Prostate cancer （PCa） is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 （PI-RADS v2） to classify men with P...Prostate cancer （PCa） is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 （PI-RADS v2） to classify men with PCa, clinically significant PCa （CSPCa）, or no PCa, especially among those with serum total prostate-specific antigen （tPSA） levels in the ＂gray zone＂ （4-10 ng ml-1）. A total of 308 patients （355 lesions） were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density （PSAD） were independent predictors of PCa and CSPCa. A PI-RADS v2 score L≥4 provided high negative predictive values （91.39% for PCa and 95.69% for CSPCa）. A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group （PI-RADS score = 5 and PSAD L≥0 15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score L≥4 with high tPSA level） with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.展开更多
Background：Prostate Imaging Reporting and Data System （PI-RADS） is a globally acceptable standardization for multiparametric magnetic resonance imaging （mp-MRI） in prostate cancer （PCa） diagnosis.The American C...Background：Prostate Imaging Reporting and Data System （PI-RADS） is a globally acceptable standardization for multiparametric magnetic resonance imaging （mp-MRI） in prostate cancer （PCa） diagnosis.The American College of Radiology revised the PI-RADS to address the limitations of version 1 in December 2014.This study aimed to determine whether the PI-RADS version 2 （PI-RADS v2） scoring system improves the diagnostic accuracy of mp-MRI of the prostate compared with PI-RADS v1.Methods：This retrospective study was approved by the institutional review board.A total of 401 consecutive patients,with clinically suspicious Pca undergoing 3.0 T mp-MRI （T2-weighted imaging ＋ diffusion-weighted imaging ＋ DCE） before transrectal ultrasound-guided biopsy between June 2013 and July 2015,were included in the study.All patients were scored using the 5-point PI-RADS scoring system based on either PI-RADS v1 or v2.Receiver operating characteristics were calculated for statistical analysis.Sensitivity,specificity,and diagnostic accuracy were compared using McNemar＇s test.Results：Pca was present in 150 of 401 （37.41%） patients.When we pooled data from both peripheral zone （PZ） and transition zone （TZ）,the areas under the curve were 0.889 for PI-RADS v1 and 0.942 for v2 （P =0.0001）.Maximal accuracy was achieved with a score threshold of 4.At this threshold,in the PZ,similar sensitivity,specificity,and accuracy were achieved with v 1 and v2 （all P 〉 0.05）.In the TZ,sensitivity was higher for v2 than for v1 （96.36% vs.76.36%,P =0.003）,specificity was similar for v2 and v1 （90.24% vs.84.15%,P =0.227）,and accuracy was higher for v2 than for v1 （92.70% vs.81.02%,P =0.002）.Conclusions：Both v1 and v2 showed good diagnostic performance for the detection of Pca.However,in the TZ,the performance was better with v2 than with v1.展开更多
