MRI 前列腺成像复发报告评估评分的诊断准确性和观察者一致性。
Diagnostic Accuracy and Observer Agreement of the MRI Prostate Imaging for Recurrence Reporting Assessment Score.
机构信息
From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.).
出版信息
Radiology. 2022 Aug;304(2):342-350. doi: 10.1148/radiol.212252. Epub 2022 May 10.
Background Prostate cancer local recurrence location and extent must be determined in an accurate and timely manner. Because of the lack of a standardized MRI approach after whole-gland treatment, a panel of international experts recently proposed the Prostate Imaging for Recurrence Reporting (PI-RR) assessment score. Purpose To determine the diagnostic accuracy of PI-RR for detecting local recurrence in patients with biochemical recurrence (BCR) after radiation therapy (RT) or radical prostatectomy (RP) and to evaluate the interreader variability of PI-RR scoring. Materials and Methods This retrospective observational study included patients who underwent multiparametric MRI between September 2016 and May 2021 for BCR after RT or RP. MRI scans were analyzed, and a PI-RR score was assigned independently by four radiologists. The reference standard was defined using histopathologic findings, follow-up imaging, or clinical response to treatment. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess PI-RR performance for each reader. The intraclass correlation coefficient was used to determine interreader agreement. Results A total of 100 men were included: 48 patients after RT (median age, 76 years [IQR, 70-82 years]) and 52 patients after RP (median age, 70 years [IQR, 66-74 years]). After RT, with PI-RR of 3 or greater as a cutoff (assigned when recurrence is uncertain), diagnostic performance ranges were 71%-81% sensitivity, 74%-93% specificity, 71%-89% PPV, 79%-86% NPV, and 77%-88% accuracy across the four readers. After RP, with PI-RR of 3 or greater as a cutoff, performance ranges were 59%-83% sensitivity, 87%-100% specificity, 88%-100% PPV, 66%-80% NPV, and 75%-85% accuracy. The intraclass correlation coefficient was 0.87 across the four readers for both the RT and RP groups. Conclusion MRI scoring with the Prostate Imaging for Recurrence Reporting assessment provides structured, reproducible, and accurate evaluation of local recurrence after definitive therapy for prostate cancer. © RSNA, 2022 See also the editorial by Haider in this issue.
背景 必须准确、及时地确定前列腺癌局部复发的位置和范围。由于缺乏全腺体治疗后标准化 MRI 方法，最近一组国际专家提出了前列腺成像复发报告（PI-RR）评估评分。目的 确定 PI-RR 检测放射治疗（RT）或根治性前列腺切除术（RP）后生化复发（BCR）患者局部复发的诊断准确性，并评估 PI-RR 评分的读者间变异性。材料与方法 本回顾性观察研究纳入了 2016 年 9 月至 2021 年 5 月间因 BCR 接受 RT 或 RP 后行多参数 MRI 检查的患者。对 MRI 扫描进行分析，并由 4 名放射科医生独立进行 PI-RR 评分。参考标准定义为组织病理学发现、随访影像学或治疗后临床反应。计算每位读者的 PI-RR 性能的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。使用组内相关系数来确定读者间的一致性。结果 共纳入 100 名男性：48 名患者为 RT 后（中位年龄 76 岁[IQR，70-82 岁]），52 名患者为 RP 后（中位年龄 70 岁[IQR，66-74 岁]）。在 RT 后，PI-RR 为 3 或更高作为截断值（当复发不确定时分配），诊断性能范围为 4 位读者的 71%-81%敏感性、74%-93%特异性、71%-89%PPV、79%-86%NPV 和 77%-88%准确性。在 RP 后，PI-RR 为 3 或更高作为截断值，性能范围为 4 位读者的 59%-83%敏感性、87%-100%特异性、88%-100%PPV、66%-80%NPV 和 75%-85%准确性。PI-RR 在 RT 和 RP 两组的组内相关系数均为 0.87。结论 前列腺成像复发报告评估的 MRI 评分可对前列腺癌确定性治疗后局部复发进行结构化、可重复且准确的评估。®RSNA，2022 年 本期杂志还刊登了 Haider 的社论。
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