Application Value Of PI-RADS V2.1 Score Combined With PSAD And ADC Value In Diagnosis Of Clinically Significant Prostate Cancer

Objective To evaluate the application value of prostate imaging reporting and data system version 2.1(PI-RADS v2.1)score combined with PSAD and ADC value in the diagnosis of clinically significant prostate cancer(cs PCa).Methods 353 patients who underwent 3.0T multiparametric MRI(mp-MRI)examination and prostate biopsy in our hospital from October 2018 to October 2020 were retrospectively analyzed.According to the results of pathological confirmation,they were divided into the cs PCa group(GS≥7 score)and no-cs PCa group(Benign and GS=6 score).Independent sample T test or rank sum test were used to evaluate whether there were significant differences in index variables(age,PSA,prostate volume,PSAD,ADC value and PI-RADS v2.1 score)between the two groups.The logistic regression model was used to perform the multivariate statistical analysis the index variables with statistical significance,and to evaluate the index variables with independent predictive value for cs PCa.Multivariate logistic regression was used to analyze the independent predictors.According to the results,the combine index variables regression models A(PI-RADS v2.1score +PSAD),B(PI-RADS v2.1score +ADC value)and C(PI-RADS v2.1 score+PSAD+ADC value)were established to predict cs PCa.The ROC curve was used to compare the difference of AUC between the combined index variable and the independent predictive index variable.Result Pathological results: among the 353 patients,164 were benign prostatic(BPH:136,prostatitis: 28),189 were prostate cancer(cs PCa: 150,ci PCa: 39).There were significant difference between the index variables(PSA,prostate volume,PSAD,ADC values and PI-RADS v2.1 score)between the cs PCa group and the no-cs PCa group(P<0.05).PSAD,ADC value and PI-RADS v2.1 score were all independent predictors of cs PCa.The AUC corresponding to the area under the ROC curve were 0.598、0.718、0.681、0.815、0.851 and 0.854 for age,PSA,prostate volume,PSAD,ADC values and PI-RADS v2.1 score.The sensitivity and specificity of PSAD,ADC and PI-RADS v2.1score were 79.3%,78.7%,85.3% and 70%,77.3%,79.8% respectively.The AUC values of area under ROC curve of combined model A,B and C were 0.898,0.891 and 0.898,respectively.The sensitivity and specificity were 85.3%,86.7%,88.7% and 80.3%,80.3%,78.3% respectively.There was no significant difference in AUC among the three combined models.The inclusion of PSAD was more valuable for the lesions with PIRADS v2.1 score of 3,and the inclusion of ADC improved the lesions with PI-RADS v2.1 score of 3 and 4.Conclusion PSAD,ADC value and PI-RADS v2.1 score were independent predictors of cs PCa,and PI-RADS v2.1 score had the highest diagnostic efficiency for cs PCa.Combined model A,B and C had better diagnostic efficiency for cs PCa than PI-RADS v2.1 score alone,but the diagnostic efficiency of three combined models was similar.