优化 MRI 评估对临床显著前列腺癌的评估：一项符合 STARD 规范的两中心研究。
Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD-Compliant Two-Center Study.
机构信息
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
出版信息
J Magn Reson Imaging. 2021 Apr;53(4):1210-1219. doi: 10.1002/jmri.27394. Epub 2020 Oct 19.
BACKGROUND
There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC).
PURPOSE
To evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC.
STUDY TYPE
Two-center, retrospective.
SUBJECTS
A total of 346 patients from center 1 and 292 patients from center 2.
FIELD STRENGTH/SEQUENCE: 3.0T scanners, T -weighted imaging (T WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging.
ASSESSMENT
Four radiologists interpreted the Bp-MRI (T WI and DWI) and Mp-MRI (T WI, DWI, and DCE) independently according to the Prostate Imaging Reporting and Data System (PI-RADS). For Op-MRI, two radiologists used an adjusted decision rule on Bp-MRI-assessed PI-RADS 3 lesions by determining early enhancement of DCE. Pathologies at biopsy and/or prostatectomy specimens were used as standard references.
STATISTICAL TESTS
Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability.
RESULTS
Interreader agreement was excellent for all three MRI assessments (all κ values >0.80). Op-MRI had comparable sensitivity (senior/junior: 90.9% [261/287] / 91.6% [263/287]) and higher specificity (78.1% [274/351] /74.4% [261/351]) compared with Mp-MRI (sensitivity: 92.3% [265/287] / 93.7% [269/287]; specificity: 67.8% [238/351] / 68.1% [239/351]) and Bp-MRI (sensitivity: 91.6% [263/287] / 93.4% [268/287]; specificity: 71.2% [250/351] / 70.1% [246/351]) for the diagnosis of CSPC. Compared to Mp-MRI, Op-MRI spared biopsy in 80.7% (515/638) of DCE scans with similar performance accuracy. Compared to Bp-MRI, Op-MRI downgraded 25.2% (31/123) of lesions at a cost of missing 6.5% (3/46) of malignancies, and upgraded 45.5% (56/123) of lesions with a positive predictive value of 62.5% (35/56) in 123 equivocal findings.
DATA CONCLUSION
The Op-MRI, using an adjusted PI-RADS decision rule, did not compromise diagnostic accuracy with sparing biopsy in 80.7% of DCE scans compared to Mp-MRI, and outperformed Bp-MRI by regrading PI-RADS lesions.
LEVEL OF EVIDENCE
4 TECHNICAL EFFICACY STAGE: 2.
背景
需要制定个性化策略，让更多疑似临床显著前列腺癌（CSPC）的男性能够接受 MRI 检查。
目的
评估优化 MRI（Op-MRI）与双参数 MRI（Bp-MRI）和多参数 MRI（Mp-MRI）在 CSPC 诊断中的表现。
研究类型
中心回顾性研究。
受试者
中心 1 共 346 例患者，中心 2 共 292 例患者。
磁场强度/序列：3.0T 扫描仪，T2 加权成像（T2WI）、扩散加权成像（DWI）和动态对比增强（DCE）成像。
评估
4 位放射科医生根据前列腺影像报告和数据系统（PI-RADS）独立解读 Bp-MRI（T2WI 和 DWI）和 Mp-MRI（T2WI、DWI 和 DCE）。对于 Op-MRI，两位放射科医生使用调整后的决策规则，根据 Bp-MRI 评估的 PI-RADS 3 级病变，判断 DCE 的早期增强情况。以活检和/或前列腺切除术标本的病理结果作为标准参考。
统计学检验
使用受试者工作特征（ROC）曲线评估性能。使用κ 统计评估观察者间的变异性。
结果
三种 MRI 评估的观察者间一致性均非常好（所有κ值＞0.80）。与 Mp-MRI 相比，Op-MRI 的敏感性（高级/初级：90.9%[261/287]/91.6%[263/287]）和特异性（78.1%[274/351]/74.4%[261/351]）相当，而特异性更高（92.3%[265/287]/93.7%[269/287]），特异性（67.8%[238/351]/68.1%[239/351]）和 Bp-MRI（敏感性：91.6%[263/287]/93.4%[268/287]；特异性：71.2%[250/351]/70.1%[246/351]）诊断 CSPC。与 Mp-MRI 相比，Op-MRI 使 80.7%（515/638）的 DCE 扫描避免了活检，且具有相似的性能准确性。与 Bp-MRI 相比，Op-MRI 将 25.2%（31/123）的病变降级，同时以漏诊 6.5%（3/46）的恶性肿瘤为代价，将 45.5%（56/123）的病变升级，阳性预测值为 62.5%（35/56），这 56 个病变在 123 个可疑发现中有 123 个。
数据结论
与 Mp-MRI 相比，使用调整后的 PI-RADS 决策规则的 Op-MRI 并未降低诊断准确性，在 80.7%的 DCE 扫描中避免了活检，且通过重新分级 PI-RADS 病变，优于 Bp-MRI。
证据水平
4 级技术功效。
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