Background： One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 （PI-RADS v2） is to diminish variation in the interpretation and reporting of prostate imaging, especially among r...Background： One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 （PI-RADS v2） is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic pcrformance of PI-RADS v2 scores in the detection of clinically significant prostate cancer （PCa）. Methods： From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale （1 5 scores） from six blinded readers （with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2）. The correlation among the readers＇ scores and the Gleason score （GS） was determined with the Kendall test. lntra-/inter-observer agreement was evaluated using K statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores. Results： Based on the PI-RADS v2, the median k score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively： the average correlation between the six readers＇ scores and the GS was positive, exhibiting weak-to-moderate strength （r = 0.391, P = 0.006）. The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively. Conclusion： The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.展开更多
目的探讨多参数MRI(multiparametric MRI,mpMRI)前列腺影像报告和数据系统2.1版(prostate imaging reporting and data system version 2.1,PI-RADS v2.1)评分在前列腺癌临床诊断中的应用价值。方法收集2015年03月至2020年03月期间328...目的探讨多参数MRI(multiparametric MRI,mpMRI)前列腺影像报告和数据系统2.1版(prostate imaging reporting and data system version 2.1,PI-RADS v2.1)评分在前列腺癌临床诊断中的应用价值。方法收集2015年03月至2020年03月期间328例的影像及临床病理资料,入组74例前列腺癌患者,术前均行前列腺MR多参数扫描,采用局麻下经直肠超声引导下的12针系统穿刺+2针靶向穿刺,记录患者年龄、穿刺病理结果、Gleason评分、病灶大小以及前列腺特异性抗原PSA水平。根据病理Gleason评分结果分为两组(非显著性癌≤6分,显著性癌7分),并进行比较和分析,计量资料呈正态分布,比较两组间采用独立样本t检验或Mann-Whitney U检验,组间比较采用χ^(2)检验或Fisher精确概率法,以P≤0.05为差异有统计学意义。采用一致性Kappa检验分析两名诊断医师间的一致性。结果共入组患者74例,包括74例年龄在49~85岁之间的患者(64.85±6.56岁),显著性癌组63例(85.14%),无显著性癌组11例(14.86%),两组间无临床意义PCa的检出率无显著差异(8.11%对16.22%,p=0.16)。相比之下,PI-RADS v2.1评分4、5对具有临床意义的癌症的检出率显著高于PIRADS v2.1评分为1-3的患者(68.92%对1.35%,P<0.0001)。肿瘤体积≥0.5ml的临床相关肿瘤组中,肿瘤体积与Gleason评分(n=36,P=0.019)之间有统计学意义的相关性。前列腺移行带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.51,0.29,前列腺外周带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.59,0.56,前列腺移行带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.43.0.45。结论PI-RADS v2.1版是比较好的质量控制方案减少前列腺影像分析过程中出现的混淆,对mpMRI的评分是适当的,且重复性好,并且随着2019 ISUP病理更新,在诊断有临床意义的前列腺癌上更加贴近临床。在外周带及PI-RADS v2.1>3分和Gleason评分>7分(4-6分)上PI-RADSv 2.1评分一致性较好,PI-RADS v2.1版可以用来诊断有临床意义前列腺癌。当评分≥4时则意味着很有可能患有临床意义的前列腺癌,有助于对肿瘤诊断及预后的监测。展开更多
目的 基于前列腺影像报告和数据系统2.1版(Prostate Imaging Report and Data System version 2.1, PI-RADS v2.1)的双参数磁共振成像(biparametric MRI, bp-MRI)和前列腺特异性抗原(prostate specific antigen, PSA)等临床指标,构建鉴...目的 基于前列腺影像报告和数据系统2.1版(Prostate Imaging Report and Data System version 2.1, PI-RADS v2.1)的双参数磁共振成像(biparametric MRI, bp-MRI)和前列腺特异性抗原(prostate specific antigen, PSA)等临床指标,构建鉴别诊断PSA(4-20 ng/mL)前列腺癌(prostate cancer, PCa)的列线图模型。材料与方法 回顾性分析宁夏医科大学总医院2017年10月至2022年2月206例行bp-MRI检查并有病理学结果的患者资料。根据病理结果分为PCa组(n=66)和前列腺增生和(或)炎症组(n=140),经单、多因素logistic回归分析筛选PSA (4-20 ng/mL) PCa患者的独立危险因素,随后使用R软件构建列线图模型,并用决策曲线分析(decision curve analysis, DCA)其临床净效益。以受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under the curve, AUC)、敏感度和特异度评价诊断效能,并通过DeLong检验比较AUC值间的差异。结果 年龄、总前列腺特异性抗原(total prostate specific antigen, tPSA)、前列腺体积(prostate volume, PV)、PI-RADS v2.1是预测PSA (4-20 ng/mL) PCa的独立危险因素。基于上述4个独立指标构建的列线图模型诊断效能最好(AUC=0.945),明显高于PI-RADS v2.1(AUC=0.816)、PV(AUC=0.772)、tPSA(AUC=0.737)、年龄(AUC=0.680)。结论 基于bp-MRI的PI-RADS v2.1评分联合临床相关指标建立的列线图模型,预测PSA (4–20 ng/mL) PCa的诊断效能明显优于单一指标,可作为一种无创精准化预测工具,将更全面、准确地预测罹患PCa的风险概率,为临床提供有效的诊疗指导。展开更多
