双参数与多参数MRI对前列腺特异性抗原灰区临床显著性前列腺癌诊断效能比较

Comparison of the diagnostic efficacy of biparametric and multiparametric MRI for the diagnosis of clinically significant prostate cancer with prostate-specific antigen gray zone

目的探讨基于前列腺影像报告与数据系统2.1版(PI-RADS v2.1)的双参数MRI(bpMRI)与多参数MRI(mpMRI)对前列腺特异性抗原(PSA)灰区(PSA 4~10 ng/mL)临床显著性前列腺癌(csPCa)的诊断效能。方法回顾性纳入2家医疗中心接受前列腺活检术并完成MRI检查的PSA灰区病人270例(中心1,220例;中心2,50例),分析病人的临床及MRI影像资料。根据Gleason评分将病人分为csPCa组(177例)和非csPCa组(93例)。基于PI-RADS v2.1标准,根据bpMRI(T2WI、DWI)与mpMRI(T2WI、DWI和DCE-MRI)对每例病人的病灶进行评分。采用独立样本t检验、Mann-Whitney U检验、χ2检验比较2组病人的一般资料[年龄、PSA、前列腺体积(PV)、PSA密度(PSAD)]、bpMRI评分和mpMRI评分。以前列腺活检病理结果为标准,绘制受试者操作特征(ROC)曲线,计算其曲线下面积(AUC)、敏感度、特异度、准确度。采用DeLong检验比较2种评分方法对csPCa的诊断效能。采用McNemar检验比较2种评分方法的敏感度和特异度。采用Kappa检验分析2名医师评估bpMRI和mpMRI评分的一致性。结果相比非csPCa组,csPCa组的PV更小、PSAD更高(均P<0.05)。csPCa组中bpMRI与mpMRI评分为4-5分病人的占比更高(76.8%和85.3%),非csPCa组中1-3分病人的占比更高(78.5%和74.2%)。bpMRI与mpMRI评分诊断csPCa的AUC值差异无统计学意义(P>0.05)。bpMRI的敏感度低于mpMRI(76.8%和85.3%,P<0.05),而特异度高于mpMRI(78.5%和74.2%,P<0.05)。bpMRI和mpMRI评分的阅片者间一致性均较好(κ=0.68和κ=0.67)。结论基于PI-RADS v2.1,bpMRI评分与mpMRI评分对PSA灰区csPCa的诊断效能相近。

Objective To investigate the diagnostic efficacy of biparametric MRI(bpMRI)and multiparametric MRI(mpMRI),based on the Prostate Imaging Reporting and Data System version 2.1(PI-RADS v2.1),for clinically significant prostate cancer(csPCa)in patients with prostate-specific antigen(PSA)levels in the gray zone(PSA 4-10 ng/mL).Methods A total 270 patients from 2 medical institutions(220 from Center 1,and 50 from Center 2)who had PSA levels in the gray zone and underwent prostate biopsy and MRI were retrospectively included,and the clinical and MRI data were analyzed.Patients were categorized into two groups based on the Gleason score:csPCa(177 patients)and non-csPCa(93 patients).Lesions were scored using bpMRI(T2WI,DWI)and mpMRI[T2WI,DWI,and dynamic contrast-enhanced MRI(DCE-MRI)]according to PI-RADS v2.1.Comparisons were made using independent samples t-test,Mann-Whitney U test,and Chi-square test for general patient data[age,PSA,prostate volume(PV),PSA density(PSAD)],bpMRI scores,and mpMRI scores.Receiver operator characteristic(ROC)curves were drawn to calculate the area under the curve(AUC),sensitivity,specificity,and accuracy,using prostate biopsy pathology results as the reference.The diagnostic efficacy of the two scoring methods for csPCa was compared using the DeLong test.Sensitivity and specificity were compared using the McNemar test.The inter-reader agreement for bpMRI and mpMRI scores was analyzed using the Kappa test.Results Compared to the non-csPCa group,the csPCa group had smaller PV and higher PSAD(both P<0.05).A higher proportion of csPCa patients scored 4-5 on both bpMRI and mpMRI(76.8%vs.85.3%),while a higher proportion of non-csPCa patients scored 1-3(78.5%vs.74.2%).There was no statistically significant difference in AUC values between bpMRI and mpMRI for diagnosing csPCa(P>0.05).The sensitivity of bpMRI was lower than that of mpMRI(76.8%vs.85.3%,P<0.05),while the specificity of bpMRI was higher than that of mpMRI(78.5%vs.74.2%,P<0.05).Inter-reader agreement was good for both bpMRI and mpMRI scores(κ=0.68 andκ=0.67,respectively).Conclusion Based on PI-RADS v2.1,the diagnostic efficacy of bpMRI and mpMRI for csPCa in the PSA gray zone is similar.