目的：基于第2版前列腺影像报告和数据系统（PI-RADS V2），探讨双参数MRI联合前列腺特异抗原密度（PSAD）对有临床意义前列腺癌（sPCa）的诊断价值。方法：经穿刺活检病理证实的前列腺癌（PCa）80例，前列腺增生（BPH）47例，前列腺炎症4例均进行3.0T双参数核磁共振检查（T2WI+DWI），由2名诊断医师在双盲情况下对以上影像图像分别进行PI-RADS评分并记录，检测患者的前列腺特异抗原（PSA），测量前列腺体积（PV），计算前列腺特异性抗原密度（PSAD），以穿刺病理结果为金标准，对PCa组与非PCa组数据进行统计学分析。结果：PCa组与非PCa组PSAD平均值分别为1.19±0.88，0.38±0.40；PI-RADS V2评分平均值分别为3.90±1.00，2.30±0.55，两组间PSAD及PI-RADS V2评分值的差异均有统计学意义（PSAD，t=10.10，P<0.05；PI-RADS，t=5.91，P<0.05）。PSAD，PI-RADS评分在ROC曲线下面积（AUC）分别为0.794，0.894。PSAD诊断sPCa的敏感度、特异度、阳性预测值、阴性预测值分别为98.68%，30%，68.18%，94.12%；PI-RADS评分诊断sPCa的敏感度、特异度、阳性预测值及阴性预测值分别为90.67%，69.23%，81.00%，83.72%；两者联合诊断sPCa时，当PI-RADS=3分及PSAD≥0.15，PI-RADS≥4分及PSAD≥0.15，sPCa阳性率分别为72%，92%；当PI-RADS<3分及PSAD≥0.15，PI-RADS>3分及PSAD<0.15，sPCa阳性率为20%，25%；当PI-RADS≤3分及PSAD<0.15，sPCa阳性率为0。结论：基于PI-RADS V2，双参数MRI联合PSAD对sPCa诊断不仅准确性更高，而且对患者穿刺病理结果的预测有重要意义，当PI-RADS≤3分及PSAD<0.15，可以有效避免不必要的穿刺活检。
Abstract
Objective: To investigate the value of diagnosis for clinically significant prostate cancer(sPCa) by combining bi-parametric magnetic resonance imaging(B-MRI) with prostate specific antigen density(PSAD) on the basis of the prostate imaging reporting and data system verison 2.0(PI-RADS V2). Methods: Eighty of prostate cancer, 47 patients of benign prostate hyperplasia(BPH) and 4 of prostatitis that were confirmed by biopsy pathology in our hospital were scanned with 3.0T B-MRI(T2WI and DWI). Two diagnostic physicians respectively assessed examination by using the PI-RADS V2 score, double-blinded to the indication for the MR imaging. All of the results were recorded. To collect the value of prostate specific antigen(PSA), prostate volume and to calculate the value of PSAD. Using the pathological results as the golden standard, the data of different group were analyzed using method of statistics. Results: The average values of PSAD and PI-RADS V2 score were 1.19±0.88, 3.90±1.00 in PCa group and 0.38±0.40, 2.30±0.55 in non-PCa group respectively. The difference of two groups were statistically significant(PSAD, t=10.10, P<0.05; PI-RADS, t=5.91, P<0.05). The area under ROC curve for PSAD and PI-RADS V2 were 0.794, 0.894. The diagnostic sensitivity was 98.68%, the specificity was 30%, the positive predictive value(PPV) was 68.18%, the negative predictive value(NPV) was 94.12% for sPCa with the cutoff point 0.15 of the PSAD. The diagnostic sensitivity was 90.67%, the specificity was 69.23%, the PPV was 81.00%, the NPV was 83.72% for sPCa with the cutoff point 0.15 of the PI-RADS V2. When PI-RADS V2 score and PSAD combined, a PI-RADS V2 score of 3 and PSAD≥0.15, or PI-RADS V2 score≥4 and PSAD≥0.15, the detection of sPCa were 72%, 92%. When a PI-RADS V2 score<3 and PSAD≥0.15, or PI-RADS V2 score≥4 and PSAD<0.15, the detection of sPCa were 20%, 25%. In contrast, when a PI-RADS V2 score≤3 and PSAD<0.15, there was no sPCa detected. Conclusion: It is very useful to predict biopsy outcome and provides even more accuracy in detecting clinically sPCa when combining B-MRI PI-RADS V2 with PSAD. Patients with a PI-RADS V2 score of ≤3 and PSA density of <0.15 may avoid unnecessary biopsies.
关键词
前列腺肿瘤 /
磁共振成像 /
活组织检查 /
针吸
Key words
Prostatic neoplasms /
Magnetic resonance imaging /
Biopsy, needle
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