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  • 邵志红,王 伟,刘卫英,等.双参数与多参数MRI对不同PSA水平前列腺癌诊断的对比研究[J].同济大学学报(医学版),2020,41(4):437-442.    [点击复制]
  • SHAO Zhi-hong,WANG Wei,LIU Wei-ying,et al.Biparametric and multiparametric MRI for diagnosis of prostate cancer in patients with different PSA levels[J].同济大学学报(医学版),2020,41(4):437-442.   [点击复制]
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双参数与多参数MRI对不同PSA水平前列腺癌诊断的对比研究
邵志红,王伟,刘卫英,樊洪周,刘梦,王培军
0
(上海市静安区市北医院放射科,上海 200435;同济大学附属同济医院放射科,上海 200065)
摘要:
目的 比较双参数与多参数MRI(biparametric MRI, Bp-MRI; multiparametric MRI, Mp-MRI)对不同前列腺特异性抗原(prostate-specific antigen, PSA)水平的前列腺临床显著癌(clinically significant prostate cancer, csPCa)的诊断价值。方法 回顾性连续收集同济大学附属同济医院2017年1月—2018年6月期间收治的298例前列腺病例临床及Mp-MRI资料。依据PSA水平分为低PSA组(PSA≤10ng/mL)和高PSA组(PSA>10ng/mL)。由4名有经验的医师分两组分别对无动态对比增强序列的Bp-MRI和含DCE的Mp-MRI进行独立评分,所有病例均采用双盲法以最新版前列腺影像报告和数据系统(PI-RADS v2.1)标准对图像进行评分。以PI-RADS≥4为阳性阈值,比较Bp-MRI与Mp-MRI对不同PSA水平csPCa的诊断性能,同时比较2名阅片者之间Bp-MRI阴性与阳性评分结果的一致性。结果 在低PSA组,Mp-MRI与Bp-MRI诊断csPCa的灵敏度分别为88.1%(37/42)、69.0%(29/42),特异度分别为89.7%(139/155)、87.1%(135/155),诊断准确度分别为89.3%(176/197)、83.2%(164/197),Bp-MRI对csPCa诊断灵敏度低于Mp-MRI(χ2=4.53,P<0.05),特异度与准确度两者比较差异均无统计学意义(P>0.05)。在高PSA组,Mp-MRI与Bp-MRI诊断csPCa的灵敏度分别为88.3%(53/60)、69.0%(50/60),特异度分别为92.7%(38/41)、87.8%(36/41),诊断准确度分别为90.1%(91/101)、85.1%(86/101),两者比较差异均无统计学意义(P>0.05)。两名阅片者Bp-MRI的PI-RADS评分阴性与阳性一致性比较具有高度一致性(κ=0.817)。结论 Bp-MRI对高PSA组csPCa的诊断性能与Mp-MRI相似,而低PSA组,Bp-MRI灵敏度低于Mp-MRI。
关键词:  前列腺癌  磁共振成像  前列腺影像报告和数据系统  对比研究  诊断
DOI:10.16118/j.1008-0392.2020.04.006
投稿时间:2019-12-31
基金项目:上海市静安区卫生和健康委员会科研课题面上项目(2018MS11)
Biparametric and multiparametric MRI for diagnosis of prostate cancer in patients with different PSA levels
SHAO Zhi-hong,WANG Wei,LIU Wei-ying,FAN Hong-zhou,LIU Meng,WANG Pei-jun
(Dept. of Radiology, Shibei Hospital, Jing'an District, Shanghai 200435, China;Dept. of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China)
Abstract:
Objective To compare the diagnostic value between biparametric MRI(Bp-MRI) and multiparametric MRI(Mp-MRI) for clinically significant prostate cancer(csPCa) in patients with different PSA levels. Methods The clinical and MRI data of 298 patients with prostate cancer admitted in Tongji Hospital of Tongji University between January 2017 and June 2018 were retrospectively reviewed. There were 197 patients with low PSA(PSA≤10ng/mL) and 101 patients with high PSA(PSA>10ng/mL). Total 102 cases of csPCs were confirmed including 42 cases in the low PSA group and 60 cases in the high PSA group. Four experienced radiologist independently scored Bp-MRI without DCE sequence and Mp-MRI with DCE sequence respectively. All patients were scored by double blind method according to the latest version of prostate imaging report and data system(PI-RADS v2.1). With PI-RADS≥4 as the positive threshold, the diagnostic performance of Bp-MRI and Mp-MRI for csPCa at different PSA levels was compared, and inter-reader agreement of negative and positive scores of Bp-MRI between the two radiologists was analyzed. Results In the low PSA group, the sensitivity of Mp-MRI and Bp-MRI was 88.1%(37/42), 69.0%(29/42), the specificity was 89.7%(139/155), 87.1%(135/155), the diagnostic accuracy was 89.3%(176/197) and 83.2%(164/197), respectively. The sensitivity of Bp-MRI for csPCa was lower than that of Mp-MRI(χ2= 4.53,P<0.05); while there were no statistically significant difference in the specificity and accuracy between Mp-MRI and Bp-MRI(P>0.05). In high PSA group, the sensitivity of Mp-MRI and Bp-MRI was 88.3%(53/60), 69.0%(50/60), the specificity was 92.7%(38/41), 87.8%(36/41), and the diagnostic accuracy was 90.1%(91/101) and 85.1%(86/101), respectively. There were no statistically significant differences for these indexes between two methods. Inter-reader agreement of two radiologists was better in negative and positive score of Bp-MRI(κ = 0.817). Conclusion Bp-MRI has similar diagnostic performance with Mp-MRI for detecting csPCa in the high PSA group, but the sensitivity of Bp-MRI is lower than that of Mp-MRI in the low PSA group.
Key words:  prostate cancer  magnetic resonance imaging  prostate imaging reporting and data system  comparative study  diagnosis

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