基于第二版前列腺影像报告和数据系统的多参数磁共振成像在前列腺癌诊断中的应用价值

Application Value of Multiparameter Magnetic Resonance Imaging Based on the Second Version of PI-RADS in the Diagnosis of Prostate Cancer

目的探索分析基于第二版前列腺影像报告和数据系统(PI-RADS)的多参数磁共振成像在前列腺癌诊断中的应用价值。方法选取2017年1月—2019年7月期间在梅州市人民医院进行诊治的前列腺病变106例患者作为研究对象,所有受检者均进行多参数磁共振成像检查,由两位不同资历医师采用盲法基于第二版对病灶进行独立阅片评分。评价两位医师基于第二版PI-RADS评分的一致性,记录不同第二版PI-RADS评分的前列腺穿刺的阳性率,并比较不同第二版PI-RADS评分进行诊断前列腺癌的诊断效能。结果在前列腺恶性病灶和良性病灶中,两位医师基于第二版PI-RADS评分诊断的一致性Kappa系数分别为0.74、0.78,一致性良好。第二版PI-RADS评分1分、2分、3分、4分、5分前列腺癌穿刺的阳性率分别为3.70%、15.00%、35.29%、57.89%、86.96%,随着第二版PI-RADS评分的上升,穿刺的阳性率呈逐渐上升的趋势(P<0.05)。随着第二版PI-RADS评分诊断阈值的不断上升,其诊断的前列腺癌的灵敏度和阴性预测值逐渐降低,特异度和阳性预测值则逐渐升高。其中以第二版PI-RADS评分4分作为诊断前列腺癌的阈值时,约登指数最高,ROC曲线下面积(AUC)为0.841。结论基于第二版PI-RADS的多参数磁共振成像诊断前列腺癌的一致性良好,通过第二版PI-RADS评分有助于减少不必要的穿刺活检,还能提升临床意义显著前列腺癌的检出率,具有进一步推广应用的价值。

Objective To explore and analyze the value of multi-parameter magnetic resonance imaging(MRI)based on prostate imaging report and data system(PI-RADS)in the diagnosis of prostate cancer.Methods 106 patients with prostate lesions diagnosed and treated in the hospital from January,2017 to July,2019 were selected as the subjects.All the subjects were examined by multi-parameter magnetic resonance imaging(MRI).The lesions were independently read by two different qualified physicians using the blind method based on the second edition of PI-RADS by blind method.The consistency of the two physicians’scores based on the second edition of PI-RADS was evaluated.The positive rate of prostate puncture with different second edition PI-RADS scores was recorded.And the diagnostic efficacy of different second edition PI-RADS scores in the diagnosis of prostate cancer was compared.Results In the malignant and benign lesions of the prostate,the consistency Kappa coefficient of the diagnosis of the two physicians based on the second edition of PI-RADS score was 0.74 and 0.78,respectively,and the consistency was good.The positive rates of prostate cancer puncture with PI-RADS scores of 1,2,3,4 and 5 were 3.70%,15.00%,35.29%,57.89%and 86.96%,respectively.With the increase of PI-RADS score in the second edition,the positive rate of prostate cancer puncture increased gradually(P<0.05).With the rising diagnostic threshold of PI-RADS score in the second edition,the sensitivity and negative predictive value of prostate cancer decreased gradually,while the specificity and positive predictive value increased gradually.When the second edition PI-RADS score 4 was used as the threshold for the diagnosis of prostate cancer,the Jordan index was the highest,and the area(AUC)under the ROC curve was 0.841.Conclusion Multi-parameter magnetic resonance imaging based on the second version of PI-RADS is consistent in the diagnosis of prostate cancer.PI-RADS score of the second edition is helpful to reduce unnecessary puncture biopsies,and can also improve the detection rate of prostate cancer of clinical significance,which has the value of further popularization and application.