| Part ? The value of the prostate imaging reporting and data system version 2.1 for the diag-nosis of prostate cancerObjective:To evaluate the value of the prostate imaging reporting and data system version 2.1(PI-RADS V2.1)for the diagnosis of prostate cancer based on 3.0-T MRI scanner.Materials and methods:The imaging data of patients with suspicious PCa who underwent a prostate 3.0-T MRI examination prior to a biopsy and subsequent pathologically confirmed at our center from January 2017 to October 2018 was analyzed retrospectively.All the enrolled cases were scanned with the same MRI scanner,sequences,scanning and parameters.All of the mpMRI sequences and scanning parameters were set in accordance with PI-RADS V2.1 recommendations.Pathological samples were obtained by a transrectal ultrasound(TRUS)-guided "10+X" systemic prostatic biopsy.Low-risk PCa was defined as a Gleason score ?3+3,and clinically significant prostate cancer(csPCa)was defined as a Gleason score?3+4.Two radiologists(radiologist 1 and 2)who had received PI-RADS V2.1 interpretation study and practical training performed blinded reviews of the enrolled cases using the PI-RADS V2.1 criteria.For each case,the radiologists provided the PI-RADS V2.1 score of the index lesion respectively.The index lesion is the one with the highest PI-RADS assessment category.If the highest PI-RADS assessment category is assigned to two or more lesions,the index lesion should be the one that shows EPE.Thus,a smaller lesion with EPE should be defined as the index lesion despite the presence of a larger tumour with the identical PI-RADS assessment category.If none of the lesions demonstrate EPE,the largest of the tumors with the highest PI-RADS assessment category should be considered the index lesion.The results of PI-RADS scores of senior doctors(Radiologist 2)were used for follow-up diagnosis efficacy study.The weighted Kappa analysis was performed to evaluate the inter-reader agreement and weighted Kappa ?0.20=poor agreement,0.21-0.40=fair agreement,0.41-0.60=moderate agreement,0.61-0.80=good agreement,and 0.81-1.00=excellent agreement.The trend chi-square test was then performed to evaluate the correlation between PI-RADS V2.1 score and biopsy pathology.Finally,receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic accuracy and effectiveness of PI-RADS V2.1 score system for PCa and csPCa And they was measured by the area under the ROC curve(AUC),sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV).Results:A subset of 433 men were enrolled,aged 41 to 95 years,mean(70.0±8.36)years,median PSA 10.0(6.21-16.20)ng/mL.And 68.1%(295/433)of men were benign,9.7%(42/433)were low-risk PCa,and 22.2%(96/433)were csPCa.Inter-rater agreement of PI-RADS V2.1 score was excellent(weighted Kappa=0.855).Among the radiologist 2 results,12 cases were scored as PI-RADS 1,196 cases were scored as PI-RADS 2,109 cases were scored as PI-RADS 3,53 cases were scored as PI-RADS 4,and 63 cases were scored as PI-RADS 5;the PCa detection rates were 0 6.6%,31.2%,71.7%and 84.1%,and the csPCa detection rates were 0,2.0%,13.8%,49.1%,81.0%,respectively.The the detection rates of PCa and csPCa increases as the score increases(X2=174.94 and 187.88,respectively,both P<0.001).On the other hand,in patients with PI-RADS>3 lesions,the proportion of PI-RADS 3,4,and 5 lesions was 48.4%(109/225),23.6%(53/225),and 28%(63/225),respectively,with PI-RADS 3 lesions have the largest proportion.In the ROC curve analysis,a PI-RADS?4 yielded a sensitivity of 65.9%,a specificity of 91.5%a PPV of 78.4%,and a NPV of 85.2%for predicting PCa with an AUC of 0.864(95%CI:0.828-0.895),and a PI-RADS?4 yielded a sensitivity of 80.2%,a specificity of 88.4%,a PPV of 66.4%,and a NPV of 94.0%for predicting csPCa with an AUC of 0.902(95%CI:0.870-0.928).Conclusions:Our study showed that there was a good inter-rater of PI-RADS V2.1 score with the rise of