双参数MRI联合临床指标对前列腺癌的诊断价值  

Diagnostic Value of Biparameter Magnetic Resonance Imaging and Clinical Markers for Prostate Cancer

作　　者：黄浩 和志君 董卫敏 齐旭红[1] 于洋[1] 温智勇[1] HUANG Hao;HE Zhijun;DONG Weimin(Department of Radiology,Beijing Electric Power Hospital,Capital Medical University,Beijing 100073,P.R.China)

机构地区：[1]首都医科大学北京电力教学医院放射科,北京100073

出　　处：《临床放射学杂志》2021年第5期954-959,共6页Journal of Clinical Radiology

基　　金：国家电网公司科技项目(编号:O2020002)。

摘　　要：目的以最新版前列腺影像报告与数据系统(PI-RADS v2.1)作为诊断标准的前提下,双参数MRI(BpMRI)联合前列腺特异性抗原(PSA)相关指标对前列腺癌的诊断效能。方法回顾性分析87例临床怀疑为前列腺癌患者的临床病理及影像学资料[年龄45~85岁,平均(69±8.16)岁],所有患者均行多参数MRI(MpMRI)检查以及经会阴前列腺饱和穿刺活检而取得病理证实,由两名放射科医师应用PI-RADS v2.1对所有患者的前列腺MR图像分别按MpMRI和BpMRI两种方案进行评分,意见不一致时由另一名高年资医师决定最终评分。依据病理穿刺结果将患者分为前列腺癌组和非前列腺癌组,对比两组间各指标的差异。将BpMRI与相关有统计学意义的临床指标相结合构建诊断模型,并绘制各诊断模型与MpMRI的受试者工作特征(ROC)曲线以分析其诊断效能,运用Z检验对比BpMRI联合临床指标与MpMRI的曲线下面积(AUC)有无差异。结果前列腺癌组血清游离前列腺特异性抗原(fPSA),血清总前列腺特异性抗原(tPSA)及前列腺特异性抗原密度(PSAD)与非前列腺癌组的差异有统计学意义,BpMRI+tPSA、BpMRI+fPSA和BpMRI+PSAD三种模型的AUC为0.913、0.881、0.946,与MpMRI(AUC=0.911)相比Z值分别为0.218、1.829、2.120,P值分别为0.828、0.0675、0.034。PSAD+BpMRI的AUC与MpMRI相比差异有统计学意义,并且高于MpMRI。结论 BpMRI联合PSA相关指标有着较好的诊断效能,其中PSAD联合BpMRI的诊断效能高于MpMRI。Objective To explore the diagnostic efficacy of Biparameter MRI(BpMRI) combined with PSA related parameters for prostate cancer based on the prostate imaging reporting and data system version 2.1(PI-RADS v2.1). Methods We retrospectively analyzed the clinical, pathological and imaging data of 87 patients who were clinically suspected prostate cancer(mean age 69±8.16,range 45-85 years).All patients underwent multi-parameter MRI(MpMRI) examination and transperineal prostate saturation biopsy to obtain pathology.Two radiologists used PI-RADS v2.1 to score the prostate MR images of all patients according to the two schemes of MpMRI and BpMRI.When the opinions were inconsistent, another senior doctor decided the final score.According to the results of pathology, the patients were divided into prostate cancer group and non-prostate cancer group.The differences of the PSA related parameters between the two groups were compared, and selected parameters that differed significantly. We combined BpMRI and related clinical parameters to build new diagnostic models, and drew the ROC curve of each diagnostic model and MpMRI to analyze its diagnostic efficacy, and used Z test to compare the area under the curve(AUC) of each diagnostic model and MpMRI. Results The differences of total PSA,free PSA and PSAD between the prostate cancer group and non-prostate cancer group were statistically significant.The AUC values of the three models of BpMRI+totalPSA,BpMRI+free PSA and BpMRI+PSAD were 0.913,0.881,0.946,and Compared with MpMRI(AUC=0.911) the Z values were 0.218,1.827,and 2.120,P values were 0.828,0.0675,and 0.034,respectively.The difference between the AUC value of PSAD+BpMRI and MpMRI was statistically significant. Conclusion BpMRI combined with PSA-related parameters have good diagnostic efficacy, and the diagnostic efficacy of PSAD combined with BpMRI is higher than MpMRI.

关 键 词：前列腺影像报告与数据系统 前列腺癌 前列腺特异性抗原 双参数MRI 

分 类 号：R737.25[医药卫生—肿瘤]