PSA密度在多参数MRI预测前列腺癌中的价值  

The value of prostate specific antigen density in the detection of prostate cancer by the multi-parametric MRI

作　　者：罗南 张凯[2] 李鸿波 杨正汉[1] 朱刚[2] Luo Nan;Zhang Kai;Li Hongbo;Yang Zhenghan;Zhu Gang

机构地区：[1]首都医科大学附属北京友谊医院放射科(北京和睦家医院放射科外请专家),100050 [2]北京和睦家医院泌尿外科,100015

出　　处：《中华泌尿外科杂志》2019年第8期601-605,共5页Chinese Journal of Urology

摘　　要：目的研究前列腺特异性抗原密度(PSAD)在多参数磁共振预测前列腺癌中的价值。方法回顾性分析北京和睦家医院2013年4月至2019年3月110例初次接受前列腺系统穿刺+MRI靶向穿刺患者的临床资料。患者中位年龄63.5岁(43.0~84.0岁),中位PSA 7.0 ng/ml(0.7~43.4 ng/ml),中位PSAD 0.16 ng/ml2(0.03~1.15 ng/ml2),中位前列腺影像报告和数据系统(PI-RADS)评分3.5分(2.0~5.0分),有临床意义前列腺癌定义为Gleason评分≥3+4分。结果110例中共诊断出前列腺癌45例,其中有临床意义前列腺癌32例。系统穿刺诊断前列腺癌36例,其中有临床意义前列腺癌23例;MRI靶向穿刺诊断前列腺癌38例,其中有临床意义前列腺癌27例。对于MRI靶向穿刺,PSAD、PI-RADS、PSAD+PI-RADS诊断前列腺癌的曲线下面积(AUC)分别为0.807、0.757、0.841,PSAD+PI-RADS的诊断效力显著高于PI-RADS (P=0.0034);三者诊断有临床意义前列腺癌的AUC分别为0.806、0.780、0.862,PSAD+PI-RADS的诊断效力显著高于PI-RADS (P=0.0128)。对于系统穿刺+MRI靶向穿刺,PSAD、PI-RADS、PSAD+PI-RADS诊断前列腺癌的AUC分别为0.765、0.791、0.857,PSAD+PI-RADS的诊断效力显著优于PI-RADS (P=0.0042);三者诊断有临床意义前列腺癌的AUC分别为0.790、0.785、0.853,PSAD+PI-RADS的诊断效力显著优于PI-RADS (P=0.0170)。结论对于初次接受前列腺穿刺的患者,无论单用MRI靶向穿刺还是系统穿刺+MRI靶向穿刺,PSAD+PI-RADS预测前列腺癌和有临床意义前列腺癌的精确性均显著高于PI-RADS。Objective To evaluate whether prostate specific antigen density(PSAD) could improve the multi-parametric MRI detection of prostate cancer. Methods A total of 110 men from Beijing United Family Hospital and clinics undergoing systematic biopsy + MRI-targeted biopsy from April 2013 to March 2019 were included in the study. The median age was 63.5 years (43.0-84.0 years), median prostate specific antigen (PSA)was 7.0 ng/ml (0.7-43.4 ng/ml), median PSAD was 0.16ng/ml2(0.03-1.15 ng/ml2), median PI-RADS was 3.5(2.0-5.0). Results A total of 45 cases of prostate cancer were detected, including 32 cases of clinically significant prostate cancer. Systematic biopsy detected 36 cases of prostate cancer, including 23 cases of clinically significant prostate cancer;MRI-targeted biopsy detected 38 cases of prostate cancer, including 27 cases of clinically significant prostate cancer. For MRI-targeted biopsy, the area under curve (AUC) of PSAD, PI-RADS and PSAD+ PI-RADS were 0.807, 0.757, 0.841 for prostate cancer and were 0.806, 0.78, 0.862 for clinically significant prostate cancer. PSAD+ PI-RADS achieved significantly superior AUC compared with PI-RADS alone for both prostate cancer detection (P=0.0034) and clinically significant prostate cancer detection(P=0.0128). For systematic biopsy + MRI-targeted biopsy, the AUC of PSAD, PI-RADS and PSAD+ PI-RADS were 0.765, 0.791, 0.857 for prostate cancer and were 0.790, 0.785, 0.853 for clinically significant prostate cancer. PSAD+ PI-RADS showed significantly higher AUC compared with PI-RADS for prostate cancer detection (P=0.0042) and clinically significant prostate cancer detection(P=0.0170). Conclusions For prostate biopsy na?ve men, PSAD+ PI-RADS showed significantly higher predictive value than PI-RADS alone for prostate cancer and clinically significant prostate cancer detection either by MRI-targeted biopsy or by systematic biopsy+ MRI-targeted biopsy.

关 键 词：前列腺肿瘤 靶向穿刺 磁共振 PSA密度 诊断 

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]