Jin Pengfei, Ding Zhenwei, Huang Fawei, Li Kai, Liu Yitao, Song Ge, Yang Liqin, Shi Lei, Wang Xu
Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Department of Radiology, The Second People's Hospital of Wuhu, Wuhu, China.
BMC Med Imaging. 2025 Aug 25;25(1):346. doi: 10.1186/s12880-025-01884-x.
The comparative diagnostic performance of biparametric MRI (bpMRI) versus multiparametric MRI (mpMRI) for clinically significant prostate cancer (csPCa) continues to be debated. This study aimed to compare mpMRI and bpMRI in detecting csPCa across prostate-specific antigen (PSA) strata and identify supplementary tools comparable to dynamic contrast-enhanced (DCE) imaging.
Images were evaluated using mpMRI-based mp-PI-RADS and bpMRI-based bp-PI-RADS and simplified PI-RADS (S-PI-RADS) schemes. The lesion volume (LV) was manually segmented by a radiologist using ITK-SNAP software on high b-value DWI images. The diagnostic performance was assessed via receiver operating characteristic (ROC) curve analysis. The differences of T2WI-score, DCE assessment and LV between csPCa and non-csPCa in peripheral zone (PZ) with DWI category 3 were compared.
For overall PSA, mp-PI-RADS and bp-PI-RADS showed comparable AUCs (0.889 vs. 0.882; P > 0.05). When PSA ≤ 10 ng/ml, mp-PI-RADS exhibited the highest specificity (91.0% vs. bp-PI-RADS: 64.4%, S-PI-RADS: 75.0%) and PPV (73.0% vs. bp-PI-RADS: 47.7%, S-PI-RADS: 52.5%). When PSA > 10 ng/ml, S-PI-RADS demonstrated higher sensitivity (91.6% vs. mp-PI-RADS: 83.2%, bp-PI-RADS: 81.2%) and F1-score (0.873 [0.822-0.924] vs. mp-PI-RADS: 0.832 [0.778-0.886], bp-PI-RADS: 0.831 [0.777-0.885]). Among DWI category 3 PZ lesions, neither DCE nor T2WI significantly stratified csPCa risk (P = 0.657 and P = 0.424), whereas LV ≥ 0.5 cm³ showed markedly higher csPCa risk (83.8% vs. 45.8%; P < 0.001).
While mpMRI and bpMRI exhibit comparable overall diagnostic performance but context-dependent strengths: mpMRI demonstrates higher specificity for avoiding unnecessary biopsies when PSA ≤ 10 ng/ml, whereas bpMRI (particularly S-PI-RADS) maximizes sensitivity for csPCa detection when PSA > 10 ng/ml. LV is anticipated to serve as a complementary radiological biomarker at the absence of DCE.
双参数磁共振成像（bpMRI）与多参数磁共振成像（mpMRI）对临床显著前列腺癌（csPCa）的诊断性能比较仍存在争议。本研究旨在比较mpMRI和bpMRI在不同前列腺特异性抗原（PSA）分层中检测csPCa的情况，并确定与动态对比增强（DCE）成像相当的补充工具。
使用基于mpMRI的mp-PI-RADS和基于bpMRI的bp-PI-RADS以及简化的PI-RADS（S-PI-RADS）方案对图像进行评估。由放射科医生使用ITK-SNAP软件在高b值扩散加权成像（DWI）图像上手动分割病变体积（LV）。通过受试者操作特征（ROC）曲线分析评估诊断性能。比较DWI分类为3的外周区（PZ）中csPCa与非csPCa之间的T2加权成像（T2WI）评分、DCE评估和LV差异。
对于总体PSA，mp-PI-RADS和bp-PI-RADS显示出相当的曲线下面积（AUC）（0.889对0.882；P>0.05）。当PSA≤10 ng/ml时，mp-PI-RADS表现出最高的特异性（91.0%对bp-PI-RADS：64.4%，S-PI-RADS：75.0%）和阳性预测值（PPV）（73.0%对bp-PI-RADS：47.7%，S-PI-RADS：52.5%）。当PSA>10 ng/ml时，S-PI-RADS表现出更高的敏感性（91.6%对mp-PI-RADS：83.2%，bp-PI-RADS：81.2%）和F1评分（0.873[0.822-0.924]对mp-PI-RADS：0.832[0.778-0.886]，bp-PI-RADS：0.831[0.777-0.885]）。在DWI分类为3的PZ病变中，DCE和T2WI均未显著分层csPCa风险（P=0.657和P=0.424），而LV≥0.5 cm³显示出明显更高的csPCa风险（83.8%对45.8%；P<0.001）。
虽然mpMRI和bpMRI总体诊断性能相当，但各有其依赖背景的优势：当PSA≤10 ng/ml时，mpMRI在避免不必要活检方面表现出更高的特异性，而当PSA>10 ng/ml时，bpMRI（特别是S-PI-RADS）在检测csPCa方面使敏感性最大化。预计在没有DCE的情况下，LV可作为一种补充性的放射生物标志物。
