多参数磁共振成像中动态对比增强状态在诊断PI-RADS 4分前列腺癌中的应用

Application of dynamic contrast enhanced status in multiparametric magnetic resonance imaging for prostatic cancer with PI-RADS 4 lesion

目的:评估多参数磁共振成像(multiparametric magnetic resonance imaging,mpMRI)中动态对比增强(dynamic contrast enhanced,DCE)序列状态对前列腺外周带前列腺影像报告和数据评分系统(prostate imaging reporting and data system,PI-RADS)4分病灶的诊断价值。方法:回顾性分析2018年1月至2021年9月在北京大学第一医院行mpMRI提示外周带PI-RADS 4分,并行前列腺穿刺活检患者的临床资料。根据DCE序列状态分为常规PI-RADS 4分组和综合PI-RADS 4分组(弥散加权成像3分+DCE阳性1分)。单因素和多因素Logistic回归分析患者的年龄、总前列腺特异性抗原(prostate specific antigen,PSA)、游离与总PSA比值(f/tPSA)、前列腺体积(prostate volume,PV)、PSA密度(PSA density,PSAD)、DCE状态等指标与前列腺穿刺活检阳性的相关性。结果:267例PI-RADS 4分患者中前列腺癌217例(81.27%),非癌病变50例(18.73%)。统计学分析提示,年龄、tPSA、PV、PSAD在前列腺癌组和非癌病变组间差异有统计学意义(P<0.05),但两组间f/tPSA差异无统计学意义。按DCE序列状态分组后,常规PI-RADS 4分组和综合PI-RADS 4分组穿刺活检结果有明显差异,常规PIRADS 4分组有更高的穿刺阳性率(88.0%vs.72.6%,P=0.001),综合PI-RADS 4分组的PV更大。Logistic单因素分析结果显示,前列腺癌的诊断与年龄、tPSA、f/tPSA、PV和DCE序列状态有关(P<0.05);多因素分析结果显示,年龄、tPSA、PV和DCE序列状态是诊断前列腺癌的独立危险因素(P<0.05)。结论:对于外周带PI-RADS 4分病灶,tPSA、f/tPSA、PV、PSAD是提高前列腺癌诊断准确性的指标;考虑mpMRI的DCE序列状态可以更精准地选择穿刺患者,降低前列腺癌漏诊率并避免不必要的穿刺。

Objective:To evaluate the diagnostic value of dynamic contrast enhanced(DCE)of multiparametric magnetic resonance imaging(mpMRI)for prostate imaging reporting and data system(PI-RADS)4 lesion in prostate peripheral zone.Methods:The clinical data of patients with PI-RADS 4 lesion in prostate peripheral zone who underwent prostate biopsy from January 2018 to September 2021 in Peking University First Hospital were retrospectively included.According to DCE status,the patients were divided into the conventional group(4 points for diffusion-weighted imaging)and the comprehensive group(3 points for diffusion-weighted imaging+1 point for DCE positive).Pearson’s chi-square test or Fisher’s exact test for comparison was conducted between prostate cancer and non-cancer patients.Univariate and multivariate Logistic regression were performed to analyze the correlation of positive biopsy with age,total prostate specific antigen(PSA),free PSA/total PSA(f/tPSA),prostate volume(PV),PSA density(PSAD)and DCE status.Results:Among the 267 prostate biopsy patients,217 cases were diagnosed as prostatic cancer(81.27%)and 50 cases were non-cancer(18.73%).Statistical analysis between the prostatic cancer group and the non-cancer group showed that there were significant differences in age,tPSA,PV and PSAD(all P<0.05),but no significant differences in f/tPSA between the two groups.About different PI-RADS 4 lesion groups,the conventional group and the comprehensive group showed significant difference in biopsy results(P=0.001),and the conventional group had a higher positive rate.The PV of comprehensive group was larger than that of the conventional group.Among the prostate cancer patients diagnosed by biopsy,statistical analysis between the conventional group and comprehensive group showed that there were not significant differences in International Society of Urological Pathology(ISUP)grade and distinguishing clinically significant prostate cancer(all P>0.05).Logistic univariate analysis showed that the diagnosis of prostate cancer was related to age,tPSA,f/tPSA,PV and DCE group status(all P<0.05).Multivariate analysis showed that age,tPSA,PV and DCE group status(all P<0.05)were independent risk factors for the diagnosis of prostatic cancer.Conclusion:tPSA,f/tPSA,PV and PSAD are the indicators to improve the diagnosis of prostatic cancer with PI-RADS 4 lesion in peripheral zone lesions.DCE status is worth considering,so that we can select patients for biopsy more accurately,reduce the rate of missed diagnosis of prostate cancer as well as avoid unnecessary prostate puncture.