Firoozeh Negar, Park Sung Yoon, Nyame Yaw, Mahdavi Arash, Nabipoorashrafi Seyed Ali, Mileto Achille, Mansoori Bahar, Westphalen Antonio C
Department of Radiology, University of Washington, Seattle, WA, USA.
Departments of Radiology, Division of Abdominal Imaging, University of Washington, Seattle, WA, USA.
Curr Probl Diagn Radiol. 2025 Sep-Oct;54(5):596-602. doi: 10.1067/j.cpradiol.2025.03.001. Epub 2025 Mar 8.
To compare Prostate Imaging Reporting and Data System (PI-RADS) scores derived from a standard multiparametric prostate MRI (mpMRI) protocol with those from a protocol consisting only of T2-weighted and dynamic contrast-enhanced images (T2+DCE MRI).
In this retrospective, single-center, cross-sectional study approved by the IRB and compliant with HIPAA, 492 MRI exams performed in 2022 were analyzed. PI-RADS scores from mpMRIs were extracted from medical records, and new scores were generated for T2+DCE MRI following PI-RADS guidelines. Score differences were evaluated using Wilcoxon signed-rank and McNemar's tests, stratified by lesion location (peripheral zone, PZ, and transition zone, TZ). Diagnostic accuracies of the two methods were compared using ROC curves, and logistic regression was employed to identify predictors of score changes.
Notable differences in PI-RADS scores were observed were observed in the PZ (P = 0.03) and TZ (P < 0.001). 4.8 % of PZ and 4.0 % of TZ PI-RADS 3-5 lesions were misclassified as PI-RADS 1-2 on T2W+DCE MRI (PZ vs TZ, P = 0.64). However, ROC curve analyses revealed no significant difference in diagnostic accuracy between mpMRI (Az = 0.77) and T2+DCE MRI (Az = 0.75, P = 0.07). PSA density was identified as a predictor of score changes from PI-RADS 3-5 to 1-2, although the effect size was modest.
Although T2+DCE MRI yields different PI-RADS scores compared to mpMRI, the clinical impact on diagnostic accuracy and decision-making is overall small. This supports the continued use of T2+DCE MRI, particularly when diffusion-weighted imaging is compromised.
比较源自标准多参数前列腺MRI（mpMRI）方案的前列腺影像报告和数据系统（PI-RADS）评分与仅由T2加权和动态对比增强图像组成的方案（T2+DCE MRI）的评分。
在这项经机构审查委员会批准并符合健康保险流通与责任法案的回顾性、单中心横断面研究中，分析了2022年进行的492例MRI检查。从病历中提取mpMRI的PI-RADS评分，并根据PI-RADS指南为T2+DCE MRI生成新的评分。使用Wilcoxon符号秩检验和McNemar检验评估评分差异，按病变位置（外周带，PZ，和移行带，TZ）分层。使用ROC曲线比较两种方法的诊断准确性，并采用逻辑回归来确定评分变化的预测因素。
在PZ（P = 0.03）和TZ（P < 0.001）中观察到PI-RADS评分存在显著差异。在T2W+DCE MRI上，4.8%的PZ和4.0%的TZ的PI-RADS 3-5级病变被误分类为PI-RADS 1-2级（PZ与TZ，P = 0.64）。然而，ROC曲线分析显示mpMRI（Az = 0.77）和T2+DCE MRI（Az = 0.75，P = 0.07）之间的诊断准确性没有显著差异。PSA密度被确定为从PI-RADS 3-5级变为1-2级评分变化的预测因素，尽管效应大小适中。
尽管与mpMRI相比，T2+DCE MRI产生不同的PI-RADS评分，但对诊断准确性和决策的临床影响总体较小。这支持继续使用T2+DCE MRI，特别是在扩散加权成像受损时。
