BP-MRI联合临床预测指标对前列腺癌的诊断价值  

Diagnosis value of BP-MRI combined clinical predictors for prostate cancer

作　　者：黄丹丹 冯倩茹 李增华 夏春华[1] HUANG Dandan;FENG Qianru;LI Zenghua;XIA Chunhua(Department of Radiology,South District of Hefei First People's Hospital(Hefei Binhu Hospital),Hefei 230000,China)

机构地区：[1]合肥市第一人民医院南区(合肥市滨湖医院)放射科,合肥230000

出　　处：《磁共振成像》2023年第10期90-97,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：安徽省卫生健康委科研项目(编号:AHWJ2021b141);合肥市第六周期医学重点学科建设项目(磁共振成像诊断)[编号:合卫医秘[2022]157号]。

摘　　要：目的 基于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)分析双参数磁共振成像(biparametric magnetic resonance imaging, BP-MRI)及其联合临床预测指标对前列腺癌(prostate cancer, PCa)的诊断价值。材料与方法 本研究回顾性分析2020年1月至2022年5月我院171例在进行系统活检前接受多参数磁共振成像(multiparametric MRI, MP-MRI)检查的临床可疑PCa患者病例资料。由两名经验丰富的放射科医师以PI-RADS v2.1评分系统对所有病灶的MR图像进行BP-MRI及MP-MRI评分,并将病灶分为全部病灶组、病灶位于周围带(peripheral zone, PZ)组和病灶位于移行带(transition zone, TZ)组。对PCa组及非前列腺癌(non prostate cancer, No PCa)组的BP-MRI、MP-MRI及各临床预测指标进行单因素分析及多因素分析,确立独立预测因素,并通过受试者工作特性(receiver operating characteristic, ROC)曲线分析两种评分及BP-MRI联合独立预测因素方案的诊断性能。结果 在全部病灶组(PZ+TZ)中,BP-MRI、MP-MRI、年龄、前列腺特异性抗原密度(prostate specific antigen density, PSAD)及游离/总前列腺特异性抗原(free/total prostate specific antigen, f/tPSA)是PCa的独立预测因素,BP-MRI与MP-MRI之间诊断效能差异无统计学意义[ROC曲线下面积(area under the curve, AUC)为0.888、0.886, P>0.05]。联合模型、BP-MRI+f/tPSA、BP-MRI+PSAD的(AUC=0.937, 0.924, 0.915)诊断效能均高于MP-MRI(AUC=0.886),差异具有统计学意义(P<0.05),三者间差异无统计学意义(P>0.05);临床独立预测因素中PSAD诊断效能最高(AUC=0.837);相较于单独应用,各临床独立预测指标联合BP-MRI后诊断准确性明显提升,差异具有统计学意义(P<0.05),而相较于年龄或f/tPSA,BP-MRI联合PSAD的综合临床诊断价值更高;在PZ或TZ组中,BP-MRI(AUC=0.821, 0.908)、MP-MRI(AUC=0.817, 0.908)是PCa的独立预测因素,两者AUC值差异无统计学意义(P>0.05)。结论 BP-MRIObjective:The aim of this study was to assess diagnostic efficacy of biparametric magnetic resonance imaging(BP-MRI)and BP-MRI combined with clinical predictors vs.multiparametric MRI(MP-MRI)for prostate cancer(PCa)based on the Prostate Imaging Reporting and Data System version 2.1(PI-RADS v2.1).Materials and Methods:This study retrospectively analyzed 171 patients with clinically suspected PCa who underwent MP-MRI examination before systematic biopsy in our hospital from January 2020 to May 2022.The prostate MR images of all lesions were scored by the two schemes of MP-MRI and BP-MRI based on PI-RADS v2.1.Combined with the results of pathology,the lesions were divided into three groups:all lesions group,lesions located in peripheral zone(PZ)group and lesions located in transition zone(TZ)group.BP-MRI,MP-MRI and clinical predictors were analyzed by univariate and multivariate analysis,and the independent predictors were established.The diagnostic performance of the two schemes and BP-MRI combined with independent predictors was analyzed by the receiver operating characteristic(ROC)curve.Results:For all of the lesions(PZ+TZ),the BP-MRI,MP-MRI,age,PSAD,and f/tPSA were the independent predictors of PCa,there was no statistical difference in the diagnostic efficacy between BP-MRI and MP-MRI[area under the curve(AUC):0.888,0.886;P>0.05].Combined model and the combination of BP-MRI and f/tPSA or PSAD(AUC=0.937,0.924,0.915)had higher diagnostic efficience than MP-MRI(AUC=0.886).The difference between the AUC value of these combined models and MP-MRI was statistically significant(P<0.05);PSAD had a larger AUC than the other predictors alone(AUC=0.837),the AUC for the combination of BP-MRI and independent predictors is significantly superior to using BP-MRI score and independent predictors alone(P<0.05),and compared with the age or f/tPSA index,combining BP-MRI and PSAD had a higher clinical diagnostic efficacy.For lesions in the PZ or TZ,the two schemes of MP-MRI and BP-MRI were the independent predictors,there was no st

关 键 词：前列腺癌 前列腺特异性抗原 前列腺癌成像报告和数据系统 双参数磁共振成像 多参数磁共振成像 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]