Brizmohun Appayya Mrishta, Sidhu Harbir S, Dikaios Nikolaos, Johnston Edward W, Simmons Lucy Am, Freeman Alex, Kirkham Alexander Ps, Ahmed Hashim U, Punwani Shonit
1 Centre for Medical Imaging, University College London, Wolfson House , London , UK.
2 Department of Radiology, University College London Hospital , London , UK.
Br J Radiol. 2018 Feb;91(1083):20170645. doi: 10.1259/bjr.20170645. Epub 2017 Dec 15.
To determine whether indeterminate (Likert-score 3/5) peripheral zone (PZ) multiparametric MRI (mpMRI) studies are classifiable by prostate-specific antigen (PSA), PSA density (PSAD), Prostate Imaging Reporting And Data System version 2 (PI-RADS_v2) rescoring and morphological MRI features.
Men with maximum Likert-score 3/5 within their PZ were retrospectively selected from 330 patients who prospectively underwent prostate mpMRI (3 T) without an endorectal coil, followed by 20-zone transperineal template prostate mapping biopsies ＋/- focal lesion-targeted biopsy. PSAD was calculated using pre-biopsy PSA and MRI-derived volume. Two readers A and B independently assessed included men with both Likert-assessment and PI-RADS_v2. Both readers then classified mpMRI morphological features in consensus. Men were divided into two groups: significant cancer (≥ Gleason 3 ＋ 4) or insignificant cancer (≤ Gleason 3 ＋ 3)/no cancer. Comparisons between groups were made separately for PSA & PSAD using Mann-Whitney test and morphological descriptors with Fisher's exact test. PI-RADS_v2 and Likert-assessment were descriptively compared and percentage inter-reader agreement calculated.
76 males were eligible for PSA & PSAD analyses, 71 for PI-RADS scoring, and 67 for morphological assessment (excluding significant image artefacts). Unlike PSA (p = 0.915), PSAD was statistically different (p = 0.004) between the significant [median: 0.19 ng ml (interquartile range: 0.13-0.29)] and non-significant/no cancer [median: 0.13 ng ml (interquartile range: 0.10-0.17)] groups. Presence of mpMRI morphological features was not significantly different between groups. Subjective Likert-assessment discriminated patients with significant cancer better than PI-RADS_v2. Inter-reader percentage agreement was 83% for subjective Likert-assessment and 56% for PI-RADS_v2.
PSAD may categorize presence of significant cancer in patients with Likert-scored 3/5 PZ mpMRI findings. Advances in knowledge: PSAD may be used in indeterminate PZ mpMRI to guide decisions between biopsy vs monitoring.
确定前列腺特异性抗原（PSA）、PSA密度（PSAD）、前列腺影像报告和数据系统第2版（PI-RADS_v2）重新评分以及形态学MRI特征能否对不确定（李克特评分为3/5）的外周带（PZ）多参数MRI（mpMRI）检查结果进行分类。
从330例前瞻性接受前列腺mpMRI（3T）检查且未使用直肠内线圈的患者中，回顾性选取PZ内李克特评分最高为3/5的男性，随后进行20区经会阴模板前列腺穿刺活检和/或局灶性病变靶向活检。PSAD使用活检前PSA和MRI得出的体积进行计算。两位阅片者A和B独立评估纳入的同时有李克特评分和PI-RADS_v2评分的男性。然后，两位阅片者共同对mpMRI形态学特征进行分类。将男性分为两组：显著癌（≥ Gleason 3＋4）或非显著癌（≤ Gleason 3＋3）/无癌。组间比较分别使用Mann-Whitney检验对PSA和PSAD进行分析，使用Fisher精确检验对形态学描述符进行分析。对PI-RADS_v2和李克特评分进行描述性比较，并计算阅片者间的百分比一致性。
76名男性符合PSA和PSAD分析条件，71名符合PI-RADS评分条件，67名符合形态学评估条件（排除明显图像伪影）。与PSA（p = 0.915）不同，PSAD在显著癌组[中位数：0.19 ng/ml（四分位间距：0.13 - 0.29）]和非显著癌/无癌组[中位数：0.13 ng/ml（四分位间距：0.10 - 0.17）]之间存在统计学差异（p = 0.004）。mpMRI形态学特征的存在在两组之间无显著差异。主观李克特评分在区分显著癌患者方面优于PI-RADS_v2。阅片者间主观李克特评分的百分比一致性为83%，PI-RADS_v2为56%。
PSAD可对PZ的李克特评分为3/5的mpMRI检查结果中显著癌的存在进行分类。知识进展：PSAD可用于不确定的PZ mpMRI，以指导活检与监测之间的决策。
