Brancato Valentina, Di Costanzo Giuseppe, Basso Luca, Tramontano Liberatore, Puglia Marta, Ragozzino Alfonso, Cavaliere And Carlo
IRCCS SDN, 80143 Napoli, Italy.
Ospedale S. Maria delle Grazie, 80078 Pozzuoli, Italy.
Diagnostics (Basel). 2020 Mar 17;10(3):164. doi: 10.3390/diagnostics10030164.
The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen's kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.
动态对比增强磁共振成像（DCE-MRI）在前列腺影像报告和数据系统（PI-RADS）评分中的作用是一个有争议的话题。在这项回顾性研究中，我们旨在使用PI-RADS v2.1评估DCE-MRI联合T2加权（T2W）和扩散加权成像（DWI）在检测前列腺癌（PCa）和临床显著前列腺癌（CS-PCa，Gleason评分≥7）方面的再现性和诊断准确性的附加值。111例患者中的117个病变通过多参数磁共振成像（mpMRI）被确定为可疑病变并进行活检。三位经验丰富的阅片者独立评估PI-RADS评分，首先使用双参数磁共振成像（bpMRI，包括DWI和T2W），然后使用多参数磁共振成像（也包括DCE）。通过Cohen's kappa（κ）评估阅片者间和方法间的一致性（基于bpMRI与基于mpMRI的评分）。进行受试者操作特征（ROC）分析以评估两种评分在检测PCa和CS-PCa方面的诊断准确性。三位阅片者对之间的阅片者间一致性极佳（κ≥0.83），而方法间一致性良好（κ≥0.73）。ROC曲线下面积（AUC）显示出相似的高值（AUC为0.8至0.85）。PI-RADS v2.1评分在阅片者之间的再现性相当且较高，根据所使用的MRI方案没有相关差异。纳入DCE并未影响诊断准确性。
