Magnetic Resonance Elastography Combined With PI-RADS v2.1 for the Identification of Clinically Significant Prostate Cancer

IF 3.5 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Magnetic Resonance Imaging Pub Date : 2024-11-08 DOI:10.1002/jmri.29653

Jie Chen MD, Yuntian Chen MD, Guoyong Chen MS, Liping Deng MS, Yuan Yuan MS, Hehan Tang PhD, Zhen Zhang MS, Tingyu Chen MS, Hao Zeng MD, Enyu Yuan MD, Meng Yin PhD, Jun Chen PhD, Bin Song MD, Jin Yao MD

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Abstract

Background

Multiparametric MRI may cause overdiagnosis of clinically significant prostate cancer (csPCa) with the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1).

Objectives

To investigate the diagnostic performance of stiffness as a standalone and complementary marker to PI-RADS v2.1 for diagnosing csPCa.

Study Type

Prospective.

Subjects

One hundred forty-seven participants with pathologically confirmed prostate lesions (≥1 cm), including 71 with csPCa.

Field Strength/Sequence

T1-weighted fast spin-echo, T2-weighted fast spin-echo, single-shot echo-planar diffusion-weighted imaging, fast 3D gradient-echo T1-weighted dynamic contrast-enhanced imaging, and 3D single-shot spin-echo based echo-planar MR elastography at 3.0 T.

Assessment

The PI-RADS v2.1 score was assessed by three radiologists independently. Lesion shear stiffness (SS) values at 60 Hz and 90 Hz were measured. A modified PI-RADS integrating stiffness with PI-RADS v2.1 was developed. Diagnostic performance for csPCa was compared between stiffness, PI-RADS v2.1 and the modified PI-RADS.

Statistical Test

Spearman's correlation, Fleiss κ and intraclass correlation, Pearson correlation, one-way analysis of variance, area under the receiver operating characteristic curve (AUC), and the Delong test. Significance level was P < 0.05.

Results

In the peripheral zone, csPCa (N = 35) had significantly higher SS than non-csPCa at 60 Hz (3.22 ± 0.66 kPa vs. 2.56 ± 0.56 kPa) and at 90 Hz (5.64 ± 1.30 kPa vs. 4.48 ± 0.84 kPa). PI-RADS v2.1 showed 100% sensitivity, 58% specificity, and 0.79 AUC for detecting csPCa. SS achieved 97% sensitivity, 52% specificity, and 0.80 AUC at 60 Hz, while SS had 63% sensitivity, 87% specificity, and 0.78 AUC at 90 Hz. The modified PI-RADS, combing SS at 60 Hz with PI-RADS v2.1, resulted in a significantly increased AUC (0.86) compared to that of PI-RADS v2.1, with a sensitivity of 97% and specificity of 75%.

Data Conclusion

Stiffness can help identifying csPCa in the peripheral zone. Combining stiffness with the PI-RADS v2.1 improved the diagnostic accuracy and specificity for csPCa.

Evidence Level

Technical Efficacy

Stage 2

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磁共振弹性成像与 PI-RADS v2.1 版相结合，用于鉴别具有临床意义的前列腺癌。

背景：使用前列腺成像报告和数据系统2.1版（PI-RADS v2.1）进行多参数磁共振成像可能会导致对有临床意义的前列腺癌（csPCa）的过度诊断：研究类型：前瞻性：研究对象147名经病理证实患有前列腺病变（≥1厘米）的参与者，其中71人患有csPCa：场强/序列：T1加权快速自旋回波、T2加权快速自旋回波、单次回波平面弥散加权成像、快速三维梯度回波T1加权动态对比增强成像、基于回波平面的三维单次自旋回波MR弹性成像（3.0 T）：PI-RADS v2.1 评分由三名放射科医生独立评估。测量病变在 60 Hz 和 90 Hz 下的剪切硬度（SS）值。开发了将僵硬度与 PI-RADS v2.1 相结合的改良 PI-RADS。对僵硬度、PI-RADS v2.1 和修改后的 PI-RADS 的 csPCa 诊断性能进行了比较：Spearman相关性、Fleiss κ和类内相关性、Pearson相关性、单因素方差分析、接收者操作特征曲线下面积（AUC）和Delong检验。显著性水平为 P 结果：在外周区，csPCa（N = 35）在 60 Hz（3.22 ± 0.66 kPa 对 2.56 ± 0.56 kPa）和 90 Hz（5.64 ± 1.30 kPa 对 4.48 ± 0.84 kPa）时的 SS 明显高于非 csPCa。PI-RADS v2.1 检测 csPCa 的灵敏度为 100%，特异性为 58%，AUC 为 0.79。在 60 Hz 时，SS 的灵敏度为 97%，特异性为 52%，AUC 为 0.80；在 90 Hz 时，SS 的灵敏度为 63%，特异性为 87%，AUC 为 0.78。与 PI-RADS v2.1 相比，将 60 Hz 时的 SS 与 PI-RADS v2.1 结合使用的改良 PI-RADS 使 AUC（0.86）显著增加，灵敏度为 97%，特异性为 75%：数据结论：僵硬度有助于识别外周区的 csPCa。将僵硬度与 PI-RADS v2.1 结合使用可提高 csPCa 的诊断准确性和特异性。

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来源期刊

Journal of Magnetic Resonance Imaging 医学-核医学

CiteScore

9.70

自引率

6.80%

发文量

494

审稿时长

2 months

期刊介绍： The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.