Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced geni...Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)after 5 years of further experience comprising>1000 scans.Intraobserver agreement was measured using Cohen's kappa.Sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's test.Results Ninety-six mpMRIp scans were included in our final analysis.Of the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions targeted.Moderate agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is moderate.Reduced sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.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
Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate v...Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.展开更多
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
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
目的评估基于前列腺成像报告和数据系统2.1版本(prostate imaging-reporting and data system version 2.1,PI-RADS v2.1)及多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)衍生标志物用于移行带临床显著性前列腺...目的评估基于前列腺成像报告和数据系统2.1版本(prostate imaging-reporting and data system version 2.1,PI-RADS v2.1)及多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)衍生标志物用于移行带临床显著性前列腺癌(clinically significant prostate cancer,csPCa)检测的价值。材料与方法回顾性分析2020年1月至2024年2月在我院行mp-MRI及病理活检的移形带前列腺疾病患者的临床及影像学资料。由具有8年前列腺成像经验的主治医生基于PI-RADS v2.1对MRI图像进行评估,并勾画病变轮廓,从而获得包括三维直径、相对病变体积(病变体积除以前列腺体积)、球形度、平整度及表面体积比等MRI特征。使用logistic分析,确定PI-RADS评分及多参数MRI衍生标志物与移行带csPCa检测的关系。结果纳入的403例患者中PI-RADS 1(n=25)、2(n=119)、3(n=130)、4(n=43)和5(n=86)类病变的csPCa检出率分别为0.00%、0.00%、3.85%、32.56%和70.93%。PI-RADS 3类、4类、5类的csPCa检出率差异具有统计学意义(P<0.001)。移行带csPCa的预测因子包括血清前列腺特异性抗原(prostate-specific antigen,PSA)[OR=1.05(95%CI:1.00~1.10);P=0.047]、PI-RADS[OR=8.92(95%CI:2.94~27.13);P<0.001]、最大二维直径[OR=0.84(95%CI:0.71~0.98);P=0.046]及网格体积[OR=1.00(95%CI:1.00~1.00);P=0.041]。结论血清PSA、PI-RADS评分、病灶直径及网格体积等是移行带csPCa的独立预测因子。展开更多
基金This research has been kindly supported by a grant from the St Vincent's Research Endowment Fund(approval number 55.2014).
文摘Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)after 5 years of further experience comprising>1000 scans.Intraobserver agreement was measured using Cohen's kappa.Sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's test.Results Ninety-six mpMRIp scans were included in our final analysis.Of the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions targeted.Moderate agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is moderate.Reduced sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.
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Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.
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。
文摘目的评估基于前列腺成像报告和数据系统2.1版本(prostate imaging-reporting and data system version 2.1,PI-RADS v2.1)及多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)衍生标志物用于移行带临床显著性前列腺癌(clinically significant prostate cancer,csPCa)检测的价值。材料与方法回顾性分析2020年1月至2024年2月在我院行mp-MRI及病理活检的移形带前列腺疾病患者的临床及影像学资料。由具有8年前列腺成像经验的主治医生基于PI-RADS v2.1对MRI图像进行评估,并勾画病变轮廓,从而获得包括三维直径、相对病变体积(病变体积除以前列腺体积)、球形度、平整度及表面体积比等MRI特征。使用logistic分析,确定PI-RADS评分及多参数MRI衍生标志物与移行带csPCa检测的关系。结果纳入的403例患者中PI-RADS 1(n=25)、2(n=119)、3(n=130)、4(n=43)和5(n=86)类病变的csPCa检出率分别为0.00%、0.00%、3.85%、32.56%和70.93%。PI-RADS 3类、4类、5类的csPCa检出率差异具有统计学意义(P<0.001)。移行带csPCa的预测因子包括血清前列腺特异性抗原(prostate-specific antigen,PSA)[OR=1.05(95%CI:1.00~1.10);P=0.047]、PI-RADS[OR=8.92(95%CI:2.94~27.13);P<0.001]、最大二维直径[OR=0.84(95%CI:0.71~0.98);P=0.046]及网格体积[OR=1.00(95%CI:1.00~1.00);P=0.041]。结论血清PSA、PI-RADS评分、病灶直径及网格体积等是移行带csPCa的独立预测因子。
