基于PI-RADS V2.1评估双参数和多参数MRI对外周带临床显著性前列腺癌的诊断价值

Comparison of the diagnostic efficiency of biparametric and multiparametric MRI in the diagnosis of peripheral zone clinically significant prostate cancer based on PI-RADS Version 2.1

目的:基于第2.1版前列腺影像报告和数据系统(PI-RADS V2.1)评估双参数(bpMRI)和多参数磁共振成像(mpMRI)对外周带临床显著性前列腺癌(csPCa)的诊断价值。方法:回顾性分析154例经穿刺活检或手术病理证实的前列腺外周带病变患者的临床和MRI资料。154例患者中,前列腺癌为75例,其中csPCa 63例,无临床意义PCa(ciPCa)12例,良性病变79例。由两位放射科医师(分别具有3和10年前列腺MRI诊断经验)基于bpMRI和mpMRI分别对前列腺外周带主病灶进行PI-RADS评分,绘制其受试者工作曲线(ROC),根据约登指数确定临界值,计算并比较两种方法的曲线下面积(AUC)及诊断符合率、敏感度、特异度、阴性和阳性预测值。结果:基于bpMRI和mpMRI,两位医师对病变PI-RADS评分的一致性均较好(Kappa值分别为0.746和0.688)。低年资医师基于bpMRI和mpMRI的PI-RADS评分诊断csPCa的AUC分别为0.761和0.774,差异无统计学意义(Z=1.469,P>0.05);高年资医师基于bpMRI和mpMRI的PI-RADS评分诊断csPCa的AUC分别为0.773和0.778,差异无统计学意义(Z=0.643,P>0.05)。两位医师基于mpMRI的诊断敏感度均显著高于bpMRI(90.5%vs.73.0%、90.5%vs.70.8%,P均<0.01),而诊断特异度均低于bpMRI(60.4%vs.69.2%、61.5%vs.71.4%,P均<0.05)。结论:不同年资医师基于bpMRI和mpMRI的PI-RADS评分对外周带csPCa的检测具有相近的诊断效能;bpMRI能使部分患者避免不必要的动态增强扫描,因而具有更佳的临床效益。

Objective:To evaluate the diagnostic efficiency of biparametric MRI(bpMRI)and multiparameter MRI(bpMRI)in the diagnosis of peripheral zone clinically significant prostate cancer(csPCa)based on the version 2.1 of the Prostate Imaging Reporting and Data System(PI-RADS V2.1).Methods:154 patients with pathologically confirmed peripheral zone disease of the prostate were retrospectively analyzed.The features of the main lesion in the peripheral zone on bpMRI and mpMRI were evaluated by two radiologists(with 3 and 10 years of experience in MRI diagnosis of prostate diseases respectively)according to PI-RADS V2.1.Receiver operating characteristic(ROC)curve was used to evaluated to determine the threshold based on Youden index.Area under the curve(AUC),accuracy,sensitivity,specificity,negative predictive value and positive predictive value of the two scoring schemes were calculated.Results:Among the 154 patients,75 were prostate cancer,including 63 csPCa,12 clinically insignificant PCa and 79 benign lesions.The Kappa coefficient of PI-RADS scores of the two radiologists was 0.746 for bpMRI and 0.688 for mpMRI.The AUC value of csPCa measured by junior physician based on PI-RADS score of bpMRI and mpMRI was 0.761 and 0.774,respectively,and there was no statistically statistical difference between them(Z=1.469,P>0.05).The AUC value of csPCa detected by senior physicians based on PI-RADS score of bpMRI and mpMRI was 0.773 and 0.778,respectively,and there was no statistical significance between them(Z=0.643,P>0.05).For both physicians,the diagnostic sensitivity of mpMRI was significantly higher than that of bpMRI(90.5%vs.73.0%,90.5%vs.70.8%,both P<0.01),while the diagnostic specificity of bpMRI was significantly higher than that of mpMRI(69.2%vs.60.4%,71.4%vs.61.5%,both P<0.05).Conclusion:The PI-RADS score evaluated by physicians with different experience based on bpMRI and mpMRI has the similar diagnostic efficacy in detection of peripheral zone csPCa.In addition,bpMRI examination can help some patients avoid unnecessary DCE examination,which can maximize the benefits of patients.