Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada.
Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Eur Radiol. 2020 Aug;30(8):4251-4261. doi: 10.1007/s00330-020-06725-9. Epub 2020 Mar 24.
To compare observation size and apparent diffusion coefficient (ADC) values in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 category 4 and 5 observations to adverse pathological features.
With institutional review board approval, 267 consecutive men with 3-T MRI before radical prostatectomy (RP) between 2012 and 2018 were evaluated by two blinded radiologists who assigned PI-RADS v2.1 scores. Discrepancies were resolved by consensus. A third blinded radiologist measured observation size and ADC (ADC.mean, ADC.min [lowest ADC within an observation], ADC.ratio [ADC.mean/ADC.peripheral zone {PZ}]). Size and ADC were compared to pathological stage and Gleason score (GS) using t tests, ANOVA, Pearson correlation, and receiver operating characteristic (ROC) analysis.
Consensus review identified 267 true positive category 4 and 5 observations representing 83.1% (222/267) PZ and 16.9% (45/267) transition zone (TZ) tumors. Inter-observer agreement for PI-RADS v2.1 scoring was moderate (K = 0.45). Size was associated with extra-prostatic extension (EPE) (19 ± 8 versus 14 ± 6 mm, p < 0.001) and seminal vesicle invasion (SVI) (24 ± 9 versus 16 ± 7 mm, p < 0.001). Size ≥ 15 mm optimized the accuracy for EPE with area under the ROC curve (AUC) and sensitivity/specificity of 0.68 (CI 0.62-0.75) and 63.2%/65.6%. Size ≥ 19 mm optimized the accuracy for SVI with AUC/sensitivity/specificity of 0.75 (CI 0.66-0.83)/69.4%/70.6%. ADC metrics were not associated with pathological stage. Larger observation size (p = 0.032), lower ADC.min (p = 0.010), and lower ADC.ratio (p = 0.010) were associated with higher GS. Size correlated better to higher Gleason scores (p = 0.002) compared to ADC metrics (p = 0.09-0.11).
Among PI-RADS v2.1 category 4 and 5 observations, size was associated with higher pathological stage whereas ADC metrics were not. Size, ADC.minimum, and ADC.ratio differed in tumors stratified by Gleason score.
• Among PI-RADS category 4 and 5 observations, size but not ADC can differentiate between tumors by pathological stage. • An observation size threshold of 15 mm and 19 mm optimized the accuracy for diagnosis of extra-prostatic extension and seminal vesicle invasion. • Among PI-RADS category 4 and 5 observations, size, ADC.minimum, and ADC.ratio differed comparing tumors by Gleason score.
比较前列腺影像报告和数据系统（PI-RADS）v2.1 第 4 类和第 5 类观察的观察大小和表观扩散系数（ADC）值与不良病理特征。
经机构审查委员会批准，2012 年至 2018 年间对 267 例连续接受 3-T MRI 检查后行根治性前列腺切除术（RP）的男性进行评估，由两名盲法放射科医生进行 PI-RADS v2.1 评分。通过共识解决差异。第三位盲法放射科医生测量观察大小和 ADC（ADC.mean、ADC.min[观察内最低 ADC]、ADC.ratio[ADC.mean/ADC. 外周区 {PZ}])。使用 t 检验、ANOVA、Pearson 相关性和接收者操作特征（ROC）分析比较大小和 ADC 与病理分期和 Gleason 评分（GS）。
共识审查确定了 267 个真正的阳性第 4 类和第 5 类观察，代表 83.1%（222/267）的 PZ 和 16.9%（45/267）的移行区（TZ）肿瘤。PI-RADS v2.1 评分的观察者间一致性为中度（K=0.45）。大小与前列腺外延伸（EPE）（19±8 毫米与 14±6 毫米，p<0.001）和精囊侵犯（SVI）（24±9 毫米与 16±7 毫米，p<0.001）相关。大小≥15 毫米可优化 EPE 的准确性，ROC 曲线下面积（AUC）和灵敏度/特异性分别为 0.68（0.62-0.75）和 63.2%/65.6%。大小≥19 毫米可优化 SVI 的准确性，AUC/灵敏度/特异性分别为 0.75（0.66-0.83）/69.4%/70.6%。ADC 指标与病理分期无关。较大的观察大小（p=0.032）、较低的 ADC.min（p=0.010）和较低的 ADC.ratio（p=0.010）与较高的 GS 相关。大小与较高的 Gleason 评分相关性更好（p=0.002），而 ADC 指标则较差（p=0.09-0.11）。
在 PI-RADS v2.1 第 4 类和第 5 类观察中，大小与较高的病理分期相关，而 ADC 指标则不然。在按 Gleason 评分分层的肿瘤中，大小、ADC.minimum 和 ADC.ratio 不同。
在 PI-RADS 第 4 类和第 5 类观察中，大小可以区分肿瘤的病理分期，而 ADC 则不能。
观察大小的 15 毫米和 19 毫米阈值可优化用于诊断前列腺外延伸和精囊侵犯的准确性。
在 PI-RADS 第 4 类和第 5 类观察中，大小、ADC.minimum 和 ADC.ratio 因 Gleason 评分的不同而有所差异。
