出移行带csPCa的AUC值分别为0.935,0.911,两者间差异无统计学意义(P>0.05)。结论建议在Mp-MRI csPCa的诊断中使用PI-RADS v2。

Objective To evaluate the interobserver reproducibility of the Prostate Imaging Reporting and Data System(PI-RADS)version 1 and version 2 and to explore the diagnostic accuracy between PI-RADS v1 and PI-RADS v2 in detecting clinically significant prostate cancer(csPCa).Methods The imaging,pathological and clinical data of patients with prostatic Mp-MRI in our hospital from January 2015 to April 2018 were retrospectively analyzed.Two radiologists visually evaluated the images using two 5-point scoring schemes based on PI-RADS v1 and PI-RADS v2 independently.Cohen’s kappa test was used to assess the interobserver reproducibility.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic accuracy of the two versions in detecting csPCa,and with Z test to investigate whether there was any difference in diagnostic accuracy between the two versions.Results 169 patients were eventually enrolled in the study.The results of the interobserver reproducibility showed that there was good agreement between the two radiologists,either using PI-RADS v1 or PI-RADS v2,with the kappa coefficient of 0.618 and 0.817,respectively.The ROC curve analysis showed that the area under the curve(AUC)of PZ csPCa detected by PI-RADS v1 and PI-RADS v2 was 0.881 and 0.939,with statistically significant difference.The ROC curve analysis showed that the AUC of TZ csPCa detected by PI-RADS v1 and PI-RADS v2 was 0.935 and 0.911,there was no statistically significant difference(P>0.05).Conclusion PI-RADS v2 could be more practicable for clinical routine.