PI-RADS V2.1和V2.0对移行区有临床意义前列腺癌诊断效能的对照研究

Comparison between PI-RADS V2.1 and V2.0 for detection of transition zone clinically significant prostate cancer

目的比较前列腺影像报告与数据系统2.1版(PI-RADS V2.1)和2.0版(PI-RADS V2.0)对移行区有临床意义前列腺癌(csPCa)的诊断效能及不同评分者之间的一致性。方法收集临床疑诊为前列腺癌且行3.0 T多参数MRI检查患者的资料,以组织病理学结果为金标准,由两位不同年资医师根据PI-RADS V2.0和PI-RADS V2.1独立评估每个病灶的T2WI、扩散加权成像序列图像并完成PI-RADS总体评分。分析评估者间一致性,绘制受试者工作特征曲线并计算曲线下面积(AUC),比较两个版本对移行区csPCa的诊断效能。结果最终纳入123例经穿刺病理证实且位于前列腺移行区的病灶,其中csPCa 39例,无临床意义前列腺癌10例,良性前列腺增生74例。两位医师应用PI-RADS V2.0和PI-RADS V2.1的Kappa值分别为0.590、0.654。两版评分系统检测移行区csPCa的灵敏度差异在两位医师中均无统计学意义(P>0.05)。PI-RADS V2.1能提高低年资医师诊断的特异度、准确度及AUC(P<0.05)。结论PI-RADS V2.1较PI-RADS V2.0相比具有更高的一致性,且有助于提高低年资医师对csPCa的诊断效能。

Objective To compare the diagnostic performance and the consistency among different readers of prostate imaging report and data system version 2.1(PI-RADS V2.1)and version 2.0(PI-RADS V2.0)for detecting transition zone clinically significant prostate cancer(csPCa).Methods Data of patients with suspected PCa who underwent 3.0T multi-parameter MRI were enrolled and the histopathological results were taken as the gold standard.The TWI,DWI sequences of each lesion were independently evaluated and the overall PI-RADS score was completed by 2 radiologists with different seniority according to PI-RADS V2.0 and PI-RADS V2.1.The consistency among evaluators was analyzed.The receiver operating characteristic curve was plotted and the area under the curve(AUC)was calculated to compare the diagnostic efficacy between the two versions.Results One hundred and twenty-three cases of lesions confirmed by biopsy pathology and located in transition zone of prostate were selected,including 39 cases of csPCa,10 cases of clinically insignificant PCa and 74 cases of benign lesions.The Kappa values of PI-RADS V2.0 and PI-RADS V2.1 were 0.590 and 0.654.For both versions,there was no significant difference in the sensitivity of detecting csPCa(P>0.05)between the two radiologists.PI-RADS V2.1 could improve diagnostic specificity,accuracy and AUC in low-seniority radiologist(P<0.05).Conclusions PI-RADS V2.1 has a higher consistency than PI-RADS V2.0,and it is helpful for junior radiologists to improve the diagnostic efficiency.