评估前列腺多参数 MRI 的前列腺外延伸：Mehralivand 前列腺外延伸分级还是前列腺外延伸 Likert 量表？
Assessing Extraprostatic Extension with Multiparametric MRI of the Prostate: Mehralivand Extraprostatic Extension Grade or Extraprostatic Extension Likert Scale?
机构信息
Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway.
出版信息
Radiol Imaging Cancer. 2020 Jan 17;2(1):e190071. doi: 10.1148/rycan.2019190071. eCollection 2020 Jan.
PURPOSE
To validate the MRI grading system proposed by Mehralivand et al in 2019 (the "extraprostatic extension [EPE] grade") in an independent cohort and to compare the Mehralivand EPE grading system with EPE interpretation on the basis of a five-point Likert score ("EPE Likert").
MATERIALS AND METHODS
A total of 310 consecutive patients underwent multiparametric MRI according to a standardized institutional protocol before radical prostatectomy was performed by using the same 1.5-T MRI unit at a single institution between 2010 and 2012. Two radiologists blinded to clinical information assessed EPE according to standardized criteria. On the basis of the readings performed until 2017, the diagnostic performance of EPE Likert and Mehralivand EPE score were compared using receiver operating characteristics (ROC) and decision curve methodology against histologic EPE as standard of reference. Prediction of biochemical recurrence-free survival (BRFS) was assessed by Kaplan-Meier analysis and log rank test.
RESULTS
Of the 310 patients, 80 patients (26%) had EPE, including 33 with radial distance 1.1 mm or greater. Interrater reliability was fair (weighted κ 0.47 and 0.45) for both EPE grade and EPE Likert. Sensitivity for identifying EPE using EPE grade versus EPE Likert was 0.83 versus 0.86 and 0.86 versus 0.91 for radiologist 1 and 2, respectively. Specificity was 0.48 versus 0.58 and 0.39 versus 0.70 ( < .05 for radiologist 2). There were no significant differences in the ROC area under the curve or on decision curve analysis. Both EPE grade and EPE Likert were significant predictors of BRFS.
CONCLUSION
Mehralivand EPE grade and EPE Likert have equivalent diagnostic performance for predicting EPE and BRFS with a similar degree of observer dependence.© RSNA, 2020 MR-Imaging, Neoplasms-Primary, Observer Performance, Outcomes Analysis, Prostate, StagingSee also the commentary by Choyke in this issue.
目的
在独立队列中验证 Mehralivand 等人在 2019 年提出的 MRI 分级系统（“前列腺外延伸 [EPE] 分级”），并比较 Mehralivand EPE 分级系统与基于 5 分 Likert 评分的 EPE 解读（“EPE Likert”）。
材料与方法
2010 年至 2012 年，在一家机构中，共有 310 例连续患者使用相同的 1.5-T MRI 单元根据标准化机构方案接受多参数 MRI 检查，随后行根治性前列腺切除术。两名放射科医生在不了解临床信息的情况下，根据标准化标准评估 EPE。基于 2017 年之前的阅读结果，使用接收者操作特征（ROC）和决策曲线方法，将 EPE Likert 和 Mehralivand EPE 评分的诊断性能与组织学 EPE 作为标准参考进行比较。通过 Kaplan-Meier 分析和对数秩检验评估生化无复发生存率（BRFS）的预测。
结果
在 310 例患者中，80 例（26%）存在 EPE，其中 33 例放射状距离≥1.1mm。EPE 分级和 EPE Likert 的观察者间可靠性均为中等（加权κ值分别为 0.47 和 0.45）。使用 EPE 分级与 EPE Likert 识别 EPE 的敏感性分别为放射科医生 1 和 2 的 0.83 与 0.86 和 0.86 与 0.91。特异性分别为 0.48 与 0.58 和 0.39 与 0.70（放射科医生 2 的差异具有统计学意义）。ROC 曲线下面积或决策曲线分析无显著差异。EPE 分级和 EPE Likert 均为 EPE 和 BRFS 的显著预测因子。
结论
Mehralivand EPE 分级和 EPE Likert 预测 EPE 和 BRFS 的诊断性能相当，观察者依赖性相似。
©2020RSNA，MR-Imaging，Neoplasms-Primary，Observer Performance，Outcomes Analysis，Prostate，Staging。
另见本期 Choyke 评论。
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