Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2020 Apr;214(4):792-799. doi: 10.2214/AJR.19.22072. Epub 2020 Feb 18.
Current criteria for positive findings on dynamic contrast-enhanced MRI (DCE-MRI) are unclear. We compared the diagnostic performance of mass enhancement on DCE-MRI versus conventional DCE-MRI criteria for identifying clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). A total of 173 consecutive patients with MRI- and surgically proven prostate cancer (PCa) were evaluated. Two readers independently interpreted DCE-MRI examinations of the PZ. Criteria denoting a positive DCE-MRI examination included conventional criteria from the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and mass enhancement. The diagnostic performance of and interreader agreement for the two types of enhancement criteria in identifying csPCa in the PZ that met Epstein criteria were investigated. The proportion of csPCa in the PZ was 69.3% (120/173). For both readers, the specificity and positive predictive value of mass enhancement were increased compared with conventional enhancement criteria (specificity, 75.5% vs 5.7% [for reader 1] and 84.9% vs 30.2% [for reader 2], respectively; positive predictive value, 87.1% vs 70.6% [for reader 1] and 91.5% vs 75.3% [for reader 2], respectively). The AUC value of mass enhancement was higher than that of conventional criteria (for reader 1, 0.744 [95% CI, 0.672-0.807] vs 0.528 [95% CI, 0.451-0.605] [ < 0.001], respectively; for reader 2, 0.783 [95% CI, 0.714-0.842] vs 0.602 [95% CI, 0.497-0.700] [ < 0.001], respectively). The weighted kappa value for agreement between the two readers was 0.206 for conventional criteria and 0.613 for mass enhancement. PZ lesions with mass enhancement on DCE-MRI are more likely to be csPCa. This enhancement pattern may need to be considered as one of the criteria in PI-RADS.
目前，动态对比增强磁共振成像（DCE-MRI）阳性结果的标准尚不清楚。我们比较了 DCE-MRI 中肿块强化与常规 DCE-MRI 标准在识别外周带（PZ）中临床显著前列腺癌（csPCa）方面的诊断性能。共评估了 173 例经 MRI 和手术证实的前列腺癌（PCa）患者。两位读者独立解读了 PZ 的 DCE-MRI 检查。表示 DCE-MRI 检查阳性的标准包括前列腺影像报告和数据系统第 2 版（PI-RADSv2）的常规标准和肿块强化。研究了这两种强化标准在识别符合爱泼斯坦标准的 PZ 中 csPCa 时的诊断性能和读者间一致性。PZ 中 csPCa 的比例为 69.3%（120/173）。对于两位读者，肿块强化的特异性和阳性预测值均高于常规强化标准（特异性，分别为 75.5%比 5.7%[读者 1]和 84.9%比 30.2%[读者 2]；阳性预测值，分别为 87.1%比 70.6%[读者 1]和 91.5%比 75.3%[读者 2]）。肿块强化的 AUC 值高于常规标准（读者 1，0.744[95%CI，0.672-0.807]比 0.528[95%CI，0.451-0.605]；<0.001；读者 2，0.783[95%CI，0.714-0.842]比 0.602[95%CI，0.497-0.700]；<0.001）。两位读者之间的一致性加权kappa 值为常规标准的 0.206，肿块强化的 0.613。DCE-MRI 上 PZ 肿块强化的病变更有可能是 csPCa。这种强化模式可能需要被视为 PI-RADS 标准之一。
