放射性治疗后前列腺癌局部复发的动态对比增强成像：对不同经验水平的读者的附加价值有限。
Dynamic contrast-enhanced imaging in localizing local recurrence of prostate cancer after radiotherapy: Limited added value for readers of varying level of experience.
机构信息
Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP, Sorbonne University Paris, France.
Academic Departement of Statistic, Hopital Pitié-Salpétrière, AP-HP, Sorbonne University, France.
出版信息
J Magn Reson Imaging. 2018 Oct;48(4):1012-1023. doi: 10.1002/jmri.25991. Epub 2018 Mar 8.
BACKGROUND
The incremental value of dynamic contrast-enhanced (DCE) imaging in localizing radiorecurrent prostate cancer is uncertain.
PURPOSE
To assess the added-value of DCE imaging to the combination T -weighted imaging (T W)+diffusion-weighted imaging (DWI) in detecting locally radiorecurrent prostate cancer (PCa), by radiologists with different levels of experience.
STUDY TYPE
Analytic retrospective study.
POPULATION
In all, 52 men with biological suspected PCa recurrence after radiotherapy were retrospectively included.
FIELD STRENGTH/SEQUENCE: All men underwent prostatic MRI (1.5T or 3T), including T W, DWI, and DCE imagings, before biopsies.
ASSESSMENT
Two junior (6 months' experience) and two senior readers (more than 3 years' experience) independently assigned a Likert score for each prostatic sextant on T W+DW+DCE imagings, then on T W+DW imagings, 4 weeks later.
STATISTICAL TESTS
The reference standard was prostatic biopsies. For two levels of positivity of Likert score, 3/5 and 4/5, sensitivity, specificity, area under the receiver operating curve (AUC), and interreader agreement were compared.
RESULTS
T W+DWI+DCE and T W+DWI imaging had similar AUC at lobe and sextant level (0.853-0.946 vs. 0.819-0.955, P from 0.071-0.534). Using a Likert score ≥4/5, T W+DWI+DCE significantly improved the sensitivity for junior readers at the patient, lobe, and sextant level (40-80% vs. 22-66%, P < 0.0001-0.041). Sensitivity was not significantly modified with DCE imaging for senior readers (54-95% vs. 50-91%, P from 0.074-1). Specificity was not modified for all readers (50-100% vs. 50%-100%, P from 0.134-1). DCE imaging improved interreader agreement for a Likert score ≥4/5 (kappa from 0.6-0.73 vs. 0.38-0.73).
DATA CONCLUSION
The addition of DCE imaging did not significantly improve accuracy in recurrent PCa detection after radiotherapy, whatever the level of experience of the readers. However, the addition of DCE imaging slightly improved the sensitivity for less-experienced readers and increased their diagnostic confidence.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1012-1023.
背景
动态对比增强（DCE）成像在定位放射性复发性前列腺癌中的增值价值尚不确定。
目的
通过不同经验水平的放射科医生评估 DCE 成像在检测局部放射性复发性前列腺癌（PCa）时，对 T 加权成像（T W）+扩散加权成像（DWI）组合的附加价值。
研究类型
分析性回顾性研究。
人群
所有 52 名接受放疗后有生物可疑 PCa 复发的男性均被回顾性纳入研究。
场强/序列：所有男性均在活检前接受前列腺 MRI（1.5T 或 3T），包括 T W、DWI 和 DCE 成像。
评估
两名初级（6 个月经验）和两名高级（3 年以上经验）读者分别对 T W+DW+DCE 成像的每个前列腺六区分区进行 Likert 评分，4 周后再对 T W+DW 成像进行评分。
统计学检验
参考标准为前列腺活检。对于 Likert 评分的两个阳性水平，即 3/5 和 4/5，比较了敏感性、特异性、受试者工作特征曲线（AUC）下面积和读者间的一致性。
结果
T W+DWI+DCE 和 T W+DWI 成像在叶和六分区水平的 AUC 相似（0.853-0.946 与 0.819-0.955，P 从 0.071-0.534）。使用 Likert 评分≥4/5，T W+DWI+DCE 显著提高了初级读者在患者、叶和六分区水平的敏感性（40%-80%与 22%-66%，P<0.0001-0.041）。DCE 成像对高级读者的敏感性无明显改变（54%-95%与 50%-91%，P 从 0.074-1）。所有读者的特异性均无改变（50%-100%与 50%-100%，P 从 0.134-1）。DCE 成像增加了 Likert 评分≥4/5 时的读者间一致性（kappa 从 0.6-0.73 与 0.38-0.73）。
数据结论
无论读者经验水平如何，DCE 成像的添加均未显著提高放射性复发性前列腺癌检测的准确性。然而，DCE 成像的添加略微提高了经验较少的读者的敏感性，并增加了他们的诊断信心。
证据水平
3 级，技术功效。磁共振成像杂志 2018；48：1012-1023。
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