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： The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System （PI-RADS） for standardizing the diagnosis of prostate cancer （PCa）. This study evaluated the PI-RA...Background： The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System （PI-RADS） for standardizing the diagnosis of prostate cancer （PCa）. This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen （PSA） 〈20 ng/ml. Methods： A total of 133 patients with PSA 〈20 ng/ml were prospectively recruited. T2-weighted （T2WI） and diffusion-weighted （DWI） magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy. Each patient＇s peripheral zone was divided into six regions on the images; each region corresponded to two of the 12 biopsy cores. T2WI, DWI, and T2W1 ＋ DWI scores were computed according to PI-RADS. The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference standard. Results： PCa was histologically diagnosed in 169 （21.2%） regions. Increased PI-RADS score correlated positively with increased cancer detection rate. The cancer detection rate for scores 1 to 5 was 2.8%, 15.0%, 34.6%, 52.6%, and 88.9%, respectively, using T2W1 and 12.0%, 20.2%, 48.0%, 85.7%, and 93.3%, respectively, using DWI. For T2WI ＋ DWI, the cancer detection rate was 1.5% （score 2）, 13.5% （scores 3-4）, 41.3% （scores 5-6）, 75.9% （scores 7-8）, and 92.3% （scores 9-10）. The area under the curve for cancer detection was 0.700 （T2WI）, 0.735 （DWI） and 0.749 （T2WI ＋ DWI）. The sensitivity and specificity were 53.8% and 89.2%, respectively, when The summed score ofT2Wl ＋ DWI展开更多
Introduction and Objective: Prostate cancer detection is a difficult process despite different modalities that are available. The current standard of practice is based on stratifying risk using Prostate Specific Antig...Introduction and Objective: Prostate cancer detection is a difficult process despite different modalities that are available. The current standard of practice is based on stratifying risk using Prostate Specific Antigen (PSA), digital rectal examination (DRE) and performing a transrectal ultrasound (TRUS) or transperineal (TP) guided biopsy. Recent advances in three-tesla multiparametric magnetic resonance imaging (MP-MRI) technology and the availability of in-gantry MRI guided biopsies (MRGB) have added another diagnostic tool in management of prostate cancer. We review MRGB performed on high Prostate Imaging Reporting and Data System (PIRADS) score lesions in a single centre retrospective study. Materials and Methods: There were 77 patients (mean age 63) with high PIRADS score (4 and 5) that underwent in-gantry MRGB. All the biopsies were performed utilizing dynacad prostate biopsy system on a three-tesla MRI scanner by an urologist with assistance of an experienced radiologist. Two to three samples were obtained from each lesion using an MRI compatible 18-gauge biopsy needle. Three experienced pathologists evaluated the samples and provided the results and Gleason score in each positive sample. Results: Out of the total 77 high PIRADS patients, 54 were PIRADS score 4 (70%) and 23 PIRADS score 5 (30%). There were 22 positive biopsies for adenocarcinoma of prostate with a Gleason score of 3 + 3 = 6 or higher. Out of the 54 PIRADS score 4 lesions, 13 were positive (24%) and out of 23 PIRADS 5 lesions, 9 were positive (39%). The remaining 55 biopsies were negative for prostate cancer. Conclusion: We present our series of MRGB in patients with a high PIRADS score for prostate cancer. While this diagnostic paradigm was in its infancy stages, MRGB was positive in 24% of PIRADS 4 and 39% of PIRADS 5 lesions in this series.展开更多
