431名前列腺特异性抗原水平升高男性中，双参数与多参数前列腺MRI检测前列腺癌的敏感性和特异性比较
Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels.
作者信息
Pesapane Filippo, Acquasanta Marzia, Meo Rosario Di, Agazzi Giorgio Maria, Tantrige Priyan, Codari Marina, Schiaffino Simone, Patella Francesca, Esseridou Anastasia, Sardanelli Francesco
机构信息
Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Santa Sofia, 9, 20122 Milano, Italy.
Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milano, Italy.
出版信息
Diagnostics (Basel). 2021 Jul 7;11(7):1223. doi: 10.3390/diagnostics11071223.
(1) Background: the study of dynamic contrast enhancement (DCE) has a limited role in the detection of prostate cancer (PCa), and there is a growing interest in performing unenhanced biparametric prostate-MRI (bpMRI) instead of the conventional multiparametric-MRI (mpMRI). In this study, we aimed to retrospectively compare the performance of the mpMRI, which includes DCE study, and the unenhanced bpMRI, composed of only T2-weighted imaging and diffusion-weighted imaging (DWI), in PCa detection in men with elevated prostate-specific-antigen (PSA) levels. (2) Methods: a 1.5 T MRI, with an endorectal-coil, was performed on 431 men (aged 61.5 ± 8.3 years) with a PSA ≥4.0 ng/mL. The bpMRI and mpMRI tests were independently assessed in separate sessions by two readers with 5 (R1) and 3 (R2) years of experience. The histopathology or ≥2 years follow-up served as a reference standard. The sensitivity and specificity were calculated with their 95% CI, and McNemar's and Cohen's κ statistics were used. (3) Results: in 195/431 (45%) of histopathologically proven PCa cases, 62/195 (32%) were high-grade PCa (GS ≥ 7b) and 133/195 (68%) were low-grade PCa (GS ≤ 7a). The PCa could be excluded by histopathology in 58/431 (14%) and by follow-up in 178/431 (41%) of patients. For bpMRI, the sensitivity was 164/195 (84%, 95% CI: 79-89%) for R1 and 156/195 (80%, 95% CI: 74-86%) for R2; while specificity was 182/236 (77%, 95% CI: 72-82%) for R1 and 175/236 (74%, 95% CI: 68-80%) for R2. For mpMRI, sensitivity was 168/195 (86%, 95% CI: 81-91%) for R1 and 160/195 (82%, 95% CI: 77-87%) for R2; while specificity was 184/236 (78%, 95% CI: 73-83%) for R1 and 177/236 (75%, 95% CI: 69-81%) for R2. Interobserver agreement was substantial for both bpMRI (κ = 0.802) and mpMRI (κ = 0.787). (4) Conclusions: the diagnostic performance of bpMRI and mpMRI were similar, and no high-grade PCa was missed with bpMRI.
(1) 背景：动态对比增强（DCE）研究在前列腺癌（PCa）检测中的作用有限，相较于传统多参数磁共振成像（mpMRI），开展非增强双参数前列腺磁共振成像（bpMRI）的兴趣日益浓厚。在本研究中，我们旨在回顾性比较包含DCE研究的mpMRI与仅由T2加权成像和扩散加权成像（DWI）组成的非增强bpMRI在前列腺特异性抗原（PSA）水平升高男性中检测PCa的性能。(2) 方法：对431名PSA≥4.0 ng/mL的男性（年龄61.5±8.3岁）进行了1.5 T带有直肠内线圈的磁共振成像检查。bpMRI和mpMRI检查由两名分别有5年（R1）和3年（R2）经验的阅片者在不同时段独立评估。组织病理学检查或≥2年的随访作为参考标准。计算敏感性和特异性及其95%置信区间，并使用McNemar检验和Cohen's κ统计量。(3) 结果：在195/431（45%）经组织病理学证实的PCa病例中，62/195（32%）为高级别PCa（GS≥7b），133/195（68%）为低级别PCa（GS≤7a）。58/431（14%）的患者经组织病理学排除PCa，178/431（41%）的患者经随访排除PCa。对于bpMRI，R1的敏感性为164/195（84%，95% CI：79 - 89%），R2的敏感性为156/195（80%，95% CI：74 - 86%）；R1的特异性为182/236（77%，95% CI：72 - 82%），R2的特异性为175/236（74%，95% CI：68 - 80%）。对于mpMRI，R1的敏感性为168/195（86%，95% CI：81 - 91%），R2的敏感性为160/195（82%，95% CI：77 - 87%）；R1的特异性为184/236（78%，95% CI：73 - 83%），R2的特异性为177/236（75%，95% CI：69 - 81%）。bpMRI（κ = 0.802）和mpMRI（κ = 0.787）的观察者间一致性均较高。(4) 结论：bpMRI和mpMRI的诊断性能相似，bpMRI未漏诊高级别PCa。
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