PI-RADS v2与v2.1在移行区病变中检测前列腺癌的直接比较：初步经验
Direct Comparison of PI-RADS Version 2 and 2.1 in Transition Zone Lesions for Detection of Prostate Cancer: Preliminary Experience.
作者信息
Byun Jieun, Park Kye Jin, Kim Mi-Hyun, Kim Jeong Kon
机构信息
Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
J Magn Reson Imaging. 2020 Aug;52(2):577-586. doi: 10.1002/jmri.27080. Epub 2020 Feb 11.
BACKGROUND
There appears to be less agreement in the identification of cancers in the transition zone (TZ), which is not as reliable as those in peripheral zone when using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2). In response to such shortcomings, the updated version 2.1 was introduced, which incorporated diffusion-weighted imaging (DWI) into category 2 and clarified lexicons.
PURPOSE
To compare the diagnostic performance for the detection of clinically significant TZ prostate cancers (csPCa) and interreader agreement between PI-RADS v2.1 and v2.
STUDY TYPE
Retrospective study.
POPULATION
In all, 142 patients, 201 TZ lesions.
FIELD STRENGTH/SEQUENCE: 3.0T; T -weighted image and DWI.
ASSESSMENT
Lesions were scored by three independent readers using PI-RADS v2 and v2.1.
STATISTICAL TESTS
The sensitivity and specificity at category ≥3 were compared between v2 and v2.1 using the generalized estimating equation model. Detection rates for csPCa of upgraded and downgraded lesions in the use of PI-RADS v2.1 from v2 were assessed. Interreader agreement was assessed using κ statistics.
RESULTS
PI-RADS v2.1 showed a higher sensitivity and specificity (94.5% and 60.9%) than v2 (91.8% and 56.3%) for category ≥3 lesions in the detection of csPCa, although not significantly. Of eight upgraded lesions from category 2 to 3 (2 + 1) with an incorporated DWI, 50% (4/8) were csPCa. This was significantly higher than category 2 lesions (4.4%; P = 0.003). No csPCa was detected among the 22.8% (46/201) downgraded lesions. There was a moderate interreader agreement for scores ≥3 (κ = 0.565) in v2.1, which was slightly higher than that for v2 (κ = 0.534), although not significantly.
DATA CONCLUSION
PI-RADS v2.1 provides moderate and comparable interreader agreement at category ≥3 than v2 in the TZ lesions. Upgraded lesions from category 2 to 3 demonstrated a higher detection rate of csPCa than category 2 lesions in v2.1.
LEVEL OF EVIDENCE
4 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:577-586.
背景
在使用前列腺影像报告和数据系统（PI-RADS）第2版（v2）时，移行区（TZ）癌症的识别似乎存在较少的一致性，其不如外周区癌症识别可靠。针对这些缺点，引入了更新的2.1版，该版本将扩散加权成像（DWI）纳入2类并明确了术语。
目的
比较PI-RADS v2.1和v2在检测临床显著的TZ前列腺癌（csPCa）方面的诊断性能以及阅片者之间的一致性。
研究类型
回顾性研究。
研究对象
共142例患者，201个TZ病变。
场强/序列：3.0T；T加权成像和DWI。
评估
由三位独立阅片者使用PI-RADS v2和v2.1对病变进行评分。
统计检验
使用广义估计方程模型比较v2和v2.1在≥3类时的敏感性和特异性。评估使用PI-RADS v2.1相对于v2时升级和降级病变的csPCa检出率。使用κ统计量评估阅片者之间的一致性。
结果
在检测csPCa时，对于≥3类病变，PI-RADS v2.1显示出比v2更高的敏感性和特异性（分别为94.5%和60.9%，而v2为91.8%和56.3%），尽管差异无统计学意义。在纳入DWI后从2类升级到3类（2 + 1）的8个病变中，50%（4/8）为csPCa。这显著高于2类病变（4.4%；P = 0.003）。在22.8%（46/20）降级病变中未检测到csPCa。对于v2.1中≥3分的评分，阅片者之间存在中度一致性（κ = 0.565），略高于v2（κ = 0.534），尽管差异无统计学意义。
数据结论
PI-RADS v2.1在TZ病变中对于≥3类提供了与v2相当的中度阅片者间一致性。在v2.1中，从2类升级到3类的病变显示出比2类病变更高的csPCa检出率。
证据水平
4 技术效能阶段：2 《磁共振成像杂志》2020；52：577 - 586。
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