PI-RADS v2.1在前列腺癌诊断中的临床应用价值  

Clinical Value of pi-rads Version 2.1 in the Diagnosis of Prostate Cancer

作　　者：陈泽谷[1] 白志明[2] 杨光[1] 王刚[2] 吴万文 徐海霞 陈晶[1] CHEN Ze-gu;BAI Zhi-ming;YANG Guang;WANG Gang;WU Wan-wen;XU Hai-xia;CHEN Jing(Department of radiology,Haikou Affiliated Hospital of Central South University Xiangya School of Medicin,Haikou 570208,Hainan Province,China;Department of urology,Haikou Affiliated Hospital of Central South University Xiangya School of Medicin,Haikou 570208,Hainan Province,China;department of pathology,Haikou Affiliated Hospital of Central South University Xiangya School of Medicin,Haikou 570208,Hainan Province,China)

机构地区：[1]海南省中南大学湘雅附属海口医院放射科,海南海口570208 [2]海南省中南大学湘雅附属海口医院泌尿外科,海南海口570208 [3]海南省中南大学湘雅附属海口医院病理科,海南海口570208

出　　处：《中国CT和MRI杂志》2023年第8期114-117,共4页Chinese Journal of CT and MRI

基　　金：海南省重点研发计划项目(ZDYF2017084)。

摘　　要：目的探讨多参数MRI(multiparametric MRI,mpMRI)前列腺影像报告和数据系统2.1版(prostate imaging reporting and data system version 2.1,PI-RADS v2.1)评分在前列腺癌临床诊断中的应用价值。方法收集2015年03月至2020年03月期间328例的影像及临床病理资料,入组74例前列腺癌患者,术前均行前列腺MR多参数扫描,采用局麻下经直肠超声引导下的12针系统穿刺+2针靶向穿刺,记录患者年龄、穿刺病理结果、Gleason评分、病灶大小以及前列腺特异性抗原PSA水平。根据病理Gleason评分结果分为两组(非显著性癌≤6分,显著性癌7分),并进行比较和分析,计量资料呈正态分布,比较两组间采用独立样本t检验或Mann-Whitney U检验,组间比较采用χ^(2)检验或Fisher精确概率法,以P≤0.05为差异有统计学意义。采用一致性Kappa检验分析两名诊断医师间的一致性。结果共入组患者74例,包括74例年龄在49~85岁之间的患者(64.85±6.56岁),显著性癌组63例(85.14%),无显著性癌组11例(14.86%),两组间无临床意义PCa的检出率无显著差异(8.11%对16.22%,p=0.16)。相比之下,PI-RADS v2.1评分4、5对具有临床意义的癌症的检出率显著高于PIRADS v2.1评分为1-3的患者(68.92%对1.35%,P<0.0001)。肿瘤体积≥0.5ml的临床相关肿瘤组中,肿瘤体积与Gleason评分(n=36,P=0.019)之间有统计学意义的相关性。前列腺移行带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.51,0.29,前列腺外周带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.59,0.56,前列腺移行带病灶PI-RADS v2.1评分观察者间一致性Kappa系数分别为0.43.0.45。结论PI-RADS v2.1版是比较好的质量控制方案减少前列腺影像分析过程中出现的混淆,对mpMRI的评分是适当的,且重复性好,并且随着2019 ISUP病理更新,在诊断有临床意义的前列腺癌上更加贴近临床。在外周带及PI-RADS v2.1>3分和Gleason评分>7分(4-6分)上PI-RADSv 2.1评分一致�Objective To investigate the application value of the prostate imaging reporting and data system version 2.1(PI-RADS v2.1)score in the clinical diagnosis of prostate cancer.Methods The imaging and clinicopathological data of 328 patients with prostate cancer from March 2015 to March 2020 were collected.All patients underwent multiparameter MR scan before operation.The patients'age,pathological results,Gleason score,lesion size and PSA level were recorded.According to Gleason score,the patients were divided into two groups(nonsignificant cancer≤6 points,significant cancer 7 points),and were compared and analyzed.The measurement data were normally distributed.Independent sample t test or Mann-Whitney U test were used to compare the two groups,andχ2 test or Fisher exact probability method were used to compare the two groups.P≤0.05 was considered to be statistically significant.Consistency was analyzed by kappa test.Results A total of 74 patients were enrolled,including 74 patients aged 49-85 years(mean±SD:64.85±6.56 years),63 cases(85.14%)with significant cancer and 11 cases(14.86%)without significant cancer.There was no significant difference in the detection rate of clinically insignificant PCA between the two groups(8.11%vs 16.22%,P=0.16).In contrast,the detection rate of clinically significant cancers in patients with PI-RADS v2.1 score 4 and 5 was significantly higher than that in patients with PI-RADS v2.1 score of 1-3(68.92%vs 1.35%;P<0.0001).There was a statistically significant between tumor volume and Gleason score(n=36,P=0.019)in clinically relevant tumor groups with tumor volume≥0.5ml.The kappa coefficients of PI-RADS v2.1 scores of prostate transitional zone lesions were 0.51 and 0.29,respectively.The kappa coefficients of PI-RADS v2.1 scores of peripheral prostate lesions were 0.59 and 0.56,respectively.The kappa coefficients of PI-RADS v2.1 scores of prostate transitional zone lesions were 0.43.0.45.Conclusion PI-RADS v2.1 is a better quality control program to reduce confusion during prostat

关 键 词：前列腺肿瘤 活检 前列腺影像报告和数据系统 磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]