Utility Of Multiparameter Magnetic Resonance Imaging To Predict Prostate Cancer Diagnosis And Risk Assessment

Part ⅠClinically Significant Prostate Cancer Detection with PIRADS v2.1 on MP-MRI:Diagnostic Efficacy and Interobserver AgreementObjective To evaluate the diagnostic performance and the interobserver agreement of the prostate imaging reporting and data system version 2.1(PIRADS v2.1)in the detection of clinically significant prostate cancer(csPCa).Patients and Methods The imaging and clinical data of 634 patients with prostate diseases were confirmed by prostate biopsy or radical prostatectomy(RP)who underwent prostate MP-MRI(T2WI/FS-T2WI,DWI or Zoomit-DWI,DCEMRI)in our hospital due to the increase of prostate specific antigen(PSA)from June 2015 to December 2020 were collected ambispectively.561 of them were enrolled in this study after excluded the patients who had performed therapy,limited data or overlapping features with other tumors.The patients were 28～92(median 67)years old.Two radiologists with different experience in our hospital analyzed the MP-MRI images of each patient according to the PI-RADS v2.1 scoring standard.The readers were blinded to the pathological results.Spss23.0 was used to analyse the PI-RADS score obtained by each patient compare with the results of histopathology.Chi-square(R×C)test performed to compare the detection rates of csPCa based on PI-RADS score from two doctors.Receive operating characteristic(ROC)curve were generated using all PI-RADS scores by two doctors,and its sensitivity,specificity as well as diagnostic accuracy of MP-MRI for csPCa were calculated respectively.The interobserver agreement between senior and junior doctors were compared by kappa test.Results All the 561 cases were confirmed by biopsies and meet the requirements of this study.Include Benign prostatic hyperplasia(BPH)168 cases,prostatitis 49 cases,Prostate intraepithelial neoplasia(PIN)20 cases,clinically insignificant Pca(ciPCa)48 cases,285 patients in all,named "non-csPCa".CsPCa 276 patients,include 69 cases in ISUP grade 2,77 cases in ISUP grade 3,60 cases in ISUP grade 4,and 70 cases in ISUP grade 5.The differences of detection rates of csPCa based on PI-RADS score from both junior and senior doctors was statistically significant(x2=248.622,277.950,P=0.000),the detection rate of 5 score was 83.6%,88.6%;4 was55.3%,69.4%;3 was 49.3%,40.8%.The sensitivity,specificity and accuracy for the detection of csPCa were74.3%,81.4%and 86.1%(95%CI:0.830-0.892)by junior doctors,as the cutoff was>3;and 79.0%,86.7%,89.5%(95%CI:0.868-0.922)for senior doctors.The agreement of PI-RADS v2.1 score in different experience physicians was good(k=0.630,95%CI:0.583-0.677,P<0.001).Conclusion Based on MP-MRI,prostate cancer can be diagnosed effectively according to PI-RADS v2.1 five-point scoring system by radiologists with different experience.The agreement of PI-RADS v2.1 scoring was good among different experience readers.Part ⅡThe Value of MP-MRI and BP-MRI in Diagnosis and Risk Assessment of CsPCa:Semi Quantitative and Quantitative AnalysisObjective To investigate the independent and comprehensive diagnostic efficacy of semi quantitative and quantitative parameters(PSA density,PI-RADS score,T2WI score,ADC,Ktrans and Kep)based on MP-MRI or BP-MRI for detecting csPCa,and establish the regression equation.Evaluate the value of quantitative parameters in predicting the Gleason grading and D’Amico risk stratification of prostate cancer.Patients and Methods 561 patients with biopsy-confirmed prostate diseases who underwent preoperative MP-MRI(T2WI/FS-T2WI,DWI or Zoomit-DWI,DCE-MRI)were included in the study(276 csPCa and 285 noncsPCa).Prostate volume was measured for the calculation of prostate specific antigen density(PSAD).Prostate index lesions were scored on a five-point scale on T2WI images(T2WI scor)and MP-MRI images(PI-RADS score)by a senior radiologist.DWI and DCE-MRI images were post-processed to measure the corresponding quantitative parameters of the index lesion,including ADC,Kep and Ktrans values.According to the pathological results after biopsy divided into two groups as csPCa and non-csPCa.The predictors of csPCa were screened by logistics regression analysis,predictive models were established and ROC curves were used to evaluate the efficacy of each parameters and the model in diagnosing csPCa,comparisons were conducted by DeLong test.Associations between the parameters and Gleason grading and D’Amico risk rank of prostate cancer were analyzed with the Kendall’s tau-b rank correlation coefficient.Rank sum test was used to analyze the differences of ADC values among different prostate pathological types.Result Compared with non-csPCa patients,patients with csPCa had higher PS AD,Kep and Ktrans value(0.124[0.069,0.250]ng/ml2 vs 0.280[0.076,0.739]ng/ml2,1.390[1.014,1.980]/min vs 1.893[1.125,2.619]/min,1.018[0.660,1.414]/min vs 1.264[0.674,1.830]/min),lower ADC value(1.024[0.851,1.200]×103mm2/s vs 0.680[0.577,0.779]×10-3mm2/s)(all P<0.05).In categorical variables,the higher the T2WI and PI-RADS score,the higher the proportion of csPCa(x2=283.327 and 277.950,P=0.000).The diagnostic efficacy of csPCa(AUC=0.918,P<0.05)by BP-MRI T2WI score(OR=2.734,95%CI:2.199～3.398,P=0.000)and ADC value(OR=0.088,95%CI:0.029～0.266,P=0.000)combined with PSAD(OR=1.639,95%CI:1.223～2.197,P=0.001)was better than PIRADS scores(AUC=0.895,P<0.05).The combined MP-MRI PI-RADS score(OR=3.064,95%CI:2.428～3.866,P=0.000),ADC value(OR=0.095,95%CI:0.032～0.288,P=0.000)and PSAD(OR=1.554,95%CI:1.170～2.064,P=0.002)had the highest diagnostic efficacy for csPCa(AUC=0.923,P<0.05).There was a good and significant negative correlation between ADC value and prostate Gleason grading(t=-0.730,p<0.001),and moderate between ADC value and D’Amico risk rank of prostate cancer(t=-0.394,P<0.001).There was a moderate but significant positive correlation between PSAD,PI-RADS score,T2WI score and Gleason grading(t=0.404,0.620,0.593,P<0.001),and between PSAD,PI-RADS score,T2WI score and D’Amico risk rank(t=0.584,0.435,0.480,P<0.001).Statistically significant differences between median values in different prostate diseases to Kruskal-Wallis test were obtained for ADC(H=311.436,P<0.001).Conclusion The MP-MRI PI-RADS score,BP-MRI T2WI score,ADC value and PSAD parameters had independent diagnostic efficacy for csPCa,but the quantitative parameters of DCE did not influence the diagnostic accuracy.The diagnostic efficacy of csPCa by BP-MRI T2WI score and ADC value combined with PSAD was better than MP-MRI PI-RADS scores.The combining of PIRADS score,ADC value and PSAD had the highest diagnostic efficacy for csPCa.PI-RADS score,T2WI score,ADC value and PSAD can indicate the invasiveness and prognosis of prostate cancer to a certain extent,and ADC value has the significant effect on the pathological type predict.