【摘要】 目的 比较基于MRI多参数图像(MpMRI)的前列腺影像报告和数据系统(PI-RADS V1和PI-RADS V2)对前列腺癌的诊断效能。方法 前瞻性收集临床拟诊为前列腺癌且行3.0T MpMRI检查的患者30例,其中前列腺癌15例,非前列腺癌15例。全部病例均行3.0T MpMRI扫描,所有病例都至少有1个序列PI-RADS V1评分≥3分,且均行MpMRI与经直肠超声融合成像实时靶向穿刺(MRI-TRUS融合穿刺)。回顾性对所有穿刺病例的MpMRI图像进行PI-RADS V1/V2评分和Likert评分,绘制受试者工作特征(ROC)曲线,评价其对前列腺癌的诊断效能。结果 前列腺癌组(19处癌灶)的PI-RADS评分高于非前列腺癌组(19处增生灶)(PI-RADS V1:12.10±2.60 vs 7.47±1.98,P<0.05;PI-RADS V2:4.21±1.18 vs 2.79±0.92,P<0.05);PI-RADS V1和PI-RADS V2曲线下面积(AUC)无统计学差异。Likert评分诊断临界值为4分,诊断敏感性、特异性、阳性预测值及阴性预测值分别为73.7%、78.9%、77.74%、75.00%(AUC=0.778,95%CI:0.63～0.93);PI-RADS V1诊断临界值为10分,诊断敏感性、特异性、阳性预测值及阴性预测值分别为73.7%、94.7%、93.29%及78.26%(AUC=0.911,95%CI:0.82～1.00);PI-RADS V2诊断临界值为4分,诊断敏感性、特异性、阳性预测值及阴性预测值分别为57.9%、100%、100%、73.37%(AUC=0.837,95%CI:0.70～0.97)。结论前列腺MRI-TRUS图像靶向实时穿刺能有效和可靠地取得组织学标本;基于MpMRI的PI-RADS评分检出前列腺癌病灶具有很好的敏感性和特异性,其诊断效能高于Likert评分,但PI-RADS V2诊断效能并不高于PI-RADS V1。更多还原

【Abstract】 Objective To evaluate the prostate imaging reporting and data system(PI-RADS) version 1 and version 2 for detection of prostate cancer(PCa) by multiparametric magnetic resonance imaging(MpMRI) in a consecutive cohort of patients with magnetic resonance imaging/transrectal ultrasonography(MRI-TRUS) fusion-guided biopsy.Methods 30 suspicious lesions including 15prostate cancer and 15 non cancer at 3.0 T MpMRI were scored according to the PI-RADS V1(≥3 scores in at least one MRI sequence)system before MRI-TRUS fusion guided biopsy and correlated to bistopathology results.PI-RADS V2 and Likert scores were determined retrospectively,diagnostic accuracy was determined using receiver operating characteristic curve analysis.Results The PI-RADS score of the dominant lesion was significantly higher in patients with PCa compared to patients with negative histopathology(PI-RADS V1:12.10±2.60 vs 7.47±1.98,P<0.05;PI-RADS V2:4.21±1.18 vs 2.79±0.92,P<0.05);Using a Likert score cut-off≥4,a sensitivity of 73.7%,a specificity of78.9 %,positive predictive value of 77.74% and a negative predictive value of 75.00%(AUC=0.778,95 %CI:0.63-0.93),a PI-RADS V1cut-off≥10,a sensitivity of 73.7%,a specificity of 94.7%,positive predictive value of 93.29% and a negative predictive value of 78.26%(AUC=0.911,95%CI:0.82-1.00) and PI-RADS V2 cut-off≥4,a sensitivity of 57.9%,a specificity of 100%,positive predictive value of 100% and a negative predictive value of 73.37%(AUC=0.837,95 % CI:0.70-0.97) were achieved.Conclusion The described fusion system is dependable and efficient for targeted MRI-TRUS fusion-guided biopsy.MpMRI PI-RADS scores combined with a novel real-time MRI-TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity,PI-RADS scores appears to be the preferable method for the evaluation of prostate cancer than Likert score,while V2 does not perform better than V1.更多还原