中高危前列腺癌患者的初步分期：多参数 MRI 和 Ga-PSMA-PET/MRI-多参数 MRI 单独或结合临床信息的定量数据有何价值？
Primary staging in patients with intermediate- and high-risk prostate cancer: Multiparametric MRI and Ga-PSMA-PET/MRI - What is the value of quantitative data from multiparametric MRI alone or in conjunction with clinical information?
机构信息
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
出版信息
Eur J Radiol. 2022 Jan;146:110044. doi: 10.1016/j.ejrad.2021.110044. Epub 2021 Nov 16.
PURPOSE
Comparing mpMRI and Ga-PSMA-PET/MRI in primary staging of PCa and investigating the value of quantitative mpMRI-measurements for prediction of extracapsular extension and N-metastases.
METHODS
Patients with PCa undergoing Ga-PSMA-PET/MRI and mpMRI during January 2016 to February 2019 were retrospectively included. Two readers each on Ga-PSMA-PET/MRI or mpMRI rated extraprostatic extension (≥T3) and regional lymph-node-metastasis (N1) on a Likert-scale. A fifth reader measured tumor volume, maximum diameter, and capsular contact length on mpMRI. Probability of lymph-node-metastasis was additionally calculated using the 2018 Briganti model. Interobserver-agreement was assessed by squared Cohen's kappa, and diagnostic accuracy was determined using radical prostatectomy (n = 35/49) as reference standard.
RESULTS
49 patients (median age 66 years [IQR: 61-72 years]) were evaluated. Interobserver-agreement for mpMRI and Ga-PSMA-PET/MRI was: ≥T3: κ = 0.58/0.47; N1: κ = 0.55/0.92. Diagnostic accuracy for mpMRI vs Ga-PSMA-PET/MRI readers for ≥ T3 was AUC: 0.72, 0.62 vs 0.71, 0.72 (p > 0.38) and for N1 was AUC: 0.39, 0.55 vs 0.72, 0.78 (p < 0.01). Quantitative parameters delivered diagnostic accuracies of: AUC: 0.70-0.72 for ≥ T3. The 2018 Briganti model achieved an AUC of 0.89 for N1.
CONCLUSIONS
Interreader-agreement regarding ≥ T3 was similar for mpMRI and Ga-PSMA-PET/MRI while for N1 it was higher for Ga-PSMA-PET/MRI. Diagnostic accuracy was comparable for ≥ T3 while for N1 it was higher in Ga-PSMA-PET/MRI and the 2018 Briganti model. Combining clinical data and quantitative data from mpMRI in the 2018 Briganti model yielded the highest AUC for prediction of lymph node metastasis and may aid in selecting patients who will benefit from Ga-PSMA-PET/MRI for primary staging.
目的
比较 mpMRI 和 Ga-PSMA-PET/MRI 在前列腺癌的初步分期中的作用，并研究定量 mpMRI 测量值对预测包膜外侵犯和 N 转移的价值。
方法
回顾性纳入 2016 年 1 月至 2019 年 2 月期间接受 Ga-PSMA-PET/MRI 和 mpMRI 的前列腺癌患者。两位读者分别对 Ga-PSMA-PET/MRI 或 mpMRI 上的前列腺外扩展（≥T3）和区域淋巴结转移（N1）进行评分。第五位读者在 mpMRI 上测量肿瘤体积、最大直径和包膜接触长度。此外，还使用 2018 年 Briganti 模型计算淋巴结转移的概率。使用平方 Cohen's kappa 评估观察者间一致性，以根治性前列腺切除术（n=35/49）作为参考标准确定诊断准确性。
结果
共评估了 49 名患者（中位年龄 66 岁[IQR：61-72 岁]）。mpMRI 和 Ga-PSMA-PET/MRI 的观察者间一致性为：≥T3：κ=0.58/0.47；N1：κ=0.55/0.92。mpMRI 与 Ga-PSMA-PET/MRI 读者对≥T3 的诊断准确性为 AUC：0.72、0.62 与 0.71、0.72（p>0.38），对 N1 的诊断准确性为 AUC：0.39、0.55 与 0.72、0.78（p<0.01）。定量参数的诊断准确性为：AUC：0.70-0.72 用于≥T3。2018 年 Briganti 模型在 N1 中获得了 0.89 的 AUC。
结论
mpMRI 和 Ga-PSMA-PET/MRI 之间关于≥T3 的观察者间一致性相似，而 N1 的观察者间一致性更高。在≥T3 方面，诊断准确性相当，而在 N1 方面，Ga-PSMA-PET/MRI 和 2018 年 Briganti 模型的诊断准确性更高。在 2018 年 Briganti 模型中结合 mpMRI 的临床数据和定量数据，可获得预测淋巴结转移的最高 AUC，可能有助于选择从 Ga-PSMA-PET/MRI 进行初步分期中获益的患者。
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