Riney Joseph C, Sarwani Nabeel E, Siddique Shehzad, Raman Jay D
Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA.
Urol Oncol. 2018 Apr;36(4):159.e1-159.e5. doi: 10.1016/j.urolonc.2017.12.013. Epub 2018 Jan 12.
To determine the diagnostic accuracy and interobserver variability of radiologic interpretation of magnetic resonance imaging (MRI) performed for surgical planning before prostatectomy.
The records of 233 men undergoing prostatectomy with presurgical multiparametric 3T surface body coil MRI were reviewed. All initial films were read by a fellowship-trained body radiologist provided with relevant clinical information. A senior radiologist then reread all pelvic MRIs blinded to the initial interpretation with findings from both readings compared to final pathology. Kappa (κ) scores as well as sensitivity, specificity, positive predictive values (PPV), negative predictive value (NPV), and accuracy were determined.
When considering extraprostatic extension (EPE), there was low concordance comparing the initial vs. repeat MRI interpretation (κ = 0.22). Additionally, when the senior radiologist reread his own initial interpretation (n = 93, blinded to initial result), concordance for EPE was greater (κ = 0.36) albeit similarly low. With regard to EPE, a comparison of initial MRI interpretation vs. reread by senior radiologist noted universal improvements in diagnostic characteristics including sensitivity (30.3% vs. 56.1%), specificity (80.2% vs. 88.6%), PPV (37.7% vs. 66.1%), NPV (74.4% vs. 83.6%), and accuracy (66.1% vs. 79.4%). In contrast, seminal vesicle invasion interpretation was more uniform whereby initial MRI interpretation vs. reread yielded similar sensitivity (18.2% vs. 27.3%), specificity (97.2% vs. 93.8%), PPV (40.0% vs. 31.6%), NPV (91.9% vs. 92.5%), and accuracy (89.7% vs. 87.6%).
Even at a tertiary referral center, interobserver variability among radiologists regarding local extent of disease on prostate MRI is high. These observations underscore the importance of uniformity when defining criteria for EPE and seminal vesicle invasion to allow for optimal presurgical planning.
确定前列腺切除术前用于手术规划的磁共振成像（MRI）的放射学解读的诊断准确性和观察者间变异性。
回顾了233例行前列腺切除术且术前行多参数3T表面体线圈MRI检查的男性患者的记录。所有初始影像由一名接受过专科培训的体部放射科医生阅读，并提供相关临床信息。然后，一名资深放射科医生在不知晓初始解读结果的情况下重新阅读所有盆腔MRI，并将两次阅读结果与最终病理结果进行比较。确定kappa（κ）评分以及敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
在考虑前列腺外侵犯（EPE）时，初始MRI解读与重复MRI解读之间的一致性较低（κ = 0.22）。此外，当资深放射科医生重新阅读自己的初始解读结果时（n = 93，不知晓初始结果），EPE的一致性更高（κ = 0.36），尽管同样较低。关于EPE，初始MRI解读与资深放射科医生重新阅读结果的比较显示，包括敏感度（30.3%对56.1%）、特异度（80.2%对88.6%）、PPV（37.7%对66.1%）、NPV（74.4%对83.6%）和准确性（66.1%对79.4%）在内的诊断特征普遍有所改善。相比之下，精囊侵犯解读更为一致，初始MRI解读与重新阅读的敏感度（18.2%对27.3%）、特异度（97.2%对93.8%）、PPV（40.0%对31.6%）、NPV（91.9%对92.5%）和准确性（89.7%对87.6%）相似。
即使在三级转诊中心，放射科医生之间关于前列腺MRI疾病局部范围的观察者间变异性也很高。这些观察结果强调了在定义EPE和精囊侵犯标准时保持一致性对于优化术前规划的重要性。
