PI-RADSv2.1联合PSAD对临床显著性前列腺癌的诊断效能  

Diagnostic efficacy of PI-RADS v2.1 in combination with prostate-specific antigen density for clinically significant prostate cancer

作　　者：姜贤梅 陈云辉 董诗存 胡娟[1] 杨亚英[1] JIANG Xianmei;CHEN Yunhui;DONG Shicun;HU Juan;YANG Yaying(Department of Radiology,First Afiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院影像科,云南昆明650032

出　　处：《大连医科大学学报》2024年第2期138-143,共6页Journal of Dalian Medical University

摘　　要：目的 探讨前列腺报告和数据系统(PI-RADS v2.1)与前列腺特异性抗原密度(PSAD)相结合对临床显著性前列腺癌(csPCa)的诊断价值。方法 收集2019年2月至2023年2月期间行前列腺MRI检查并行穿刺活检522例患者的临床资料,记录患者的年龄、实验室指标(tPSA、f/tPSA、PSAD)、前列腺体积(PV)、表现扩散系数平均值(ADCmean)、PI-RADS v2.1评分。根据穿刺或手术结果,分为前列腺癌(PCa)组和良性前列腺增生(BPH)组;根据病理结果,分为csPCa组和非csPCa组。通过单因素和多因素Logistic回归及受试者工作特征(ROC)曲线分析,比较不同预测因子的诊断效能,并根据PSAD检测PCa和csPCa及识别异常值的分界点,将患者分为4个不同等级亚组,进一步分析PI-RADS v2.1不同评分和PSAD不同等级对诊断csPCa的临床意义。结果 单因素分析显示,患者的年龄、tPSA、PV、PSAD、ADCmean、PI-RADS在PCa组和BPH组,以及csPCa组和非csPCa组间差异均有统计学意义(P<0.05);多因素回归分析显示,PI-RADS v2.1评分和PSAD是csPCa的危险因素(P<0.001)。两者联合诊断PCA和csPCa的AUC分别为0.895和0.936;根据确定的PCa和csPCa的PSAD值分界点(0.24,0.64)和接受阈值(0.15)进一步分析显示,PSAD≥0.15 ng/(mL·cm^(3))或PI-RADS v2.1评分≥4分组与PI-RADS v2.1评分≤2分或PI-RADS v2.1评分为3分且PSAD<0.15 ng/(mL·cm^(3))组之间差异有统计学意义(P<0.05)。结论 PI-RADS v2.1评分和PSAD联合检测对csPCa的诊断效能较好,PI-RADS v2.1评分≤2分或PI-RADS v2.1评分为3分且PSAD<0.15 ng/(mL·cm^(3))的患者发生csPCa的风险较低。Objective To investigate the diagnostic value of prostate reporting and data system(PI-RADS v2.1)combined with prostate-specific antigen density(PSAD)for clinically significant prostate cancer(csPCa).Methods Clinical data of 522 patients,who underwent prostate MRI examination and biopsy between February 2019 and February 2023,were collected.The patients'age,laboratory indicators(tPSA,f/tPSA,PSAD),PV,ADCmean,and PI-RADS v2.1 score were reviewed.The patients were divided into PCa group and BPH group based on puncture biopsy or surgical results;according to the pathological results,they were further divided into csPCa group and non csPCa group.By using univariate and multivariate logistic regression and receiver operating characteristic(ROC)curve analysis,the diagnostic efficacy of different predictive factors was compared.Based on the cutoff points for detecting PCa and csPCa and identifying outliers using PSAD,the patients were divided into four PSAD subgroups to further analyze the clinical significance of different PI-RADS v2.1 scores and PSAD levels in diagnosing csPCa.Results Univariate analysis revealed statistically significant differences in patient age,tPSA,PV,PSAD,ADCmean,and PI-RADS between the PCa and BPH groups,as well as between the csPCa and non csPCa groups(P<0.05).Multivariate regression analysis demonstrated that PI-RADS v2.1 score and PSAD were risk factors for csPCa(P<0.001).The AUC were 0.895 and 0.936,when combining the two indicators in diagnosing PCa and csPCa.Further analysis based on the determined PSAD cutoff values(0.24,0.64)and the acceptance threshold(0.15)for PCa and csPCa revealed that there was a statistically significant difference(P<0.05)between the PSAD≥0.15 ng/(mL·cm^(3))or PI-RADS v2.1 score≥4 group and the group with PI-RADS v2.1 score≤2 or PI-RADS v2.1 score=3 and PSAD<0.15 ng/(mL·cm^(3)).Conclusion The combination of PI-RADS v2.1 score and PSAD has better diagnostic efficacy for detecting csPCa.Patients with PI-RADS v2.1 score≤2 or PI-RADS v2.1 score=3 and PSAD<0.1

关 键 词：前列腺影像报告与数据系统 多参数磁共振成像 前列腺特异性抗原密度 诊断 

分 类 号：R445.4[医药卫生—影像医学与核医学]