多参数与快速 MRI 方案在检测临床显著前列腺癌中的比较及详细成本分析。
Comparison of Multiparametric and Fast MRI Protocols in Detecting Clinically Significant Prostate Cancer and a Detailed Cost Analysis.
机构信息
Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey.
Department of Pathology, School of Medicine, University of Pamukkale, Denizli, Turkey.
出版信息
J Magn Reson Imaging. 2022 Nov;56(5):1437-1447. doi: 10.1002/jmri.28142. Epub 2022 Mar 11.
BACKGROUND
Due to the long acquisition time and high cost of multiparametric magnetic resonance imaging (mpMRI), biparametric and, more recently, fast prostate magnetic resonance imaging (fpMRI) protocols have been described. However, there is insufficient data about the diagnostic performance and cost of fpMRI.
PURPOSE
To compare the diagnostic performances and cost analysis of fpMRI and mpMRI in clinically significant prostate cancer (csPCA).
STUDY TYPE
Retrospective.
POPULATION
A total of 103 patients (63 had csPCA) with a mean age of 66.83 (± 7.22) years were included.
FIELD STRENGTH/SEQUENCE: A 1.5-T; T1- and T2-weighted turbo spin-echo imaging (T1WI and T2WI), echo-planar diffusion-weighted images, and dynamic contrast-enhanced T1W imaging.
ASSESSMENT
Three readers independently evaluated the fpMRI and mpMRI images in different sessions blinded to all patient information. Diagnostic performances of fpMRI and mpMRI were evaluated. Kappa coefficient (κ) was used to determine the interreader and intrareader agreement. A detailed cost analysis was performed for each protocol.
STATISTICAL TESTS
Receiver operating characteristics analysis, area under the curve (AUC), and κ test were used. Diagnostic performance parameters were also calculated.
RESULTS
Of the 63 malignant index lesions (csPCA), 53/63 of those (84.1%) originated from the peripheral zone and 10/63 lesions (15.9%) originated from the transition zone. The AUC values for fpMRI were 0.878 for reader 1, 0.937 for reader 2, and 0.855 for reader 3. For mpMRI, the AUC values were 0.893 for reader 1, 0.94 for reader 2, and 0.862 for reader 3. Inter and intrareader agreements were moderate to substantial (κ range, 0.5-0.79). The total cost per examination was calculated as €12.39 and €30.10 for fpMRI and mpMRI, respectively.
DATA CONCLUSIONS
Fast MRI protocol has similar diagnostic performance with mpMRI in detecting csPCA, and fpMRI can be considered an alternative protocol that could create a lower financial burden on health-care systems.
LEVEL OF EVIDENCE
4 TECHNICAL EFFICACY STAGE: 6.
背景
由于多参数磁共振成像（mpMRI）采集时间长且成本高，现已描述了双参数和最近的快速前列腺磁共振成像（fpMRI）方案。然而，关于 fpMRI 的诊断性能和成本分析的数据还不够充分。
目的
比较 fpMRI 和 mpMRI 在临床上显著前列腺癌（csPCA）中的诊断性能和成本分析。
研究类型
回顾性。
人群
共纳入 103 名患者（63 名患有 csPCA），平均年龄为 66.83（±7.22）岁。
磁场强度/序列：1.5-T；T1 加权和 T2 加权涡轮自旋回波成像（T1WI 和 T2WI）、体素内不相干运动扩散加权成像和动态对比增强 T1W 成像。
评估
三位读者在不同的会议中独立评估 fpMRI 和 mpMRI 图像，对所有患者信息均不知情。评估了 fpMRI 和 mpMRI 的诊断性能。使用 Kappa 系数（κ）来确定读者间和读者内的一致性。对每个方案进行了详细的成本分析。
统计检验
使用接收者操作特征分析、曲线下面积（AUC）和κ检验。还计算了诊断性能参数。
结果
在 63 个恶性指数病变（csPCA）中，53/63 个病变（84.1%）来源于外周带，10/63 个病变（15.9%）来源于移行带。读者 1 的 fpMRI 的 AUC 值为 0.878，读者 2 的 AUC 值为 0.937，读者 3 的 AUC 值为 0.855。对于 mpMRI，读者 1 的 AUC 值为 0.893，读者 2 的 AUC 值为 0.94，读者 3 的 AUC 值为 0.862。读者间和读者内的一致性为中度至高度（κ范围，0.5-0.79）。每次检查的总费用分别计算为 fpMRI 为 12.39 欧元和 mpMRI 为 30.10 欧元。
数据结论
快速 MRI 方案在检测 csPCA 方面与 mpMRI 具有相似的诊断性能，fpMRI 可以被视为一种替代方案，可以减轻医疗保健系统的财务负担。
证据水平
4 技术功效分期：6。
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