Lee Myoung Seok, Park Jeong Hwan, Kim Sang Youn, Kim Taek Min, Oh Sohee, Moon Min Hoan
Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Abdom Radiol (NY). 2025 Apr;50(4):1653-1661. doi: 10.1007/s00261-024-04615-y. Epub 2024 Oct 1.
To compare the performance of diffusion-weighted imaging-guided transitional zone (TZ) lesion scoring on T2-weighted imaging (DWI-guided TZ scoring) to conventional PI-RADS TZ scoring.
Forty patients carried transition zone prostate cancer (TZPCa), and 40 patients had benign prostatic hyperplasia without TZPCa. A lesion-base, one-to-one correlation between the pathologic mapping sheet and the corresponding MR imaging was conducted by consensus between the genitourinary-specialized radiologist and pathologist. DWI-guided TZ scoring was defined as evaluating the DWI/apparent diffusion coefficient (ADC) images first, identifying the suspicious foci, then correlating the foci with the T2-weighted imaging, and finally assigning the PI-RADS score based on PI-RADS v2.1. Three other radiologists independently recorded the PI-RADS v2.1 scoring for TZ and the DWI-guided TZ scoring, with a time interval of 4 weeks.
When a PI-RADS score of ≥ 3 was considered a positive lesion, the specificity, PPV, NPV and sensitivity between the DWI-guided TZ scoring and conventional PI-RADS TZ scoring were 0.896 vs. 0.542 (p < .001), 0.764 vs. 0.439 (p < .001), 0.853 vs. 0.759 (p = .001), and 0.687 vs. 0.676 (p = .836), respectively. When PI-RADS scores ≥ 4 was considered cancer-positive, the specificity and PPV were also higher when applying DWI-guided TZ scoring (0.986 vs. 0.944, p = .007; 0.943 vs. 0.810, p = .009, respectively); however, the sensitivity and NPV were not statistically different (0.468 vs. 0.468, p = .998; 0.785 vs. 0.776, p = .537, respectively). The interobserver agreement presented as κ-value was higher in DWI-guided TZ scoring (0.584) than in conventional PI-RADS TZ scoring (0.155) (p = .003).
DWI-guided TZ scoring improves the interobserver agreement, specificity, and predictive value without impairing the sensitivity.
比较扩散加权成像引导的移行区（TZ）病变在T2加权成像上的评分（DWI引导的TZ评分）与传统PI-RADS TZ评分的表现。
40例患有移行区前列腺癌（TZPCa）的患者和40例无TZPCa的良性前列腺增生患者。由泌尿专科放射科医生和病理科医生共同确定病理图谱与相应磁共振成像之间基于病变的一对一对应关系。DWI引导的TZ评分定义为首先评估DWI/表观扩散系数（ADC）图像，识别可疑病灶，然后将病灶与T2加权成像相关联，最后根据PI-RADS v2.1分配PI-RADS评分。另外三名放射科医生独立记录TZ的PI-RADS v2.1评分和DWI引导的TZ评分，时间间隔为4周。
当将PI-RADS评分≥3视为阳性病变时，DWI引导的TZ评分与传统PI-RADS TZ评分之间的特异性、阳性预测值、阴性预测值和敏感性分别为0.896对0.542（p<0.001）、0.764对0.439（p<0.001）、0.853对0.759（p = 0.001）和0.687对0.676（p = 0.836）。当将PI-RADS评分≥4视为癌症阳性时，应用DWI引导的TZ评分时特异性和阳性预测值也更高（分别为0.986对0.944,p = 0.007；0.943对0.810,p = 0.009）；然而，敏感性和阴性预测值无统计学差异（分别为0.468对0.468,p = 0.998；0.785对0.776,p = 0.537）。以κ值表示的观察者间一致性在DWI引导的TZ评分（0.584）中高于传统PI-RADS TZ评分（0.155）（p = 0.003）。
DWI引导的TZ评分提高了观察者间的一致性、特异性和预测价值，且不损害敏感性。
