摘要目的 探讨基于第2版前列腺影像报告和数据系统(PI?RADS v2)的多参数MRI (Mp?MRI)与简化的双参数MRI(Bp?MRI)检出前列腺癌(PCa)及临床显著前列腺癌(csPCa)的效能.方法 回顾性分析2015年2月至2018年6月苏州大学附属第二医院经病理证实且行前列腺Mp?MRI检查患者的影像、病理及临床资料.首先任意抽取其中250例患者,由2名影像科医师分别运用基于Mp?MRI及Bp?MRI的两种5分制评分方案对图像进行评估,其余患者由其中1名医师运用两种方案独立完成评估.以最终病理结果作为诊断标准,根据病理Gleason评分(GS)将病灶分为临床显著PCa (csPCa)和非csPCa.运用加权Kappa检验评估2名医师图像判读结果的一致性.运用ROC曲线评估两种评分方案对PCa及csPCa的检出效能,并运用Z检验分别判断两种方案曲线下面积(AUC)间有无差异.结果 978例患者纳入研究,非PCa患者66.46%(650/978),PCa患者33.54%(328/978);非csPCa患者75.36%(737/978),csPCa患者24.64%(241/978).采用Mp?MRI评估时2名医师间的加权Kappa系数为0.800,采用Bp?MRI评估时加权Kappa系数为0.812,均具有较强的一致性.运用Mp?MRI与Bp?MRI检出PCa的AUC值分别为0.873、0.879,检出csPCa的AUC值分别为0.922、0.932, AUC值之间的差异均无统计学意义(Z值分别为0.816、1.687,P值分别为0.415、0.092).结论 基于Bp?MRI的评分系统在前列腺良恶性评估中具有较好的稳定性,对PCa及csPCa的检出效能并不低于基于PI?RADS v2评分标准的Mp?MRI.

abstractsObjective To explore the difference in efficacy between multiparametric MRI (Mp?MRI) based on prostate imaging reporting and data system version 2 (PI?RADS v2) and abbreviated biparametric MRI (Bp?MRI) in detecting prostate cancer (PCa) and clinically significant prostate cancer (csPCa), and to evaluate the consistency of image interpretation between different readers. Methods The imaging, pathological and clinical data of patients with prostatic Mp?MRI in our hospital from February 2015 to June 2018 were retrospectively analyzed. At the beginning, 250 patients were randomly selected. Two radiologists visually evaluated the images of those patients using two 5?point scoring schemes based on Mp?MRI and Bp?MRI. The remaining cases were independently proceeded by one of the radiologists using two schemes respectively. Weighted Kappa test was used to assess the consistency of the results interpreted by the two radiologists. The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of the two scoring schemes in detecting PCa and csPCa, and with Z test to investigate whether there was any difference in detection efficiency between the two schemes. Results Nine hundred and seventy eight patients were eventually enrolled in the study. The results of the consistency assessment showed that there was good agreement between the two radiologists, whether using Mp?MRI or Bp?MRI, with the weighted Kappa coefficient of 0.800 and 0.812, respectively. The ROC curve analysis showed that the area under the curve (AUC) of PCa detected by Mp?MRI and Bp?MRI was 0.873 and 0.879, respectively, and the AUC of csPCa detected was 0.922 and 0.932, respectively. In addition, there was no statistically significant difference between the AUC of PCa and csPCa detected by the two schemes (P>0.05). Conclusion The Bp?MRI scoring scheme has good stability in the evaluation of benign and malignant prostate, and its detection efficiency of PCa or csPCa is not lower than that of standard Mp?MRI based on PI?RADS v2.