the PI-RADS V2.1 score system.The detection rates of PCa and csPCa showed a significant upward trend as the score increases.There would be a good accuracy and effectiveness of PCa and csPCa if regarding PI-RADS score 4 as the diagnostic threshold.Patients with suspected PI-RADS 3 lesions still need to be evaluated with clinically relevant indicators.Part ? The value of the prostate imaging reporting and data system version 2.1 for the aggressiveness of prostate cancerObjective:To evaluate the assessed value of the prostate imaging reporting and data system version 2.1(PI-RADS V2.1)for the aggressiveness of prostate cancer based on 3.0-T MRI scanner.Demographic,clinical,MRI,and pathologic dataMaterials and methods:The MRI,clinical,and pathologic data of patients with suspicious PCa who underwent a prostate 3.0-T MRI examination prior to a biopsy and subsequent PCa pathologically confirmed at our center from January 2017 to October 2018 was analyzed retrospectively.All the enrolled cases were scanned with the same scanner,sequences,and scanning parameters.All of the mpMRI sequences and parameters were set in accordance with PI-RADS V2.1 recommendations.Pathological samples were obtained by a transrectal ultrasound(TRUS)-guided "10+X" systemic prostatic biopsy.Low-risk PCa was defined as a Gleason score ?3+3,and medium-high-risk PCa was defined as a Gleason score>3+4.Radiologist 1 counted the Gleason score and the location of cancerous lesions in patients,and those with multiple cancerous lesions were based on the location of the highest Gleason score.Two radiologists(radiologist 2 and 3)who had received PI-RADS V2.1 interpretation study and practical training performed blinded reviews of the enrolled cases using the PI-RADS V2.1 criteria.For each case,the radiologists provided the PI-RADS V2.1 score of the above-mentioned lesion until consensus was reached.Rradiologist 1 collected the PSA series indicators,including tPSA,f/tPSA,and PSAD.Spearman correlation analysis was performed to evaluate the correlation between PSA series indicators,PI-RADS V2.1 score and Gleason score.The Mann-Whitney U test was then performed to evaluate the differences between the above variables in the low-risk and medium-high-risk PCa groups.Finally,receiver operating characteristic(ROC)curve analysis was used to evaluate the efficacy of statistically significant indicators in the single-factor analysis for the differential diagnosis of low-risk and medium-high-risk PCa.Results:A subset of 163 PCa cases were enrolled,aged 46 to 89 years,mean(72.5±8.22)years,median PSA 13.8(7.15-33.00)ng/mL.And 30.1%(41/136)of men were low-risk PCa,and 69.9%(95/136)were medium-high-risk PCa.The values of PSA,PSAD and PI-RADS V2.1 score were positively correlated with Gleason score(r value was 0.437?0.446?0.602,both P<0.001),while the values of f/tPSA were negatively correlated with Gleason score |r| value was 0.206,P<0.001).And PI-RADS V2.1 score had the best correlation.In the Univariate analysis,the differences of PSA,PSAD,f/tPSA and PI-RADS V2.1 score were all statistically significant between low-risk PCa and medium-high-risk PCa group.In the ROC curve analysis,the efficacy of the above-mentioned indictors for the differential diagnosis of low-risk and medium-high-risk PCa were 0.707,0.737,0.638 and 0.813,respectively.And PI-RADS V2.1 score had the best efficacy.Conclusions:Our study showed that PSA series indicators and PI-RADS V2.1 score were not only related to the PCa Gleason score,but also can help diagnose low-risk and medium-high-risk PCa.They can reflect the invasive degree of the prostate cancer to some degree,therefore.And The PI-RADS V2.1 score was more effective than PSA series indicators in evaluating the invasiveness of PCa.Thus,can provide an important reference for clinicians to formulate patient treatment plans. |
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