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
目的 探讨表观扩散系数平均值(mean apparent diffusion coefficient,ADCmean)联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)≥...目的 探讨表观扩散系数平均值(mean apparent diffusion coefficient,ADCmean)联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)≥3分临床显著性前列腺癌(clinical significant prostate cancer,csPCa)的预测价值。材料与方法 回顾性分析2022年2月至2024年8月期间我院行前列腺MRI检查PI-RADS评分≥3分且有病理组织学检查患者的临床资料和影像资料。选择最高PI-RADS评分且最大病灶的最大层面勾画感兴趣区(region of interest,ROI),测量病灶的ADCmean和表观扩散系数最小值(min apparent diffusion coefficient,ADCmin)。单因素和多因素logistic回归分析筛选出预测csPCa的最佳临床和影像指标,采用受试者工作特征(receiver operating characteristics,ROC)曲线比较最佳临床和影像预测模型及两者联合模型的诊断效能,计算曲线下面积(area under the curve,AUC)、敏感度和特异度,并行DeLong检验。结果 本研究共纳入csPCa患者75例(48.39%),非csPCa患者80例(51.61%)。csPCa组的年龄、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free prostate specific antigen,fPSA)、PSAD大于非csPCa组,csPCa组的前列腺体积(prostate volume,PV)、fPSA和tPSA比值(f/t)、ADCmin、ADCmean均小于非csPCa组,差异具有统计学意义(均P<0.05)。逐步logistic回归筛选和ROC曲线分析,获得预测csPCa的最佳临床指标为PSAD和影像指标ADCmean,AUC分别为0.846、0.898,PSAD诊断阈值为0.307 ng/mL2,敏感度为66.67%,特异度为91.25%,ADCmean诊断阈值为773.5 mm2/s,敏感度为86.67%,特异度为85.00%,两者联合模型的AUC高达0.925。DeLong检验比较联合模型与单一模型的AUC差异有统计学意义(P<0.05),联合模型预测csPCa的敏感性和特异度分别为86.67%和88.75%。结论 ADCmean对PI-RADS≥3分csPCa的预测效能优于ADCmin,与PSAD的联合模型能进一步提高对PI-RADS≥3分csPCa的预测价值,对临床诊疗具有指导意义。展开更多
目的探讨基于双参数磁共振成像(biparametric magnetic resonance imaging,bp-MRI)的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)联合前列腺特异性抗原密度(prostate specific a...目的探讨基于双参数磁共振成像(biparametric magnetic resonance imaging,bp-MRI)的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)联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)鉴别诊断总前列腺特异性抗原(total prostate specific antigen,tPSA)4~20 ng/mL临床显著性前列腺癌(clinically significant prostate cancer,csPCa)的价值及风险分层。材料与方法回顾性分析了宁夏医科大学总医院2017年10月至2023年6月304例PSA 4~20 ng/mL前列腺疾病患者的bp-MRI图像和临床资料。根据病理结果分为csPCa组(Gleason评分≥7分,n=66)和非csPCa(Gleason评分<7分及良性疾病,n=238)。经单因素、多因素logistic回归分析筛选独立危险因子并建立联合模型,再用决策曲线分析(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)比较独立危险因子与联合模型的诊断效能,并对独立危险因子进行等级划分和组合。结果联合模型(PI-RADS v2.1+PSAD)的诊断效能最好(AUC为0.901,95%CI:0.858~0.944)。将PI-RADS v2.1与PSAD等级划分并组合,当PI-RADS v2.1≤2且PSAD≤0.15 ng/mL^(2),csPCa阳性率为0%;当PI-RADS v2.1为3分且PSAD<0.30 ng/mL^(2)时,csPCa阳性率<15%;当PI-RADS v2.1为4~5分且PSAD为0.15~0.29 ng/mL^(2)时,csPCa阳性率为46.5%;当PI-RADS v2.1为4~5分且PSAD≥0.30 ng/mL^(2)时,csPCa阳性率高达81.3%。结论PI-RAD v2.1≤2或PI-RAD v2.1=3且PSAD值<0.30 ng/ml2的患者可避免不必要的活检。PI-RADS v2.1联合PSAD能显著提高tPSA 4~20 ng/mL csPCa的诊断效能,将二者联合有助于穿刺前对csPCa的患者进行风险评估,以减少部分患者不必要的穿刺,并为临床提供一定的决策指导。展开更多
