更新前列腺圖像報告和數據系統版本2（PI-RADS v2）用於在具有升高的PSA水平的患者中檢測臨床上重要的前列腺癌
王俊傑、黃哲勳、余家政1、吳東霖1
高雄榮民總醫院 放射線部，1外科部 泌尿科
Updating prostate image reporting and data system version 2 (PI-RADS v2) for the detection of clinically significant prostate cancer in patients with elevated PSA level
Chun-Chieh Wang, Jer-Shyung Huang, Chia-Cheng Yu 1, Tony Tong-Lin Wu 1
Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Division of Urology1, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Purpose: To determine the predictive value of prostate image reporting and data system (PI-RADS v2) for the assessment of clinically significant prostate cancer by multiparametric MRI (mp-MRI) patients with elevated PSA level.
Materials and Methods: A retrospective and prospective study was performed in 255 patients with elevated prostate-specific antigen (PSA) level by 1.5T or 3T mp-MRI. MRI studies containing T2 weighted, diffusion weighted, and dynamic contrast enhancement images. Two experienced abdominal radiologists reviewed images and reported all the studies according to recent PI-RADS v2 scoring system. All suspected lesions were recorded due to multifocal prostate cancer, and then we focused on index lesions (defined by PI-RADS v2) in each patient. Patients who had PI-RADS 3, 4, 5 received either targeted biopsies and systematic biopsies. Clinically significant prostate cancer was defined by PI-RADS v2 (Gleason score (GS) ≥ 3+4 or tumor volume ≥ 0.5 ml). ROC curve for clinically significant prostate cancer using PI-RADS v2 category was analyzed.
Results: 212 patients diagnosed as clinically significant prostate cancer, 197 patients tumor volume ≥ 0.5 ml (any Gleason score) , 15 patients tumor volume < 0.5 ml (GS ≥ 3+4). Area under ROC curve for clinically significant prostate cancer using PI-RADS was 0.816. For the threshold of PI-RADS scores of 3 or greater, sensitivity was 94.81%, specificity was 48.84%, positive predictive value (PPV) was 90.13%, negative predictive value (NPV) was 65.63%. Interobserver agreement for PI-RADS scoring system was excellent (k=0.89).
Conclusion: PI-RADS v2 can be a simple and valuable diagnostic tool for the detection of clinically significant prostate cancer.