多参数磁共振对有临床意义前列腺癌的诊断价值

doi:10.19558/j.cnki.10-1020/r.2021.02.008

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摘要 目的： 在经前列腺穿刺确诊前列腺癌的患者中以根治性前列腺切除（RP）术后病理为对照,研究多参数磁共振（mp-MRI）对有临床意义前列腺癌（csPCa）诊断的准确性,并对csPCa的因素进行分析。方法： 回顾性分析2014年8月–2020年8月于北京医院泌尿外科接受RP、且术前行mp-MRI检查和前列腺穿刺活检患者的相关临床资料,1名放射科医生根据前列腺影像报告和数据系统版本2（PI-RADSv2）进行盲法阅片,前列腺活检病理和RP术后病理分别由2名病理科医生回顾阅片并作出诊断。以RP术后病理作为对照,分析mp-MRI对csPCa的诊断能力,并对csPCa预测的相关因素进行分析。结果： 纳入285例患者,年龄平均（68.0±6.5）岁,PSA平均（14.1±14.0）μg/L。其中260例（91.23%）csPCa以PI-RADSv2评分3分为临界值,mp-MRI对csPCa诊断的敏感性、特异性、阳性预测值和阴性预测值分别为90.38%、56.00%、95.53%和35.90%,曲线下面积（AUC）0.815。Bland-Altman分析显示PI-RADS v2评分与穿刺病理Gleason评分、RP术后病理Gleason评分的pearson相关系数分别为0.309（P<0.001）和0.396（P<0.001）。多因素分析显示,PI-RADS v2评分、癌占穿刺组织最大百分比和穿刺阳性针数百分比是csPCa的独立预测因素（P=0.003、P=0.001、P=0.022）。对活检时Gleason评分为6分的患者（76例,26.67%）进行亚组分析,mp-MRI对该亚组RP术后csPCa诊断的AUC为0.739,多因素分析显示,PI-RADS v2评分和癌占穿刺组织最大百分比是该亚组患者csPCa的独立预测因素（P=0.022、P=0.001）。结论： 前列腺癌患者术前多参数磁共振的PI-RADSv2评分是鉴别csPCa可靠而有效的手段,并且与肿瘤的Gleason评分有较好的一致性。

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	王萱
	谢江凌
	李春媚
	何磊
	龙星博
	王淼
	方芳
	万奔
	王建业
	刘明

关键词 ：有临床意义前列腺癌, 多参数磁共振, 根治性前列腺切除术

Abstract：Objective： To study the diagnostic accuracy of multiparametric magnetic resonance imaging （mpMRI） on clinically significant prostate cancer （csPCa） in patients with prostate cancer confirmed by prostate biopsy, and to analyze the predictive factors of csPCa. The results of mpMRI were compared with the radical prostatectomy （RP） specimens. Methods： The clinical data of patients who underwent RP in Urology Department of Beijing Hospital from August 2014 to August 2020 were retrospectively collected. These patients who underwent mp-MRI examination and prostate biopsy in our hospital before RP were enrolled. Prostate MR images were interpreted by one radiologist who were blinded to pathology results based on Prostate Imaging Reporting and Data System version 2 （PI-RADS v2）, and the specimens of prostate biopsy and RP were reviewed by two pathologists respectively. The diagnostic abilities of mpMRI for the detection of csPCa were analyzed using the pathology of RP specimens as the reference standard, and the predictive factors of csPCa were analyzed. Results： A total of 285 patients were included for analysis. The mean age was （68.0 ± 6.5） years and mean preoperative PSA was （14.1 ± 14.0） μg/L. CsPCa was found in 91.23% （260/285） of patients. MpMRI PIRADS v2 score ≥ 3 had a 90.38% sensitivity, 56.00% specificity, 95.53% positive predictive value （PPV） and 35.90% negative predictive value （NPV） for csPCa. In ROC curve analysis, the area under the ROC curve （AUC） was 0.815. Bland-Altman analysis showed that the pearson correlation coefficients of PI-RADS v2 score with biopsy Gleason score and Gleason score after RP were 0.309 （P < 0.001） and 0.396 （P < 0.001）, respectively. Multivariate analysis showed that PI-RADS v2 score, greatest percentage of biopsy core, and percentage of positive biopsy cores were independent predictors of csPCa （P = 0.003, P = 0.001, and P = 0.022）. A subgroup analysis was performed on patients with Gleason score of 6 on prostate biopsy （76 cases, 26.67%）. The AUC of csPCa diagnosis after RP in this subgroup was 0.739 by mp-MRI. Multivariate analysis showed that PI-RADS v2 score and greatest percentage of biopsy core were independent predictors of csPCa in this subgroup （P = 0.022, P = 0.001）. Conclusions： PI-RADS v2 score of preoperativemp MRI is a reliable and effective method to identifycs PCa in patients with prostate cancer, and it has good consistency with Gleason score of the tumor.

Key words： clinically significant prostate cancer multiparametric magnetic resonance imaging radical prostatectomy

收稿日期: 2020-03-31

基金资助:中央高校基本科研业务费专项资金（3332020069）; 北京医院临床研究121工程项目（BJ-2018-090）; 北京市自然科学基金项目（7194315）; 北京医院院级课题（BJ-2015-138）

通讯作者: 刘明,liuming19731029@163.com

引用本文:

王萱, 谢江凌, 李春媚, 何磊, 龙星博, 王淼, 方芳, 万奔, 王建业, 刘明. 多参数磁共振对有临床意义前列腺癌的诊断价值[J]. 微创泌尿外科杂志, 2021, 10(2): 111-117.
WANG Xuan, XIE Jiangling, LI Chunmei, HE Lei, LONG Xingbo, WANG Miao, FANG Fang, WAN Ben, WANG Jianye, LIU Ming. Diagnostic Value of Multiparametric MRI in Clinically Significant Prostate Cancer. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(2): 111-117.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1665.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2021/V10/I2/111

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