Sun Zhoujie, Wang He, Fu Weixiao, Zhu Sainan, Song Gang
Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, 100034, China.
Institute of Urology, Peking University, Beijing, 100034, China.
Abdom Radiol (NY). 2023 Jan;48(1):390-398. doi: 10.1007/s00261-022-03712-0. Epub 2022 Oct 28.
To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions.
We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided 12-core SB. The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions. Based on the TB + SB results as a standard reference, we analyzed the sensitivity, negative predictive value, and diagnostic accuracy of TB alone or SB alone.
Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010). For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100).
DWI 4 tends to have worse results than DWI 3/DCE+. TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10 ng/mL.
比较弥散加权成像(DWI)4序列与DWI 3序列联合动态对比增强(DCE)呈阳性(以下简称“DWI 3/DCE+”)的外周带(PZ)病变中具有临床意义的前列腺癌(csPCa)检出率,并探讨靶向活检(TB)或系统活检(SB)对前列腺影像报告和数据系统(PI-RADS)4类病变患者的诊断性能。
我们回顾性纳入了206例行多参数磁共振成像且外周带至少有一个PI-RADS 4类病变的患者。所有患者随后均接受了磁共振成像/超声融合引导下的联合TB及超声引导下的12针SB。采用卡方检验比较DWI 4序列与DWI 3/DCE+病变的csPCa检出率。以TB+SB结果作为标准参照,分析单独TB或单独SB的敏感性、阴性预测值及诊断准确性。
当采用TB+SB、TB及SB时,DWI 4序列病变患者的csPCa检出率高于DWI 3/DCE+病变患者,且对于TB+SB(72.22%对54.84%,p = 0.015)或SB(65.97%对46.77%,p = 0.010)而言,差异具有统计学意义。对于前列腺特异性抗原水平为4至10 ng/mL的DWI 3/DCE+患者,单独TB显示出最高的阴性预测值(95%可信区间78.12 - 100)。
DWI 4序列的结果往往比DWI 3/DCE+序列更差。TB对DWI 3/DCE+患者具有很好的诊断性能,尤其是对于那些前列腺特异性抗原水平为4至10 ng/mL的患者。