目的探讨基于双参数磁共振成像(biparametric magnetic resonance imaging,bpMRI)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)评分联合前列腺特异性抗原密度(prostate specif...目的探讨基于双参数磁共振成像(biparametric magnetic resonance imaging,bpMRI)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)评分联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对移行带前列腺癌(transitional zone prostate cancer,TZPCa)的诊断价值。材料与方法回顾性分析115例经病理证实的前列腺疾病患者资料,分为TZPCa组和良性前列腺增生(benign prostatic hyperplasia,BPH)组,依据PI-RADS v2.1评分对MRI图像进行评分,采用单因素和多因素logistic回归分析患者的年龄、前列腺体积(prostate volume,PV)、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free PSA,fPSA)与tPSA的比值(fPSA/tPSA)、PSAD及PI-RADS v2.1评分等指标。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析PI-RADS V2.1、PSAD及联合诊断对TZPCa的诊断效能,并计算曲线下面积(area under the curve,AUC)。结果tPSA、fPSA/tPSA、PSAD与PI-RADS v2.1评分在TZPCa组与BPH组差异具有统计学意义(P<0.05);PI-RADS v2.1评分、PSAD是TZPCa的独立预测因子;PI-RADS v2.1评分、PSAD及联合模型诊断TZPCa的AUC分别为0.916[95%置信区间(confidence interval,CI):0.864~1.000],0.812(95%CI:0.702~0.921),0.952(95%CI:0.903~1.000),联合模型诊断效能最优。结论PI-RADS v2.1评分联合PSAD提高了对TZPCa的诊断价值,减少不必要的穿刺活检。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
目的探讨基于第2版前列腺影像报告和数据系统(prostate imaging-reporting and data system version 2,PI-RADS V2)多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)对临床显著性移行带前列腺癌(transition zone p...目的探讨基于第2版前列腺影像报告和数据系统(prostate imaging-reporting and data system version 2,PI-RADS V2)多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)对临床显著性移行带前列腺癌(transition zone prostate cancer,TZ-PCa)的诊断价值。材料与方法回顾性分析经病理证实的105例前列腺病变(前列腺癌41例,良性前列腺增生64例)的病例资料,所有患者行mp-MRI检查,包括T1WI、T2WI常规序列及扩散加权成像(diffusion weighted imaging,DWI)、动态增强MRI (dynamic constrast-enhanced MRI,DCE-MRI)功能成像。两位医师依据PI-RADS V2对T2WI、DWI、DCE-MRI各独立序列及mp-MRI (T2WI+DWI)联合技术评分,以病理结果为金标准绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC),分析各方案对前列腺癌的诊断价值。结果两位医师PI-RADS评分具有较好的一致性(Kappa值=0.83)。T2WI、DWI、DCE-MRI及mp-MRI诊断移行带前列腺癌的AUC分别为0.914、0.887、0.773、0.927。经Medcalc分析,T2WI与mpMRI间AUC差异无统计学意义(P=0.107),余其他扫描方案间差异均有统计学意义(P<0.05),4种扫描方案诊断灵敏度、特异度分别为85.4%、84.4%,78.0%、81.3%,78.0%、76.6%,92.7%、83.9%。结论基于PI-RADS V2的mp-MRI对临床显著性移行带前列腺癌的诊断具有重要指导意义。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
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.
