| PartⅠThe agreement research of two physicians for PI-RADS(v1/ v2)diagnostic scoring at 1.5 T MR equipment and without the endorectal coilObjective: To preliminarily analyze and evaluate the consistency of two physicians for diagnostic scoring of prostate cancer by applying PI-RADS v1 and PI-RADS v2 based on 1.5T MR equipment and without the endorectal coil.Materials and Methods: The clinical,pathological and Mp-MRI data of prostate cancer patients who had 1.5 T prostate Mp-MRI(scanning sequence including: axial high resolution T2 WI,DWI and DCEI)and confirmed by transrectal ultrasound guided prostate system biopsy were retrospective analyzed from December 2009 to December 2015.Finally,a total of 175 cases met this standard and were included in this study,all of them are men,aging from 52 to 92,and the average age was 73.45 ± 6.59.Two independent physicians independently analyzed(both were trained by Mp-MRI PI-RADS v1 and v2 application of prostate;Reader 1: engaged in the diagnosis of prostate MRI ≤ 1 year,the cases of prostate Mp-MRI reading < 300;Reader 2: engaged in the diagnosis of prostate MRI 6 years,the cases of prostate Mp-MRI reading > 2000)the Mp-MRI images of the patients who were included without knowing biopsy results according to the PI-RADS v1 and PI-RADS v2 scoring standard,and scored the lesions in peripheral zone and transition zone respectively,the location of lesions were negotiated jointly by two physicians,the intervaltime of the same physician did the diagnosis score on the same case by using PI-RADS v1 and PI-RADS v2 were more than 3 weeks,record the diagnostic results of two physicians using the PI-RADS v1 and PI-RADS v2 respectively.The inter-reader agreement was tested by weighted Kappa method in PI-RADS v1 and PI-RADS v2(The inter-reader agreement was defined excellent(quadratic weighted k > 0.81),good(quadratic weighted k = 0.61–0.80),moderate(quadratic weighted k = 0.41–0.60),fair(quadratic weighted k = 0.21–0.40)and poor(quadratic weighted k ≤ 0.20)),and the Bland-Altman plot was also drawn for further comparison of the inter-reader agreement of two physicians using PI-RADS v1 and PI-RADS v2 in diagnostic score of the lesions in peripheral zone and transition zone.Results: In lesions of peripheral zone,the agreement of PI-RADS v1 score in different physicians was just fair(quadratic weighted k value was 0.338,95% CI: 0.184 ~ 0.492);the agreement of PI-RADS v2 score in different physicians was also fair(quadratic weighted k value was 0.396,95% CI: 0.251 ~ 0.541).In the transition zone,the agreement of PI-RADS v1 score in different physicians was moderate(quadratic weighted k value were 0.407,95% CI: 0.139 ~ 0.675),the agreement of PI-RADS v2 score in different physicians was good(quadratic weighted k value were 0.658,95% CI: 0.424 ~ 0.892).In all lesions,the agreement of PI-RADS v1 and PI-RADS v2 score was just moderate(quadratic weighted k value were 0.386 and 0.532,95% CI: 0.245 ~ 0.528,0.398 ~ 0.666);The consistency between the two physicians by using PI-RADS v1 and PI-RADS v2 in diagnostic score of transition zone cancer was higher than the peripheral zone cancer.Draw the Bland-Altman scatterplot of the two physicians in diagnostic score of peripheral zone and transition zone cancer by using the PI-RADS v1 and PI-RADS v2 respectively,the results show that the mean of difference values in different physicians,PI-RADS v2 is closer to represent difference of zero line than PI-RADS v1,also revealed that considering the inter-reader agreement of PI-RADS score results in peripheral zone and transition zone cancer,PI-RADS v2 were higher than PI-RADS v1.Conclusion:At 1.5 T MR equipment and without the endorectal coil,PI-RADS v1 and PI-RADS v2 were applied by two physicians to diagnostic score the prostate cancer in peripheral zone and transition zone,the consistency of the two physicians was the highest in transition zone;The consistency of the two physicians by using PI-RADS v2 in cancers of peripheral zone and transition zone were higher than PI-RADS v1.PartⅡ The preliminariy comparison and analysis of diagnostic efficiency of PI-RADS v1 and PI-RADS v2 in identifying clinically significant prostate cancer at 1.5 T MR equipment and without the endorectal coilObjective: The contrast analyzed the diagnostic efficiency differences of PI-RADS v1 and PI-RADS v2 score in different physicians to identify the clinically significant prostate cancer at 1.5 T MR equipment and without the endorectal coil.Materials and Methods: The clinical,pathological and Mp-MRI data of prostate cancer patients who had 1.5 T prostate Mp-MRI(scanning sequence including: axial high resolution T2 WI,DWI and DCEI)and confirmed by transrectal ultrasound guided prostate system biopsy were retrospective analyzed from December 2009 to December 2015.Finally,a total of 175 cases met this standard and were included in this study,all of them are men,aging from 52 to 92,and the average age was 73.45 ± 6.59.The cases of prostate cancer who were included in the study are divided into two groups according to the results of Gleason score: the group of clinically