Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA.
Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, University of Chicago, Chicago, IL, USA.
Abdom Radiol (NY). 2022 Feb;47(2):801-813. doi: 10.1007/s00261-021-03371-7. Epub 2021 Dec 8.
To validate prostate tissue composition measured using hybrid multi-dimensional MRI (HM-MRI) by comparing with reference standard (ground truth) results from pathologists' interpretation of clinical histopathology slides following whole mount prostatectomy.
36 prospective participants with biopsy-confirmed prostate cancer underwent 3 T MRI prior to radical prostatectomy. Axial HM-MRI was acquired with all combinations of echo times of 57, 70, 150, 200 ms and b-values of 0, 150, 750, 1500 s/mm and data were fitted using a 3-compartment signal model using custom software to generate volumes for each tissue component (stroma, epithelium, lumen). Three experienced genitourinary pathologists independently as well as in consensus reviewed each histology image and provide an estimate of percentage of epithelium and lumen for regions-of-interest corresponding to MRI (n = 165; 64 prostate cancers and 101 benign tissue). Agreement statistics using total deviation index (TDI) was performed for tissue composition measured using HM-MRI and reference standard results from pathologists' consensus.
Based on the initial results showing typical variation among pathologists TDI = 25%, we determined we will declare acceptable agreement if the 95% one-sided upper confident limit of TDI is less than 30%. The results of tissue composition measurement from HM-MRI compared to ground truth results from the consensus of 3 pathologists, reveal that ninety percent of absolute paired differences (TDI) were within 18.8% and 22.4% in measuring epithelium and lumen, respectively. We are 95% confident that 90% of absolute paired differences were within 20.6% and 24.2% in measuring epithelium and lumen, respectively. These were less than our criterion of 30% and inter-pathologists' agreement (22.3% for epithelium and 24.2% for lumen) and therefore we accept the agreement performance of HM-MRI. The results revealed excellent area under the ROC curve for differentiating cancer from benign tissue based on epithelium (HM-MRI: 0.87, pathologists: 0.97) and lumen volume (HM-MRI: 0.85, pathologists: 0.77).
The agreement in tissue composition measurement using hybrid multidimensional MRI and consensus of pathologists is on par with the inter-raters (pathologists) agreement.
通过比较病理学家对全前列腺切除术后临床组织学切片的解释作为参考标准（金标准）的结果，验证使用多维磁共振成像（HM-MRI）测量的前列腺组织成分。
36 名经活检证实患有前列腺癌的前瞻性患者在根治性前列腺切除术前接受了 3T MRI 检查。使用定制软件，对所有组合的 57、70、150、200ms 的回波时间和 0、150、750、1500s/mm 的 b 值进行轴向 HM-MRI 采集，以生成每个组织成分（基质、上皮、管腔）的体积。3 名经验丰富的泌尿生殖系统病理学家分别独立地对每张组织学图像进行了评估，并对与 MRI 相对应的感兴趣区域的上皮和管腔的百分比进行了估计（n=165；64 例前列腺癌和 101 例良性组织）。使用总偏差指数（TDI）对使用 HM-MRI 测量的组织成分和病理学家共识的参考标准结果进行了一致性统计分析。
基于最初的研究结果显示病理学家之间存在典型的差异（TDI=25%），我们确定如果 TDI 的 95%单侧置信上限小于 30%，则我们将宣布可接受的一致性。与 3 位病理学家共识的组织成分测量结果相比，HM-MRI 测量的组织成分结果表明，上皮和管腔的绝对值配对差异（TDI）中有 90%分别在 18.8%和 22.4%以内。我们有 95%的信心认为上皮和管腔的绝对值配对差异分别有 90%在 20.6%和 24.2%以内。这些都小于我们的 30%标准和病理学家之间的一致性（上皮为 22.3%，管腔为 24.2%），因此我们接受 HM-MRI 的一致性表现。结果表明，基于上皮（HM-MRI：0.87，病理学家：0.97）和管腔体积（HM-MRI：0.85，病理学家：0.77），HM-MRI 对区分癌症和良性组织具有出色的 ROC 曲线下面积。
使用多维磁共振成像和病理学家共识进行组织成分测量的一致性与病理学家之间的（观察者间）一致性相当。