文摘目的 探讨表观扩散系数平均值(mean apparent diffusion coefficient,ADCmean)联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)≥3分临床显著性前列腺癌(clinical significant prostate cancer,csPCa)的预测价值。材料与方法 回顾性分析2022年2月至2024年8月期间我院行前列腺MRI检查PI-RADS评分≥3分且有病理组织学检查患者的临床资料和影像资料。选择最高PI-RADS评分且最大病灶的最大层面勾画感兴趣区(region of interest,ROI),测量病灶的ADCmean和表观扩散系数最小值(min apparent diffusion coefficient,ADCmin)。单因素和多因素logistic回归分析筛选出预测csPCa的最佳临床和影像指标,采用受试者工作特征(receiver operating characteristics,ROC)曲线比较最佳临床和影像预测模型及两者联合模型的诊断效能,计算曲线下面积(area under the curve,AUC)、敏感度和特异度,并行DeLong检验。结果 本研究共纳入csPCa患者75例(48.39%),非csPCa患者80例(51.61%)。csPCa组的年龄、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free prostate specific antigen,fPSA)、PSAD大于非csPCa组,csPCa组的前列腺体积(prostate volume,PV)、fPSA和tPSA比值(f/t)、ADCmin、ADCmean均小于非csPCa组,差异具有统计学意义(均P<0.05)。逐步logistic回归筛选和ROC曲线分析,获得预测csPCa的最佳临床指标为PSAD和影像指标ADCmean,AUC分别为0.846、0.898,PSAD诊断阈值为0.307 ng/mL2,敏感度为66.67%,特异度为91.25%,ADCmean诊断阈值为773.5 mm2/s,敏感度为86.67%,特异度为85.00%,两者联合模型的AUC高达0.925。DeLong检验比较联合模型与单一模型的AUC差异有统计学意义(P<0.05),联合模型预测csPCa的敏感性和特异度分别为86.67%和88.75%。结论 ADCmean对PI-RADS≥3分csPCa的预测效能优于ADCmin,与PSAD的联合模型能进一步提高对PI-RADS≥3分csPCa的预测价值,对临床诊疗具有指导意义。
文摘目的探讨基于双参数磁共振成像(biparametric magnetic resonance imaging,bpMRI)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)评分联合前列腺特异性抗原密度(prostate specific antigen density,PSAD)对移行带前列腺癌(transitional zone prostate cancer,TZPCa)的诊断价值。材料与方法回顾性分析115例经病理证实的前列腺疾病患者资料,分为TZPCa组和良性前列腺增生(benign prostatic hyperplasia,BPH)组,依据PI-RADS v2.1评分对MRI图像进行评分,采用单因素和多因素logistic回归分析患者的年龄、前列腺体积(prostate volume,PV)、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free PSA,fPSA)与tPSA的比值(fPSA/tPSA)、PSAD及PI-RADS v2.1评分等指标。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析PI-RADS V2.1、PSAD及联合诊断对TZPCa的诊断效能,并计算曲线下面积(area under the curve,AUC)。结果tPSA、fPSA/tPSA、PSAD与PI-RADS v2.1评分在TZPCa组与BPH组差异具有统计学意义(P<0.05);PI-RADS v2.1评分、PSAD是TZPCa的独立预测因子;PI-RADS v2.1评分、PSAD及联合模型诊断TZPCa的AUC分别为0.916[95%置信区间(confidence interval,CI):0.864~1.000],0.812(95%CI:0.702~0.921),0.952(95%CI:0.903~1.000),联合模型诊断效能最优。结论PI-RADS v2.1评分联合PSAD提高了对TZPCa的诊断价值,减少不必要的穿刺活检。
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
文摘目的探讨基于第2版前列腺影像报告和数据系统(prostate imaging-reporting and data system version 2,PI-RADS V2)多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)对临床显著性移行带前列腺癌(transition zone prostate cancer,TZ-PCa)的诊断价值。材料与方法回顾性分析经病理证实的105例前列腺病变(前列腺癌41例,良性前列腺增生64例)的病例资料,所有患者行mp-MRI检查,包括T1WI、T2WI常规序列及扩散加权成像(diffusion weighted imaging,DWI)、动态增强MRI (dynamic constrast-enhanced MRI,DCE-MRI)功能成像。两位医师依据PI-RADS V2对T2WI、DWI、DCE-MRI各独立序列及mp-MRI (T2WI+DWI)联合技术评分,以病理结果为金标准绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC),分析各方案对前列腺癌的诊断价值。结果两位医师PI-RADS评分具有较好的一致性(Kappa值=0.83)。T2WI、DWI、DCE-MRI及mp-MRI诊断移行带前列腺癌的AUC分别为0.914、0.887、0.773、0.927。经Medcalc分析,T2WI与mpMRI间AUC差异无统计学意义(P=0.107),余其他扫描方案间差异均有统计学意义(P<0.05),4种扫描方案诊断灵敏度、特异度分别为85.4%、84.4%,78.0%、81.3%,78.0%、76.6%,92.7%、83.9%。结论基于PI-RADS V2的mp-MRI对临床显著性移行带前列腺癌的诊断具有重要指导意义。
