Study On The Application Value Of PI-RADS V2.1 In The Diagnosis And Treatment Of Prostate Cance

Part Ⅰ Comparison between Multiparametric and Biparametric MRI DiagnosisStrategy for Prostate Cancer in the Peripheral Zone using PI-RADS Version 2.1 Purpose:To compare and analyse the diagnostic value of PI-RADS v2.1 when used with multiparametric MRI(mpMRI)versus biparametric MRI(bpMRI),DWI versus T2WI to detect peripheral-zone prostate cancer(pzPCa)and clinically significant peripheral-zone prostate cancer(cs-pzPCa).Materials and Methods:The diagnostic efficiencies of mpMRI and bpMRI as well as DWI and T2WI in pzPCa and cs-pzPCa were compared using a PI-RADS score of ≥4 as the positive threshold and prostate biopsy and radical prostatectomy as the reference standards.Results:A total of 307 prostate cases were included in the study,including 142 cases in the non-pzPCa group,165 cases in the pzPCa group,and 130 cases in the cs-pzPCa group,177 cases in the non cs-pzPCa group.The AUCs of mpMRI and bpMRI were 0.717 and 0.733(P=0.317),respectively,for the diagnosis of pzPCa(sensitivities:89.1%and 81.8%;specificities:54.2%and 64.8%,both P<0.001)and 0.708 and 0.725(P=0.309),respectively,for the diagnosis of cs-pzPCa(sensitivities:93.1%and 86.2%,P=0.004;specificities:48.6%and 58.8%,P<0.001).The AUCs of DWI and T2WI were 0.733 and 0.749(P=0.308),respectively,for the diagnosis of pzPCa(sensitivities:81.8%and 84.2%;specificities:64.8%and 66.2%,both P>0.05)and 0.725 and 0.732(P=0.634),respectively,for the diagnosis of cs-pzPCa(sensitivities:86.2%and 87.7%;specificities:58.8%and 58.8%,both P>0.05).Conclusion:AUCs of mpMRI and bpMRI in the diagnosis of pzPCa and cs-pzPCa were similar,and bpMRI had higher diagnostic specificity.BpMRI can be an alternative to mpMRI to optimize the clinical workup.DWI and T2WI exhibited similar diagnostic efficiencies in pzPCa and cs-pzPCa.When the scanning quality of DWI images is poor and subsequently affects the diagnosis of prostate diseases,it should pay more attention to T2WI sequence.Part Ⅱ Effects of Dynamic Contrast Enhancement on Transition Zone Prostate Cancer in Prostate Imaging Reporting and Data System Version 2.1Purpose:To analyse the effects of dynamic contrast enhanced(DCE)-MRI on transitional-zone prostate cancer(tzPCa)and clinically significant transitional-zone prostate cancer(cs-tzPCa)in Prostate Imaging Reporting and Data System(PI-RADS)version 2.1.Materials and methods:The diagnostic efficiencies of T2WI+DWI,T2WI+DCE,and T2WI+DWI+DCE in tzPCa and cs-tzPCa were compared using the score of ≥4 as the positive threshold and prostate biopsy as the reference standard.Results:A total of 425 prostate cases were included in the study:203 cases in the tzPCa group,222 cases in the non-tzPCa group,and 146 cases in the cs-tzPCa group,279 cases in the non cs-tzPCa group.The areas under the curves(AUCs)were 0.863,0.868,and 0.863 for tzPCa,0.840,0.833,and 0.824 for cs-tzPCa in T2WI+DWI,T2WI+DCE,and T2WI+DWI+DCE,respectively.The sensitivity of T2WI+DCE and T2WI+DWI+DCE(84.7%and 85.7%for tzPCa;88.4%and 89.7%for cs-tzPCa,respectively)in diagnosing tzPCa and cs-tzPCa was significantly greater than that of T2WI+DWI(79.3%for tzPCa;82.9%for cs-tzPCa).The specificity of T2WI+DWI(86.5%for tzPCa;74.9%for cs-tzPCa)were significantly greater than those of T2WI+DCE and T2WI+DWI+DCE(68.0%and 68.5%for tzPCa;59.1%and 59.5%for cs-tzPCa,respectively)(all P<0.05).The diagnostic efficacies of T2WI+DCE and T2WI+DWI+DCE had no significant differences(all P>0.05).Conclusions:DCE-MRI can improve the sensitivity of diagnosis and has a potential impact on the detection of tzPCa and cs-tzPCa.Meanwhile,DCE-MRI can clearly show small cancers and is useful for small PCa lesion diagnosis.Part Ⅲ The relationship between preoperative Prostate Imaging Reporting and Data System version 2.1 and Gleason score change after radical prostatectomyPurpose:Biopsy Gleason score(bGS)is sometimes inconsistent with the corresponding Gleason score after radical prostatectomy(pGS).We sought to investigate the relationship between preoperative Prostate Imaging Reporting and Data System version 2.1(PI-RADS v2.1)and Gleason score(GS)change after radical prostatectomy(RP).Materials and methods:The clinical and MRI data of 225 patients with prostate diseases admitted to our hospital from January 2015 to December 2021 were continuously collected.All patients underwent needle biopsies followed by RP.Univariate and multivariate regression analyses were performed to analyse the factors influencing change between bGS and pGS.Receiver operating characteristic curve analysis was performed to estimate the area under curve(AUC)for the prediction of GS upgrading to determine the diagnostic performance of preoperative clinical variables and PI-RADS v2.1.Results:GS after RP was upgraded in 91 cases(40.4%),downgraded in 45 cases(20%)and consistent in 89 cases(39.6%).Univariate analysis showed age,the number of positive biopsy cores(No.of PBCs),bGS and PI-RADS v2.1 score were factors driving a postoperative GS change(all P<0.05).Further multivariate regression analysis showed that ≥4 PBCs,bGS of<7 and PI-RADS v2.1 score of 4-5 were independent predictors of GS upgrading after RP(all P<0.05).The AUCs of No.of PBCs,bGS and PI-RADS v2.1 score were 0.713,0.637 and 0.611,respectively.The AUC of the model combining three independent predictors was 0.817,which was greater than those of the three aforementioned variables alone(all P<0.05).Conclusion:No.of PBCs,bGS,and PI-RADS v2.1 score could help predict preoperative GS upgrading.By combining three independent predictors,the likelihood of prostate cancer undertreatment can be minimized.