多读者探索性评估前列腺多参数磁共振成像（MRI）中个体脉冲序列对癌症的检测。
A Multireader Exploratory Evaluation of Individual Pulse Sequence Cancer Detection on Prostate Multiparametric Magnetic Resonance Imaging (MRI).
机构信息
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD 20814.
Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Frederick, Maryland.
出版信息
Acad Radiol. 2019 Jan;26(1):5-14. doi: 10.1016/j.acra.2018.03.024. Epub 2018 Apr 25.
RATIONALE AND OBJECTIVES
To determine independent contribution of each prostate multiparametric magnetic resonance imaging (mpMRI) sequence to cancer detection when read in isolation.
MATERIALS AND METHODS
Prostate mpMRI at 3-Tesla with endorectal coil from 45 patients (n = 30 prostatectomy cases, n = 15 controls with negative magnetic resonance imaging [MRI] or biopsy) were retrospectively interpreted. Sequences (T2-weighted [T2W] MRI, diffusion-weighted imaging [DWI], and dynamic contrast-enhanced [DCE] MRI; N = 135) were separately distributed to three radiologists at different institutions. Readers evaluated each sequence blinded to other mpMRI sequences. Findings were correlated to whole-mount pathology. Cancer detection sensitivity, positive predictive value for whole prostate (WP), transition zone, and peripheral zone were evaluated per sequence by reader, with reader concordance measured by index of specific agreement. Cancer detection rates (CDRs) were calculated for combinations of independently read sequences.
RESULTS
44 patients were evaluable (cases median prostate-specific antigen 6.83 [ range 1.95-51.13] ng/mL, age 62 [45-71] years; controls prostate-specific antigen 6.85 [2.4-10.87] ng/mL, age 65.5 [47-71] years). Readers had highest sensitivity on DWI (59%) vs T2W MRI (48%) and DCE (23%) in WP. DWI-only positivity (DWI+/T2W-/DCE-) achieved highest CDR in WP (38%), compared to T2W-only (CDR 24%) and DCE-only (CDR 8%). DWI+/T2W+/DCE- achieved CDR 80%, an added benefit of 56.4% from T2W-only and of 42% from DWI-only (P < .0001). All three sequences interpreted independently positive gave highest CDR of 90%. Reader agreement was moderate (index of specific agreement: T2W = 54%, DWI = 58%, DCE = 33%).
CONCLUSIONS
When prostate mpMRI sequences are interpreted independently by multiple observers, DWI achieves highest sensitivity and CDR in transition zone and peripheral zone. T2W and DCE MRI both add value to detection; mpMRI achieves highest detection sensitivity when all three mpMRI sequences are positive.
背景与目的
确定当独立读取时，每个前列腺多参数磁共振成像（mpMRI）序列对癌症检测的独立贡献。
材料与方法
回顾性分析了 45 例患者（30 例前列腺切除术患者，15 例阴性磁共振成像[MRI]或活检的对照者）在 3.0T 场强下进行的直肠内线圈前列腺 mpMRI。将序列（T2 加权[T2W]MRI、扩散加权成像[DWI]和动态对比增强[DCE]MRI；N=135）分别分发给三个不同机构的放射科医生。读者在不了解其他 mpMRI 序列的情况下对每个序列进行盲法评估。结果与全前列腺（WP）、移行区和周围区的全视病理学相关。根据每位读者的序列评估了检测灵敏度、整体前列腺（WP）、移行区和周围区的阳性预测值（PPV），通过特定协议指数测量读者间的一致性。计算了独立阅读序列的组合的癌症检测率（CDR）。
结果
44 例患者可评估（病例中位前列腺特异性抗原 6.83[范围 1.95-51.13]ng/ml，年龄 62[45-71]岁；对照者前列腺特异性抗原 6.85[2.4-10.87]ng/ml，年龄 65.5[47-71]岁）。读者在 WP 中 DWI（59%）比 T2W MRI（48%）和 DCE（23%）的灵敏度更高。DWI 阳性（DWI+/T2W-/DCE-）在 WP 中的 CDR 最高（38%），而 T2W 仅（CDR 24%）和 DCE 仅（CDR 8%）。DWI+/T2W+/DCE-的 CDR 为 80%，与 T2W 相比增加了 56.4%，与 DWI 相比增加了 42%（P<.0001）。所有三个序列均独立为阳性，获得了最高的 CDR 为 90%。读者间的一致性为中等（特定协议指数：T2W=54%，DWI=58%，DCE=33%）。
结论
当由多个观察者独立解释前列腺 mpMRI 序列时，DWI 在移行区和周围区中实现了最高的灵敏度和 CDR。T2W 和 DCE MRI 均对检测有价值；当所有三个 mpMRI 序列均为阳性时，mpMRI 可实现最高的检测灵敏度。
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