目的：探讨前列腺影像报告和数据系统第2版（Prostate Imaging Reporting and Data System version 2，PI-RADS v2）与调整前列腺特异性抗原密度（adjusted-Prostate-Specific Antigen Density，adjusted-PSAD）联合运用在前列腺高级别癌中的诊断价值。方法：回顾性分析2013年1月—2016年9月168例前列腺磁共振扫描的患者资料，其中高级别癌52例（Gleason评分≥7分）和非高级别癌116例（前列腺良性病变+低级别癌）。由两名观察者运用盲法分析对所有多参数磁共振图像进行PI-RADS v2评分，采用Kappa检验分析两名观察者独立对病灶PI-RADS v2评分的一致性，ROC曲线分析PI-RADS v2法（PR法）、PI-RADS v2联合前列腺特异性抗原密度（Prostate-Specific Antigen Density，PSAD）法（PP法）、PI-RADS v2联合adjusted-PSAD法（PA法）在前列腺高级别癌中的诊断价值，利用Spearman分析各参数与高级别癌Gleason评分的相关性。结果：两名观察者采用PI-RADS v2法对于高级别癌评分的一致性为中等（Kappa=0.633）；ROC曲线分析表明：三种方法中以PI-RADS v2联合adjusted-PSAD法的曲线下面积（Area under the curve，AUC）最大（P<0.05），AUC、敏感性、特异性、阳性预测值、阴性预测值分别为91%，85%、87%、75%、93%。PI-RADS v2评分与Gleason评分呈正相关（r=0.475，P=0.001）。结论：PI-RADS v2联合adjusted-PSAD法对于前列腺高级别癌的诊断价值较为理想，且PI-RADS v2评分可作为评价前列腺高级别癌侵袭性的指标。
Abstract
Objective: To evaluate the value of combing Prostate Imaging Reporting and Data System(PI-RADS) scores with adjusted-Prostate Specific Antigen Density(adjusted-PSAD) in diagnosing high-grade prostate cancer(HGPCa). Methods: Magnetic resonance imaging data of 168 patients from January 2013 to August 2016 were analyzed retrospectively. According to the pathological results, the cases were divided into two groups, one was high-grade group(52 cases), the other was non-high-grade group. The concordance of PI-RADS v2 scores in two independent observers was tested by Kappa statistic. The performance of PI-RADS v2 alone and PI-RADS v2 combined with other parameters in the diagnosis of high-grade prostate cancer were assessed. Futhermore, Spearman correlation analysis was used to explore the relationship between each parameter with Gleason score. Results: The concordance of PI-RADS v2 scores in two independent observers was moderate(Kappa=0.478). The ROC curve analysis showed that the area under the curve(AUC) of PI-RADS v2 combined with adjusted-PSAD was larger(P<0.05), and AUC, sensitivity, specificity, PPV, NPV were 91%, 85%, 87%, 75%, 93%, respectively. Furthermore, PI-RADS v2 score showed a significant positive correlation with Gleason scores of HGPCa(r=0.423, P=0.001). Conclusions: PI-RADS v2 combined with adjusted-PSAD demonstrated good accuracy in detecting HGPCa, and PI-RADS v2 score can be served for evaluating aggressiveness of HGPCa non-invasively.
关键词
前列腺肿瘤 /
磁共振成像
Key words
Prostatic neoplasms /
Magnetic resonance imaging
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参考文献
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基金
四川省医学科研青年创新课题计划（Q14004）；成都市卫生计划生育委员会课题项目（2015080）。
