From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.).
Radiology. 2022 Apr;303(1):99-109. doi: 10.1148/radiol.210500. Epub 2022 Jan 18.
Background Urinary continence after radical prostatectomy (RP) is an important determinant of patient quality of life. Anatomic measures at prostate MRI have been previously associated with continence outcomes, but their predictive ability and interrater agreement are unclear in comprehensive clinical models. Purpose To evaluate the predictive ability and interrater agreement of MRI-based anatomic measurements of post-RP continence when combined with clinical multivariable models. Materials and Methods In this retrospective cohort study, continence outcomes were evaluated in men who underwent RP from August 2015 to October 2019. Preoperative MRI-based anatomic measures were obtained retrospectively by four abdominal radiologists. Before participation, these radiologists completed measure-specific training. Logistic regression models were developed with clinical variables alone, MRI variables alone, and combined variables for predicting continence at 3, 6, and 12 months after RP; some patient data were missing at each time point. Interrater agreement of MRI variables was assessed by using intraclass correlation coefficients (ICCs). Results A total of 586 men were included (mean age ± standard deviation: 63 years ± 7). The proportion of patients with incontinence was 0.2% (one of 589) at baseline, 27% (145 of 529) at 3 months, 14% (63 of 465) at 6 months, and 9% (37 of 425) at 12 months. Longer coronal membranous urethra length (MUL) improved the odds of post-RP continence at all time points (odds ratio per 1 mm: 0.86 [95% CI: 0.80, 0.93], < .001; 0.86 [95% CI: 0.78, 0.95], = .003; and 0.79 [95% CI: 0.67, 0.91], = .002, respectively) in models that incorporated both clinical and MRI predictors. No other MRI variables were predictive. Age and baseline urinary function score were the only other predictive clinical variables at every time point. Interrater agreement was moderate (ICC, 0.62) for MUL among readers with measure-specific prostate MRI training and poor among those without the training (ICC, 0.38). Conclusion Preoperative MRI-measured coronal membranous urethra length was an independent predictor of urinary continence after prostatectomy. © RSNA, 2022
背景 根治性前列腺切除术（RP）后的尿控是患者生活质量的重要决定因素。前列腺 MRI 的解剖学指标以前与控尿结果相关，但在综合临床模型中，其预测能力和观察者间一致性尚不清楚。目的 评估 RP 后基于 MRI 的解剖学测量值与临床多变量模型相结合时的预测能力和观察者间一致性。材料与方法 在这项回顾性队列研究中，评估了 2015 年 8 月至 2019 年 10 月期间接受 RP 的男性的控尿结果。通过四位腹部放射科医生回顾性地获得术前基于 MRI 的解剖学指标。在参与之前，这些放射科医生完成了特定于测量的培训。使用临床变量单独、MRI 变量单独以及综合变量来建立预测 RP 后 3、6 和 12 个月控尿的逻辑回归模型；每个时间点都有部分患者数据缺失。使用组内相关系数（ICC）评估 MRI 变量的观察者间一致性。结果 共纳入 586 名男性（平均年龄±标准差：63 岁±7 岁）。基线时失禁患者的比例为 0.2%（589 例中的 1 例），3 个月时为 27%（529 例中的 145 例），6 个月时为 14%（465 例中的 63 例），12 个月时为 9%（425 例中的 37 例）。冠状膜状尿道长度（MUL）每增加 1 毫米，RP 后控尿的可能性就会提高（每增加 1 毫米的优势比：0.86[95%CI：0.80，0.93]，<.001；0.86[95%CI：0.78，0.95]，=.003；0.79[95%CI：0.67，0.91]，=.002，分别），这在纳入临床和 MRI 预测因素的模型中都是如此。没有其他 MRI 变量具有预测性。年龄和基线尿功能评分是每个时间点的其他唯一预测性临床变量。接受过特定于前列腺 MRI 测量培训的读者之间的 MUL 观察者间一致性为中度（ICC，0.62），而没有接受过培训的读者之间的观察者间一致性较差（ICC，0.38）。结论 术前 MRI 测量的冠状膜状尿道长度是前列腺切除术后尿控的独立预测因素。©RSNA，2022