目的初步探讨3.0 T磁共振成像条件下,前列腺影像报告和数据系统第2版(prostate image report and data system version 2,PI-RADS V2)评分诊断方法在前列腺中央腺体癌诊断中的应用价值。材料与方法回顾性分析50例经病理证实的前列腺癌(p...目的初步探讨3.0 T磁共振成像条件下,前列腺影像报告和数据系统第2版(prostate image report and data system version 2,PI-RADS V2)评分诊断方法在前列腺中央腺体癌诊断中的应用价值。材料与方法回顾性分析50例经病理证实的前列腺癌(prostate cancer,Pca)患者的多参数磁共振成像(mutli-parameter magnetic resonance imaging,Mp-MRI)资料和临床资料。根据6分区切割模型进行前列腺中央腺体分区。两位观察者根据PI-RADS V2评分标准及常规阅片,对入组病例Mp-MRI前列腺图像的有效预定义分区进行评分,分析评分结果的一致性。评分结果与该分区相应的病理结果进行对照,分析PI-RADS V2、常规阅片对前列腺中央腺体诊断中的敏感度、特异度、准确度、阳性预测值和阴性预测值,评价PI-RADS V2在前列腺中央腺体癌的诊断效能。结果 50例患者的Mp-MRI前列腺图像共分割为300个前列腺中央腺体分区,获得有效预定义的分区238个。结果显示,2位观察者PI-RADS V2诊断结果一致性极佳(K=0.84)。PI-RADS V2评分"4"分为诊断界值时,诊断结果准确度为79.2%,敏感度为70.4%,特异度为83.8%。常规阅片诊断结果准确度为72.7%,敏感度为49.7%,特异度为92.3%。PI-RADS V2评分诊断效能优于常规阅片。结论在3.0 T磁共振成像系统,Mp-MRI前列腺中央腺体癌诊断中,应用PI-RADS V2进行评分诊断结果的一致性较高,具有较好的诊断效能和临床应用价值。展开更多
文摘Prostate cancer （PCa） is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 （PI-RADS v2） to classify men with PCa, clinically significant PCa （CSPCa）, or no PCa, especially among those with serum total prostate-specific antigen （tPSA） levels in the ＂gray zone＂ （4-10 ng ml-1）. A total of 308 patients （355 lesions） were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density （PSAD） were independent predictors of PCa and CSPCa. A PI-RADS v2 score L≥4 provided high negative predictive values （91.39% for PCa and 95.69% for CSPCa）. A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group （PI-RADS score = 5 and PSAD L≥0 15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score L≥4 with high tPSA level） with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.
基金This study was supported by a grant of National Natural Science Foundation of China （No. 81171307）.
文摘Background：Prostate Imaging Reporting and Data System （PI-RADS） is a globally acceptable standardization for multiparametric magnetic resonance imaging （mp-MRI） in prostate cancer （PCa） diagnosis.The American College of Radiology revised the PI-RADS to address the limitations of version 1 in December 2014.This study aimed to determine whether the PI-RADS version 2 （PI-RADS v2） scoring system improves the diagnostic accuracy of mp-MRI of the prostate compared with PI-RADS v1.Methods：This retrospective study was approved by the institutional review board.A total of 401 consecutive patients,with clinically suspicious Pca undergoing 3.0 T mp-MRI （T2-weighted imaging ＋ diffusion-weighted imaging ＋ DCE） before transrectal ultrasound-guided biopsy between June 2013 and July 2015,were included in the study.All patients were scored using the 5-point PI-RADS scoring system based on either PI-RADS v1 or v2.Receiver operating characteristics were calculated for statistical analysis.Sensitivity,specificity,and diagnostic accuracy were compared using McNemar＇s test.Results：Pca was present in 150 of 401 （37.41%） patients.When we pooled data from both peripheral zone （PZ） and transition zone （TZ）,the areas under the curve were 0.889 for PI-RADS v1 and 0.942 for v2 （P =0.0001）.Maximal accuracy was achieved with a score threshold of 4.At this threshold,in the PZ,similar sensitivity,specificity,and accuracy were achieved with v 1 and v2 （all P 〉 0.05）.In the TZ,sensitivity was higher for v2 than for v1 （96.36% vs.76.36%,P =0.003）,specificity was similar for v2 and v1 （90.24% vs.84.15%,P =0.227）,and accuracy was higher for v2 than for v1 （92.70% vs.81.02%,P =0.002）.Conclusions：Both v1 and v2 showed good diagnostic performance for the detection of Pca.However,in the TZ,the performance was better with v2 than with v1.
