Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy.
Eur J Radiol. 2019 Sep;118:51-57. doi: 10.1016/j.ejrad.2019.07.002. Epub 2019 Jul 2.
To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization.
Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive.
GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified.
Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.
测试从 DCE-MRI 分析中得出的药代动力学参数对 PI-RADSv.2 分类在前列腺病变特征诊断性能的潜在影响。
在接受多参数前列腺 MRI（mpMRI）（2016 年 1 月至 2018 年 3 月）并进行组织学评估（靶向活检/前列腺切除术）的患者中，回顾性选择了 103 名男性。为每位患者识别出指数病变，并评估药代动力学参数（Ktrans、Kep、Ve、Vp）。考虑 PI-RADS≥3 为阳性，评估 MRI 在检测有意义肿瘤（Gleason 评分[GS]≥7）方面的诊断性能。
GS≥7（n=59）的 Ktrans（p<0.01）和 Kep（p=0.01）均高于 GS<7。在 ROC 曲线分析中，确定 Ktrans 截断值为 191×10/min 以预测 GS≥7 的存在（AUC：0.75；灵敏度：95%；特异性：61%）。使用 PI-RADSv.2 的 mpMRI 的灵敏度和 PPV 分别为 98%和 61%。根据 Ktrans 截断值重新分类 PI-RADS≥3 病变，22 个假阳性病变转变为真阴性病变，3 个假阴性病变；PPV 提高到 79%。将 Ktrans 截断值应用于外周区 PI-RADS 3 病变（n=18），发现 12 个真阴性、4 个真阳性、2 个假阳性病变。
尽管前列腺 mpMRI 具有很高的灵敏度，但它会产生许多假阳性病例：除了 PIRADS v.2 外，Ktrans 似乎还可以提高 MRI-PPV，并有助于避免不必要的活检。
