基于多参数MRI的多种评估系统对前列腺癌包膜外侵犯的诊断价值  

Diagnostic value of multiparametric MRI-based models in the assessment of extra-prostatic extension of prostate cancer

作　　者：刘百川 王海屹[1] 董喆[2] 张云[2] 白旭 丁效蕙[3] 张晓晶[1] 许伟 赵建 郝雨薇 叶慧义[1] Liu Baichuan;Wang Haiyi;Dong Zhe;Zhang Yun;Bai Xu;Ding Xiaohui;Zhang Xiaojing;Xu Wei;Zhao Jian;Hao Yuwei;Ye Huiyi(Department of Radiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Department of Pathology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心放射诊断科,北京100853 [2]解放军总医院第六医学中心放射诊断科,北京100048 [3]解放军总医院第一医学中心病理科,北京100853

出　　处：《中华医学杂志》2023年第19期1439-1445,共7页National Medical Journal of China

基　　金：国家自然科学基金(81771785)

摘　　要：目的探讨基于多参数MRI(mpMRI)的多种评估系统对前列腺癌包膜外侵犯(EPE)的诊断价值。方法回顾性连续入组2021年1月至2022年2月期间于解放军总医院第一医学中心行根治性前列腺切除术,并于术前行标准mpMRI扫描的168例前列腺癌患者,年龄48~82(66.6±6.8)岁。由2名放射科医师使用欧洲泌尿生殖放射学会(ESUR)评分、EPE分级及多参数磁共振前列腺癌包膜外侵犯(mEPE)评分对所有病例进行独立评估,有分歧的病例通过高年资医师审核作为最终结果。采用受试者工作特征曲线评估各MRI-EPE评估系统预测EPE的诊断效能,运用DeLong检验对比不同评估系统间曲线下面积(AUC)差异。运用加权Kappa检验评价各MRI-EPE评估系统的观察者间一致性。结果共计62例(36.9%)前列腺癌患者经术后病理证实存在EPE。基于mpMRI的ESUR评分、EPE分级及mEPE评分诊断EPE的AUC分别为0.836(95%CI:0.771~0.888)、0.834(95%CI:0.769~0.887)和0.785(95%CI:0.715~0.844);ESUR评分与EPE分级的AUC均高于mEPE评分(均P<0.05);ESUR评分与EPE分级间的AUC差异无统计学意义(P=0.900)。EPE分级及mEPE评分均具备良好的观察者间一致性,加权Kappa值分别为0.65(95%CI:0.56~0.74)和0.74(95%CI:0.64~0.84)。ESUR评分的观察者间一致性为中等,加权Kappa值为0.52(95%CI:0.40~0.63)。结论基于mpMRI的多种评估系统对术前预测EPE均展现出一定价值,其中EPE分级的诊断效能较高,且观察者间一致性良好。Objective To evaluate the diagnostic value of multiparametric magnetic resonance imaging(mpMRI)based models in the assessment of extra-prostatic extension(EPE)of prostate cancer.Methods This retrospective study included 168 consecutive men with prostate cancers[aged 48 to 82(66.6±6.8)years]who underwent radical prostatectomy and preoperative mpMRI examinations at the First Medical Center of the PLA General Hospital from January 2021 to February 2022.According to European Society of Urogenital Radiology(ESUR)score,EPE grade and mEPE score,all cases were independently evaluated by two radiologists,with disagreement reviewed by a senior radiologist as the final result.The diagnostic performance of each MRI-based model for pathologic EPE prediction was assessed using receiver operating characteristic curve(ROC),and the differences between the corresponding area under the curve(AUC)were compared using the DeLong test.The weighted Kappa test was used to evaluate the inter-reader agreement of each MRI-based model.Results A total of 62(36.9%)prostate cancer patients had pathologic confirmed EPE after radical prostatectomy.The AUC of ESUR score,EPE grade and mEPE score for predicting pathologic EPE were 0.836(95%CI:0.771-0.888),0.834(95%CI:0.769-0.887)and 0.785(95%CI:0.715-0.844),respectively.The AUC of ESUR score and EPE grade were both superior to that of mEPE score with significant differences(all P<0.05),while there was no significant difference between the ESUR score and EPE grade models(P=0.900).EPE grading and mEPE score had good inter-reader consistency,with weighted Kappa values of 0.65(95%CI:0.56-0.74)and 0.74(95%CI:0.64-0.84),respectively.The inter-reader consistency of ESUR score was moderate,and the weighted Kappa value was 0.52(95%CI:0.40-0.63).Conclusion All MRI-based models showed good preoperative diagnostic value in predicting EPE,among which the EPE grade resulted in more reliable performance with substantial inter-reader agreement.

关 键 词：放射学 磁共振成像 前列腺癌 包膜外侵犯 横断面研究 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]