Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey.
Department of Radiology, Kocaeli University Hospital, Kocaeli, Turkey.
Clin Imaging. 2021 Oct;78:98-103. doi: 10.1016/j.clinimag.2021.03.011. Epub 2021 Mar 20.
To investigate the diagnostic performance of Prostate Imaging-Reporting and Data System version 2.0 (PI-RADSv2.0) for differentiating clinically significant prostate cancer (csPCa) from benign prostate disease on prebiopsy multiparametric MRI stratified by total prostate specific antigen (PSA) concentration.
150 patients who had prebiopsy mpMRI, serum PSA concentration and subsequent biopsy were retrospectively analyzed. Patients were stratified by PSA concentration (Group1 ≥ 10 ng/mL; Group2 4.0-<10 ng/mL). MRI findings were assessed using PI-RADSv2.0 by two blinded radiologists. Lesions were graded histopathologically using the International Society of Urological Pathology (ISUP) score. Diagnostic performance of PI-RADSv2.0 was evaluated and compared to PSA and PSA Density (PSAD). The performance of the radiologists was compared including inter-observer agreement for PI-RADSv2.0. The correlation between imaging and histopathological biopsy results was analyzed.
The differences in total PSA, free/total PSA ratio and PSAD between benign (n = 78) and malignant (n = 72) groups were significant (p < 0.05). The PI-RADSv2.0 scores of the radiologists were strongly correlated (r = 0.912, p < 0.001) with excellent agreement, κ = 0.97 (95%CI: 0.90-1.03; p < 0.005). Receiver operating characteristics curve analysis showed significantly high predictive power for PI-RADSv2.0, total PSA and PSAD alone. Comparison of age, prostate volume, PSAD, free/total PSA ratio and total PSA values between ISUP1 and ISUP ≥ 2 cases revealed significantly increased PSAD (p < 0.001) and total PSA (p = 0.001) in the ISUP ≥ 2 group.
PI-RADSv2.0 had high diagnostic accuracy in both PSA groups. PI-RADSv2.0, PSAD and total PSA alone had significant high predictive power to detect csPCa. However, the combination of PI-RADSv2.0 and PSAD or total PSA for each reader showed no statistically significant improvement when compared to PI-RADSv2.0 alone.
探讨前列腺影像报告和数据系统第 2 版（PI-RADSv2.0）在基于总前列腺特异性抗原（PSA）浓度的前列腺多参数 MRI 术前区分临床显著前列腺癌（csPCa）和良性前列腺疾病的诊断性能。
回顾性分析了 150 例接受过术前多参数 MRI、血清 PSA 浓度和随后活检的患者。根据 PSA 浓度（Group1≥10ng/mL；Group2 4.0-<10ng/mL）对患者进行分层。由两名盲法阅片医生使用 PI-RADSv2.0 评估 MRI 结果。使用国际泌尿病理学会（ISUP）评分对病变进行组织病理学分级。评估 PI-RADSv2.0 的诊断性能，并与 PSA 和 PSA 密度（PSAD）进行比较。比较了不同观察者的 PI-RADSv2.0 表现，包括观察者间的一致性。分析了影像学和组织学活检结果之间的相关性。
良性组（n=78）和恶性组（n=72）的总 PSA、游离/总 PSA 比值和 PSAD 差异有统计学意义（p<0.05）。两位阅片医生的 PI-RADSv2.0 评分呈强相关（r=0.912，p<0.001），具有极好的一致性，κ=0.97（95%CI：0.90-1.03；p<0.005）。受试者工作特征曲线分析表明，PI-RADSv2.0、总 PSA 和 PSAD 单独预测的能力显著较高。比较 ISUP1 与 ISUP≥2 病例的年龄、前列腺体积、PSAD、游离/总 PSA 比值和总 PSA 值，发现 ISUP≥2 组的 PSAD（p<0.001）和总 PSA（p=0.001）显著升高。
PI-RADSv2.0 在 PSA 两组中均具有较高的诊断准确性。PI-RADSv2.0、PSAD 和总 PSA 单独对检测 csPCa 具有显著的高预测能力。然而，与 PI-RADSv2.0 相比，每位读者的 PI-RADSv2.0 与 PSAD 或总 PSA 的组合并未显示出统计学上的显著改善。
