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目的探讨前列腺影像报告和数据系统第二版(prostate imaging reporting and data system version2.0,PI-RADS v2)在前列腺疾病中的评分一致性及其在前列腺癌中的诊断价值。方法回顾性分析经超声引导下穿刺活检、并经病理证实的158例前列腺病变的多参数磁共振成像(mp-MRI)表现。由两位观察者盲法对病灶进行评分。Kappa检验对两位观察者评分一致性进行分析,并以穿刺活检病理检查结果为金标准,采用受试者工作特征曲线(ROC曲线)分析观察者1运用PI-RADS v2在前列腺外周带癌和移行带癌中的诊断价值。结果 PIRADS v2在前列腺外周带和移行带病灶中的评分一致性kappa系数分别为0.65和0.61;对于外周带和移行带按前列腺癌的标准病理分级系统(Gleason评分)≥7分的癌灶,PI-RADS v2诊断敏感性、特异性、阳性预测值、阴性预测值分别为88.3%、85.6%、82.7%、89.4%和83.4%、63.9%、69.2%、85.3%。结论 PI-RADS v2对于前列腺外周带和移行带病灶,观察者间一致性高,对外周带Gleason评分≥7分的癌灶,PI-RADS v2可取得较高的诊断敏感性和特异性,但对移行带Gleason评分≥7分的癌灶,虽然诊断敏感性较高,但仍需进一步探索增加其诊断特异性的方法。
Objective To investigate the scoring consistency of prostate imaging reporting and data system version 2.0 (PI-RADS v2) in prostate disease and its diagnostic value in prostate cancer. Methods We retrospectively analyzed the multi-parametric magnetic resonance imaging (MRI) of 158 prostate biopsy specimens confirmed by pathology. Two observers blinded the lesions. Kappa test analysis of the consistency of the two observers score and biopsy pathological examination results as the gold standard, using the receiver operating characteristic curve (ROC curve) analysis of the observer 1 using PI-RADS v2 prostate cancer and Diagnostic value of transitional zone cancer. Results The consistent kappa coefficients of PIRADS v2 in the peripheral and transitional zone of prostate were 0.65 and 0.61, respectively. For peripheral zone and transition zone, the standard pathological grading system of prostate cancer (Gleason score) ≥7 points, PI The sensitivity, specificity, positive predictive value and negative predictive value of -RADS v2 were 88.3%, 85.6%, 82.7%, 89.4% and 83.4%, 63.9%, 69.2% and 85.3% respectively. Conclusions PI-RADS v2 has high sensitivity and specificity for the diagnosis of peripheral lesion and transitional zone of the prostate with high interobserver agreement and peripheral lesions with Gleason score ≥7 and PI-RADS v2 For the lesion with Gleason score≥7, the diagnosis sensitivity is still high, however, it is necessary to further explore ways to increase its diagnostic specificity.