双参数磁共振PI-RADS v2联合临床指标对前列腺移行带临床显著癌的诊断价值

Biparametric MRI-based PI-RADS v2 and clinical indicators predict clinically significant prostate cancer in the transition zone

目的探讨基于双参数MRI的第二版前列腺影像报告和数据系统(PI-RADS v2)评分联合临床指标对移行带临床显著癌(cs-PCa)的诊断价值。方法选取2016年1月~2019年12月进行前列腺双参数MRI检查的249例患者,经直肠超声前列腺穿刺活检确诊。Logistic回归分析确定独立预测指标,构建联合模型。应用加权Kappa检验评估医师间的评分一致性。应用受试者工作特征曲线评估诊断效能。结果PI-RADS v2评分和前列腺特异性抗原(PSAD)是诊断移行带cs-PCa的独立预测指标。医师间的评分有较强一致性(加权Kappa系数为0.636)。联合模型检出移行带cs-PCa的AUC为0.951,显著高于PI-RADS v2评分(AUC=0.923)和PSAD(AUC=0.885)(P<0.05)。单独应用PI-RADS v2评分和PSAD诊断移行带cs-PCa的敏感度和特异度分别为87.5%、88.0%;77.5%、86.1%;而联合模型的诊断敏感度和特异度分别为87.5%、94.7%。结论PI-RADS v2评分联合PSAD能显著提高对移行带cs-PCa的诊断特异度,避免不必要的穿刺活检。

Objective To evaluate the diagnostic performance of prostate imaging reporting and data system version 2(PI-RADS v2)score based on biparametric magnetic resonance imaging(bp-MRI)combined with clinical indicators for detecting clinically significant prostate cancer(cs-PCa)in the transition zone(TZ).Methods From January 2016 to December 2019,249 patients with suspicious prostate lesions in the TZ who underwent prostate bp-MRI and confirmed pathologically by transrectal ultrasound(TRUS)-guided prostate biopsy were enrolled in this study.Multivariate logistic regression analysis was performed to determine independent predictors for the detection of TZ cs-PCa,thereby establishing a combination model.Cohen’s weighted Kappa test was used to evaluate the inter-reader agreement between the two radiologists.The receiver operating characteristic curve(ROC)was used to assess the diagnostic performance of the combination model and independent predictors for TZ cs-PCa.The areas of ROC(AUCs)were calculated and compared using Z test.Results PI-RADS v2 score and prostate specific antigen density(PSAD)were independent predictors of TZ cs-PCa(P<0.05).There was a substantial agreement between the two radiologists for the PI-RADS v2 score(weighted kappa value of 0.636).The AUC value in the combination model was 0.951,significantly higher than those in PI-RADS v2 score(AUC=0.923)and PSAD(AUC=0.885)(P<0.05).In addition,the diagnostic sensitivity and specificity of combination model for detecting cs-PCa were 87.5%and 94.7%,which were higher than those in PI-RADS v2 score(87.5%,88.0%)and PSAD(77.5%,86.1%).Conclusion PI-RADS v2 score based on bp-MRI and PSAD are the independent predictors for the detection of TZ cs-PCa.In addition,combining PI-RADS v2 with PSAD can significantly improve the diagnostic specificity,thus avoiding unnecessary biopsies.