文摘Background： One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 （PI-RADS v2） is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic pcrformance of PI-RADS v2 scores in the detection of clinically significant prostate cancer （PCa）. Methods： From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale （1 5 scores） from six blinded readers （with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2）. The correlation among the readers＇ scores and the Gleason score （GS） was determined with the Kendall test. lntra-/inter-observer agreement was evaluated using K statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores. Results： Based on the PI-RADS v2, the median k score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively： the average correlation between the six readers＇ scores and the GS was positive, exhibiting weak-to-moderate strength （r = 0.391, P = 0.006）. The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively. Conclusion： The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.
文摘目的基于第二版前列腺影像报告数据系统(PI-RAVS V2)对比双参数磁共振成像(BP-MRI)和多参数磁共振成像(MP-MRI)对前列腺癌(PCa)的诊断价值。方法选取2015年3月至2017年12月南京医科大学附属淮安第一医院收治的66例未经治疗临床怀疑PCa的患者进行MRI检查,包括T2加权成像(T2WI)、扩散加权成像(DWI)及动态对比增强磁共振成像(DCE-MRI),均经前列腺活检确定病理结果。两名放射科医师基于PI-RADS V2对BP-MRI及MP-MRI方案的诊断性能进行评估。结果病理证实27例PCa,其中23例位于外周带,4例位于移行带。BP-MRI检测PCa的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为90.6%(25/27)、97.7%(38/39)、92.4%(61/66)、95.8%(23/24)、94.7%(36/38),MP-MRI为87.2%(23/27)、95.3%(36/39)、93.9%(62/66)、89.3%(25/28)、90.5%(34/43)。结论与常规MP-MRI方案相比,3.0 T BP-MRI方案具有相似的诊断精度,检查时间较短且无需使用对比剂。
文摘目的初步探讨3.0 T磁共振成像条件下,前列腺影像报告和数据系统第2版(prostate image report and data system version 2,PI-RADS V2)评分诊断方法在前列腺中央腺体癌诊断中的应用价值。材料与方法回顾性分析50例经病理证实的前列腺癌(prostate cancer,Pca)患者的多参数磁共振成像(mutli-parameter magnetic resonance imaging,Mp-MRI)资料和临床资料。根据6分区切割模型进行前列腺中央腺体分区。两位观察者根据PI-RADS V2评分标准及常规阅片,对入组病例Mp-MRI前列腺图像的有效预定义分区进行评分,分析评分结果的一致性。评分结果与该分区相应的病理结果进行对照,分析PI-RADS V2、常规阅片对前列腺中央腺体诊断中的敏感度、特异度、准确度、阳性预测值和阴性预测值,评价PI-RADS V2在前列腺中央腺体癌的诊断效能。结果 50例患者的Mp-MRI前列腺图像共分割为300个前列腺中央腺体分区,获得有效预定义的分区238个。结果显示,2位观察者PI-RADS V2诊断结果一致性极佳(K=0.84)。PI-RADS V2评分"4"分为诊断界值时,诊断结果准确度为79.2%,敏感度为70.4%,特异度为83.8%。常规阅片诊断结果准确度为72.7%,敏感度为49.7%,特异度为92.3%。PI-RADS V2评分诊断效能优于常规阅片。结论在3.0 T磁共振成像系统,Mp-MRI前列腺中央腺体癌诊断中,应用PI-RADS V2进行评分诊断结果的一致性较高,具有较好的诊断效能和临床应用价值。
