摘要目的 比较全科影像医生和泌尿影像医生基于前列腺影像报告和数据系统(PI-RADS)诊断有临床意义前列腺癌的差异.方法 回顾性分析2015年8月至2018年2月北京和睦家医院45例行前列腺多参数核磁(mpMRI)检查以及核磁靶向认知融合前列腺穿刺患者的临床资料.年龄(60.0±8.0岁),前列腺特异性抗原(PSA)中位值7.2 ng/ml(1.2 ～ 95.8 ng/ml),前列腺体积中位值45.0 ml(18.3～127.0 ml).由北京和睦家医院全科影像医生根据PI-RADS 2.0进行诊断和PI-RADS评分.之后由首都医科大学附属北京安贞医院1名高年资主治泌尿影像医生单盲重新阅片,同样根据PI-RADS 2.0进行评分.PI-RADS≥3分的患者怀疑有临床意义前列腺癌.分析全科影像医生和泌尿影像医生对前列腺癌,尤其是有临床意义前列腺癌诊断的准确性及阳性预测价值(PPV).结果 全科影像医生诊断PI-RADS评分中位值3.0分,其中1、2、3、4、5分者分别为0、8、19、14、4例.泌尿影像医生诊断PI-RADS评分中位值2.8分,其中1、2、3、4、5分者分别为4、24、5、1、11例,二者的评分分布差异无统计学意义(P =0.064).45例穿刺病理共检出前列腺癌14例,其中有临床意义前列腺癌9例.全科影像医生诊断PI-RADS ≥3分者37例(82.2％),而泌尿影像医生诊断PI-RADS≥3分者17例(37.8％).二者诊断的一致率仅17.8％ (8/45).全科影像医生和泌尿影像医生诊断PI-RADS≥3分对前列腺癌的PPV分别为35.1％(13/37)和76.5％(13/17),对有临床意义前列腺癌的PPV分别为21.6％(8/37)和52.9％(9/17).结论 泌尿影像医生采用PI-RADS评分对有临床意义前列腺癌的预测价值高于全科影像医生.在有泌尿影像诊断经验的中心可以尝试只对高PI-RADS评分患者进行穿刺活检,以减少不必要穿刺.

abstractsObjective To compare the diagnostic accuracy of clinically significant prostate cancer by general radiologist and uroradiology specialist based on the Prostate Imaging Reporting and Data System (PI-RADS).Methods A total of 45 men from Beijing United Family Hospital and Clinics undergoing prostate mpMRI examination and subsequent MRI-targeted biopsy were included in the study.The age of patients was (60.0 ± 8.0) years,the median PSA level was 7.2 ng/ml (1.2-95.8 ng/ml) and the median prostate volume was 45.0 ml (18.3-127.0 ml).The general radiologists from Beijing United Family Hospital and Clinics made the diagnosis according to PI-RADS 2.0.One uroradiology specialist from Beijing Anzhen hospital reviewed all the mpMRIs retrospectively and marked new PI-RADS score based on PI-RADS 2.0.The PI-RADS ≥ 3 lesion was recognized as suspicious of clinically significant prostate cancer.The distribution of PI-RADS score from different doctors and the diagnostic accuracy of clinically significant prostate cancer was compared.Results All the 45 patients underwent MRI-targeted cognitive biopsy and 14 cases of prostate cancer were detected,including 9 cases of clinically significant prostate cancer.There was no significant difference in the distribution of PI-RADS by general radiologist and uroradiology specialist (P =0.064).82.8％ (37/45) and 37.8％ (17/45) patients were diagnosed with PI-RADS ≥ 3 by general radiologist and uroradiology specialist respectively.The interobserver agreement was only 17.8％ (8/45).The positive predictive value of PI-RADS≥3 was 35.1％ (13/37) and 76.5％ (13/17) for prostate cancer by general radiologist and uroradiology specialist respectively,and for clinically significant prostate cancer,the positive predictive value of PI-RADS ≥ 3 was 21.6％ (8/37) and 52.9％ (9/17) respectively.Conclusions Uroradiology specialist achieved significantly superior in predictive value of PI-RADS for clinically significant prostate cancer compared with general radiologist.In the experienced centers,MRI-targeted biopsy could be performed only on high PI-RADS score lesions,thus to reduce unnecessary biopsies and to avoid over diagnosis and over treatment of prostate cancer.