significant cancer include 83 cases(Gleason score ≥ 7),the group of none clinically significant cancer include 92 cases(Gleason score ≤ 6).Two independent physicians independently analyzed(both were trained by Mp-MRI PI-RADS v1 and v2 application of prostate;Reader 1: engaged in the diagnosis of prostate MRI ≤ 1 year,the cases of prostate Mp-MRI reading < 300;Reader 2: engaged in the diagnosis of prostate MRI 6 years,the cases of prostate Mp-MRI reading > 2000)the Mp-MRI images of the patients who were included without knowing biopsy results according to the PI-RADS v1 and PI-RADS v2 scoring standard,and scored the lesions in peripheral zone and transition zone respectively,the location of lesions were negotiated jointly by two physicians,the intervaltime of the same physician did the diagnosis score on the same case by using PI-RADS v1 and PI-RADS v2 were more than 3 weeks,record the diagnostic results of two physicians using the PI-RADS v1 and PI-RADS v2 respectively,and compared with the results of pathology biopsy,the diagnostic ability of PI-RADS v1 and PI-RADS v2 for differentiating clinically significant prostate cancers were determined by ROC curve.The sensitivity and specificity of the two physicians each used PI-RADSv1 and PI-RADS v2 score to diagnosis clinically significant cancer were calculated at a cutoff point that maximized the value of Youden index.The differences of diagnosis efficiency of two physicians in identifying clinically significant cancer with PI-RADS v1 and PI-RADS v2 was compared through the area under the curve(the value of AUC),P < 0.05 was defined as statistically significant.Results: A total of 175 cases of prostate cancer were included in this study,among them,the cancer in the peripheral zone include 116 cases,the cancer in the transition zone include 59 cases;The clinically significant cancer(Gleason score ≥7)include 83 cases and none clinically significant cancer(Gleason score ≤6)include 92 cases.The ROC curve results of readers with different experience using PI-RADSv1 and PI-RADS v2 respectively to diagnosis clinically significant prostate cancer showed that the lower qualification reader could identify the clinically significant cancer in peripheral zone well by using PI-RADS v1 and PI-RADS v2,the AUC values were 0.657(v1)and 0.702(v2),sensitivity 39.02%(v1)and 68.29%(v2)respectively,specificity were 88.68%(v1)and 69.81%(v2).The diagnostic efficiency of lower qualification reader to identify the clinically significant cancer in transition zone with PI-RADS v1 and PI-RADS v2 was limited(P > 0.05).The higher qualification reader could identify the clinically significant cancer in peripheral zone well by using PI-RADS v1 and PI-RADS v2,AUC values were 0.636(v1)and 0.717(v2),sensitivity 51.22%(v1)and 51.22%(v2)respectively,specificity were 69.81%(v1)and 77.36%(v2),the diagnostic performance of PI-RADS v2 was better than that of PI-RADS v1,the difference was statistically significant(Z = 2.344,P = 0.0191).The higher qualification reader could identify the clinically significant cancer in transition zone well by using PI-RADS v1 and PI-RADS v2,the AUC value were 0.762(v1)and 0.740(v2),the sensitivity was 84.21%(v1)and 73.68%(v2),specificity were 62.07%(v1)and 68.97%(v2),the difference of diagnosis efficiency between PI-RADS v1 and PI-RADS v2 had no statistically significant(P > 0.05).Considering the diagnostic efficiency of different PI-RADS versions in identifying clinical significant prostate cancer,the AUC differences had no statistical significance for low qualification radiologist no matter where the lesions are(P > 0.05).Only in the lesions of peripheral zone,the AUC of PI-RADS v2 was statistically different with PI-RADS v1 for high qualification radiologist(Z = 2.344,P = 0.0191).Considering the diagnostic efficiency of different readers in identifying clinical significant prostate cancer,the AUC differences had no statistical significance for PI-RADS v2 in any lesions(P > 0.05),while for PI-RADS v1,only in the lesions of transition zone,the AUC differences was statistically significant between higher and lower qualification radiologists(Z = 2.022,P = 0.0431).Conclusion: This study found that the diagnostic efficiency of higher qualification physician in identifying clinically significant cancer in peripheral zone by using PI-RADS v2 was better than PI-RADS v1 based on 1.5 T MR equipment and without the endorectal coil.After the adoption of PI-RADS v2,the diagnostic efficiency of lower qualification physician in identifying clinically significant cancer can reach the same level of the higher qualification physician,at the same time,PI-RADS v2 simplify the procedure of diagnosis and it is more easily to utilize,and more suitable for the popularization and application between lower qualification radiologists and clinicians,revealed that the clinical applicability of PI-RADS v2 may be higher than PI-RADS v1.Therefore,under the conditions of 1.5 T MR equipment and without the endorectal coil,PI-RADS v2 was recommended in the diagnostic score of prostate Mp-MRI. |
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