Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy.
Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy -
Minerva Urol Nephrol. 2022 Feb;74(1):29-37. doi: 10.23736/S2724-6051.20.03952-1. Epub 2020 Oct 5.
The aim of this paper was to compare the accuracy of multiple abbreviated multiparametric magnetic resonance imaging (mpMRI)-derived protocols in detecting clinically significant prostate cancer (csPCa).
One hundred and eight men undergoing staging 3.0T mpMRI with a Prostate Imaging - Reporting and Data System version 2 (PI-RADSv2)-compliant protocol before radical prostatectomy (RP) were retrospectively evaluated. Two readers (R1, R2) independently analyzed mpMRI, assigning a PI-RADSv2 category to each observation as appearing on each examination sequence. A study coordinator assessed final PI-RADSv2 category by combining readers' assignments according to four protocols: short MRI (sMRI) (diffusion-weighted imaging + axial T2-weighted imaging), contrast-enhanced short MRI (cesMRI) (sMRI + dynamic contrast-enhanced [DCE] imaging), biparametric MRI (diffusion-weighted imaging + multiplanar T2-weigthed imaging), and mpMRI. Using RP pathology as the reference standard for csPCa, we calculated the per-lesion cancer detection rate (CDR) and false discovery rate (FDR) for each MRI protocol (cut-off PI-RADSv2 category ≥3), and the per-PI-RADSv2 category prevalence of csPCa and false positives.
Pathology after RP found 142 csPCas with median International Society of Urogenital Pathology grade group 2, and stage ≤pT2c in 68.6% of cases. CDR was comparable across the four MRI protocols (74.6% to 75.3% for R1, and 68.3% for R2). FDR was comparable as well (14.4%-14.5% for R1 and 11.1% for R2). sMRI was the minimum protocol equaling mpMRI in terms of CDR, although cesMRI, similarly to mpMRI, was associated with fewer PI-RADSv2 category 3 assignments and higher prevalence of csPCa within PI-RADSv2 category 3 observations (66.7% versus 76.9% for R1, and 100% versus 91.7% for R2, respectively).
Among multiple abbreviated mpMRI-derived protocols, cesMRI was the one equaling mpMRI in terms of csPCa detection and minimizing PI-RADSv2 category 3 assignments.
本文旨在比较多种简化的多参数磁共振成像（mpMRI）衍生方案在检测临床显著前列腺癌（csPCa）方面的准确性。
回顾性分析 108 例在根治性前列腺切除术（RP）前接受 3.0T 分期 mpMRI 检查的患者，这些患者均符合前列腺成像报告和数据系统第 2 版（PI-RADSv2）协议。两位读者（R1、R2）独立分析 mpMRI，根据每个检查序列上的表现为每个观察分配 PI-RADSv2 类别。一位研究协调员根据以下四个方案组合读者的分配来评估最终的 PI-RADSv2 类别：简化 MRI（sMRI）（弥散加权成像+轴位 T2 加权成像）、增强简化 MRI（cesMRI）（sMRI+动态对比增强[DCE]成像）、双参数 MRI（弥散加权成像+多平面 T2 加权成像）和 mpMRI。以 RP 病理学为 csPCa 的参考标准，我们计算了每个 MRI 方案（PI-RADSv2 类别≥3）的病变癌检出率（CDR）和假阳性率（FDR），以及每个 PI-RADSv2 类别中 csPCa 和假阳性的发生率。
RP 术后病理发现 142 例 csPCa，中位国际泌尿病理学会（ISUP）分级组 2，68.6%的病例为 pT2c 期。四种 MRI 方案的 CDR 相当（R1 为 74.6%至 75.3%，R2 为 68.3%）。FDR 也相当（R1 为 14.4%-14.5%，R2 为 11.1%）。sMRI 在 CDR 方面与 mpMRI 相当，尽管 cesMRI 与 mpMRI 一样，与更少的 PI-RADSv2 类别 3 分配和更高的 PI-RADSv2 类别 3 观察中 csPCa 的发生率相关（R1 为 66.7%比 76.9%，R2 为 100%比 91.7%）。
在多种简化的 mpMRI 衍生方案中，cesMRI 在 csPCa 检测和最小化 PI-RADSv2 类别 3 分配方面与 mpMRI 相当。
