基于PI-RADS v2.1不同参数磁共振成像对前列腺癌诊断效能的比较

Comparison of the diagnostic efficacy of magnetic resonance imaging with different parameters for prostate cancer based on PI-RADS v2.1

目的基于PI-RADS v2.1不同参数磁共振成像[快速双参数磁共振成像(fast bp-MRI)、双参数磁共振成像(bp-MRI)和多参数磁共振成像(mp-MRI)]对前列腺癌诊断效能的比较。方法回顾性分析88例活检前接受前列腺磁共振成像检查的前列腺特异性抗原升高(PSA>4 ng/mL)患者临床资料,非前列腺癌44例,前列腺癌44例。前列腺癌中外周带(PZ)28例,移行带(TZ)16例,进行多参数磁共振扫描(包括T2WI、DWI和DCE序列),以PI-RADS v2.1为诊断标准,在PZ及TZ中单独对T2WI、DWI和DCE进行评分。将所有患者进行完整的磁共振序列检查,分成3种方案(fast bp-MRI、bp-MRI、mp-MRI)分别对图像进行总体评分,采用独立样本t检验比较3种检查方案前列腺癌和非前列腺癌的PI-RADS v2.1评分,建立受试者工作特征(ROC)曲线,采用Z检验比较曲线下面积(AUC)的差异,取约登指数最大值所对应的PI-RADS v2.1评分为临界值,计算3种检查方案诊断前列腺的敏感度、特异度及准确度。结果3种检查方案的前列腺癌和非前列腺癌患者PI-RADS v2.1评分差异均有统计学意义(均P<0.05)。fast bp-MRI、bp-MRI、mp-MRI方案ROC曲线下面积分别为0.831、0.903、0.905,差异均无统计学意义(均P>0.05)。以PI-RADS v2.1评分≥4分为临界值,mp-MRI的敏感度最高;fast bp-MRI与bp-MRI的特异度相当,略高于mp-MRI;mp-MRI的准确度最高,fast bp-MRI的准确度最低。结论mp-MRI对前列腺癌诊断效能最高,bp-MRI诊断效能与之相近,可保留bp-MRI诊断以供选择临床适应证。

Objective To compare the diagnostic efficacy of fast bi-parametric magnetic resonance imaging(fast bp-MRI),bi-parametric magnetic resonance imaging(bp-MRI),and multi-parametric magnetic resonance imaging(mp-MRI)for prostate cancer based on PIRADS v2.1.Methods Eighty-eight patients with PSA>4 ng/mL,including 44 with non-prostate cancers and 44 with prostate cancer[28 in the peripheral zone(PZ)and 16 in the transitional zone(TZ)],were analyzed retrospectively.PI-RADS v2.1 as the diagnostic standard,T2WI,DWI,and DCE were scored separately in the PZ and TZ,and all the cases were examined with complete magnetic resonance sequences,which were divided into three schemes,namely fast bp-MRI,bp-MRI,and mp-MRI.Independent sample t test was used to compare the PI-RADS v2.1 scores of prostate cancer and non-prostate cancer patients.PI-RADS v2.1 score was used to establish the receiver operating characteristic(ROC)curve of the subjects,and Z test was used to compare the area under the curve(AUC).The PIRADS v2.1 score corresponding to the maximum value of the Jordan index was taken as the critical value,and the sensitivity,specificity,and accuracy of the three examination schemes for the diagnosis of prostate cancer were calculated.Results There were significant differences in the mean PI-RADS v2.1 scores between the prostate cancer and non-prostate cancer(P<0.05).AUC for fast bp-MRI,bp-MRI,and mp-MRI was 0.831,0.903,and 0.905,respectively,and there was no significant difference among three schemes(P>0.05).mp-MRI had the highest sensitivity,while fast bp-MRI and bp-MRI had the same specificity,slightly higher than that of mp-MRI.mp-MRI had the highest accuracy and fast bp-MRI had the lowest accuracy.Conclusion mp-MRI is the most effective method in the diagnosis of prostate cancer,and bp-MRI is similar to it.bp-MRI can be reserved for clinical indications.