目的探讨多参数MRI联合影像组学在区分前列腺影像报告数据系统(PI-RADS)4~5分病灶良恶性中的应用价值,旨在构建能够有效区分两者的模型,提高诊断精确度。材料与方法回顾性分析2018年1月至2021年6月在我院行前列腺多参数MRI(multiparamet...目的探讨多参数MRI联合影像组学在区分前列腺影像报告数据系统(PI-RADS)4~5分病灶良恶性中的应用价值,旨在构建能够有效区分两者的模型,提高诊断精确度。材料与方法回顾性分析2018年1月至2021年6月在我院行前列腺多参数MRI(multiparametric MRI,mpMRI)检查后PI-RADS评分为4~5分的患者病例共135例,其中病理诊断良性64例,恶性71例。将入组病例随机分层采样按照7∶3的比例划分为训练集(95例,良性45例,恶性50例)和测试集(40例,良性19例,恶性21例),分析前列腺特异性抗原(prostate specific antigen,PSA)、MRI传统参数表观弥散系数(apparent diffusion coefficient,ADC)、多模态影像组学模型[T2WI、弥散加权成像(diffusion weighted imaging,DWI)、ADC三种模态]及联合模型(多模态影像组学联合传统参数ADC值)对PI-RADS 4~5分病灶良恶性的鉴别效力,构建诊断模型。结果良性病变组ADC值[(0.791±0.149)×10^(-3)mm^(2)/s]显著高于恶性组[(0.612±0.110)×10^(-3)mm^(2)/s],其在训练集、测试集中的曲线下面积(area under the curve,AUC)分别为0.870、0.772。而良性病变组总PSA(total PSA,tPSA)略低于恶性组,两组之间差异无统计学意义。ADC、DWI和T2WI多模态组合影像组学在训练集、测试集中的AUC分别为0.942、0.850。联合模型在训练集、测试集中的AUC分别为0.952、0.842。结论综合多模态MRI(T2WI、DWI、ADC)影像组学联合传统参数的模型能有效帮助鉴别PI-RADS 4~5分病灶的良恶性,帮助提高诊断准确度,进一步辅助个体化治疗方案的制订。展开更多
目的:比较前列腺靶向穿刺、系统穿刺、靶向穿刺+6针系统穿刺活检对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)5分患者的前列腺癌(prostate cancer,PCa)及临床有意义前列腺癌(clinically significan...目的:比较前列腺靶向穿刺、系统穿刺、靶向穿刺+6针系统穿刺活检对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)5分患者的前列腺癌(prostate cancer,PCa)及临床有意义前列腺癌(clinically significant prostate cancer,csPCa)的诊断效能,以优化前列腺穿刺方案。方法:回顾性分析2019年1月至2022年6月北京大学第一医院多参数磁共振(multiparametric magnetic resonance imaging,mpMRI)检查PI-RADS评分5分且行前列腺穿刺活检的患者资料。所有患者在mpMRI/经直肠超声(transrectal ultrasound,TRUS)认知融合引导下,行联合穿刺活检(靶向穿刺联合系统穿刺)。以联合穿刺活检病理结果作为金标准,对比靶向穿刺、系统穿刺及靶向穿刺+6针系统穿刺对PCa和csPCa的诊断效能。按mpMRI T分期(cT2,cT3,cT4)进行分组,通过McNemar及Cochran’s Q检验比较不同穿刺方案对PCa和csPCa的检出情况。结果:入组585例患者,联合穿刺阳性560例(95.7%),阴性25例(4.3%)。mpMRI T分期cT2期233例(39.8%),cT3期214例(36.6%),cT4期138例(23.6%)。按临床T分期分层后发现,cT2、cT3、cT4亚组中靶向穿刺与联合穿刺对PCa、csPCa检出率差异无统计学意义(PCa:P=0.203、P=0.250、P>0.999;csPCa:P=0.700、P=0.250、P>0.999),靶向穿刺+6针系统穿刺与联合穿刺对PCa、csPCa检出率差异亦无统计学意义(P均>0.999)。系统穿刺PCa和csPCa漏诊率分别为2.1%(12/560)和1.8%(10/549),靶向穿刺分别为1.8%(10/560)和1.4%(8/549),而靶向穿刺+6针系统穿刺检出了所有的PCa和csPCa。但与联合穿刺相比,靶向穿刺和靶向穿刺+6针系统穿刺的平均穿刺针数更少(P<0.001),单针阳性率更高(P<0.001)。结论:对于PI-RADS 5分患者,靶向穿刺及靶向穿刺+6针系统穿刺有较高的单针阳性率及PCa、csPCa检出率,可作为前列腺穿刺方案的选择之一。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
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： The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System （PI-RADS） for standardizing the diagnosis of prostate cancer （PCa）. This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen （PSA） 〈20 ng/ml. Methods： A total of 133 patients with PSA 〈20 ng/ml were prospectively recruited. T2-weighted （T2WI） and diffusion-weighted （DWI） magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy. Each patient＇s peripheral zone was divided into six regions on the images; each region corresponded to two of the 12 biopsy cores. T2WI, DWI, and T2W1 ＋ DWI scores were computed according to PI-RADS. The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference standard. Results： PCa was histologically diagnosed in 169 （21.2%） regions. Increased PI-RADS score correlated positively with increased cancer detection rate. The cancer detection rate for scores 1 to 5 was 2.8%, 15.0%, 34.6%, 52.6%, and 88.9%, respectively, using T2W1 and 12.0%, 20.2%, 48.0%, 85.7%, and 93.3%, respectively, using DWI. For T2WI ＋ DWI, the cancer detection rate was 1.5% （score 2）, 13.5% （scores 3-4）, 41.3% （scores 5-6）, 75.9% （scores 7-8）, and 92.3% （scores 9-10）. The area under the curve for cancer detection was 0.700 （T2WI）, 0.735 （DWI） and 0.749 （T2WI ＋ DWI）. The sensitivity and specificity were 53.8% and 89.2%, respectively, when The summed score ofT2Wl ＋ DWI
文摘Introduction and Objective: Prostate cancer detection is a difficult process despite different modalities that are available. The current standard of practice is based on stratifying risk using Prostate Specific Antigen (PSA), digital rectal examination (DRE) and performing a transrectal ultrasound (TRUS) or transperineal (TP) guided biopsy. Recent advances in three-tesla multiparametric magnetic resonance imaging (MP-MRI) technology and the availability of in-gantry MRI guided biopsies (MRGB) have added another diagnostic tool in management of prostate cancer. We review MRGB performed on high Prostate Imaging Reporting and Data System (PIRADS) score lesions in a single centre retrospective study. Materials and Methods: There were 77 patients (mean age 63) with high PIRADS score (4 and 5) that underwent in-gantry MRGB. All the biopsies were performed utilizing dynacad prostate biopsy system on a three-tesla MRI scanner by an urologist with assistance of an experienced radiologist. Two to three samples were obtained from each lesion using an MRI compatible 18-gauge biopsy needle. Three experienced pathologists evaluated the samples and provided the results and Gleason score in each positive sample. Results: Out of the total 77 high PIRADS patients, 54 were PIRADS score 4 (70%) and 23 PIRADS score 5 (30%). There were 22 positive biopsies for adenocarcinoma of prostate with a Gleason score of 3 + 3 = 6 or higher. Out of the 54 PIRADS score 4 lesions, 13 were positive (24%) and out of 23 PIRADS 5 lesions, 9 were positive (39%). The remaining 55 biopsies were negative for prostate cancer. Conclusion: We present our series of MRGB in patients with a high PIRADS score for prostate cancer. While this diagnostic paradigm was in its infancy stages, MRGB was positive in 24% of PIRADS 4 and 39% of PIRADS 5 lesions in this series.
文摘目的探讨多参数MRI联合影像组学在区分前列腺影像报告数据系统(PI-RADS)4~5分病灶良恶性中的应用价值,旨在构建能够有效区分两者的模型,提高诊断精确度。材料与方法回顾性分析2018年1月至2021年6月在我院行前列腺多参数MRI(multiparametric MRI,mpMRI)检查后PI-RADS评分为4~5分的患者病例共135例,其中病理诊断良性64例,恶性71例。将入组病例随机分层采样按照7∶3的比例划分为训练集(95例,良性45例,恶性50例)和测试集(40例,良性19例,恶性21例),分析前列腺特异性抗原(prostate specific antigen,PSA)、MRI传统参数表观弥散系数(apparent diffusion coefficient,ADC)、多模态影像组学模型[T2WI、弥散加权成像(diffusion weighted imaging,DWI)、ADC三种模态]及联合模型(多模态影像组学联合传统参数ADC值)对PI-RADS 4~5分病灶良恶性的鉴别效力,构建诊断模型。结果良性病变组ADC值[(0.791±0.149)×10^(-3)mm^(2)/s]显著高于恶性组[(0.612±0.110)×10^(-3)mm^(2)/s],其在训练集、测试集中的曲线下面积(area under the curve,AUC)分别为0.870、0.772。而良性病变组总PSA(total PSA,tPSA)略低于恶性组,两组之间差异无统计学意义。ADC、DWI和T2WI多模态组合影像组学在训练集、测试集中的AUC分别为0.942、0.850。联合模型在训练集、测试集中的AUC分别为0.952、0.842。结论综合多模态MRI(T2WI、DWI、ADC)影像组学联合传统参数的模型能有效帮助鉴别PI-RADS 4~5分病灶的良恶性,帮助提高诊断准确度,进一步辅助个体化治疗方案的制订。
