| Purpose:To investigate the preliminary applicability of PI-RADS for the diagnosis of early prostate cancer (PCa) in the condition of 1.5T multi-parametric magnetic resonance imaging(Mp-MRI):traditional MR imaging(T2WI) in combination with diffusion-weighted imaging(DWI) and dynamic contrast-enhanced imaging (DCE) using a non endorectal coil.Materials and Methods:Collect prostate MRI data of 149 patients which were confirmed pathologically, from 2011.1 to 2014.6. All patients were evaluated by Mp-MRI examination, a combination of traditional MRI(T2WI) plus two kinds of functional MRI(DWI and DCE), were not using endorectal coil; examinations were prior to puncture, operation, frozen, endocrine and radiation related treatment. According to the prostate imaging reporting and data system(PI-RADS), which was proposed by the European Society of Urogenital Radiology(ESUR) in the《magnetic resonance guidelines of prostate》 in 2012 and by Chinese Journal of Radiology working group and editorial board of the diagnosis and treatment of prostate disease in the《MRI examination and diagnosis on prostate cancer)), two MRI radiologists together analysis of 149 cases of patients with prostate disease of T2WI, DWI and DCE images,using a five point scale method to score the possibility of prostate cancer. First of all, the 149 patients were divided into peripheral zone lesions group and the central gland lesions group, calculation of the detection rate of PCa in peripheral zone and central gland using T2WI、DWI and DCE three sequences of 1-5 point, comparison T2WI、DWI and DCE three sequences in the imaging diagnosis score results of two groups with histopathological findings, and then drawing the ROC curve, calculation of the area under the ROC curve (Az value), Z test was used to evaluate the area under the curve (Az value), to compare the diagnostic efficacy for peripheral zone PCa and central gland PCa respectively. Then calculation of T2WI、DWI and DCE sequences and the combination (T2WI+DWI+DCE) of the PCa detection rate, comparison the four methods of imaging diagnosis results with histopathological findings, and then drawing the ROC curve, calculation of the area under the ROC curve (Az value), Z test was used to evaluate the area under the curve (Az value), to compare the three single sequence and the combination diagnostic efficiency for PCa. Finally, calculate the sensitivity and specificity of T2WI、DWI、DCE and the combination in the diagnosis of PCa. The data were analyzed using SPSS 17.0 statistical software, P<0.05 difference was statistically significant.Results:In 149 cases of prostate cancer patients in study group, including the early PCa (TNM stage T1-2N0M0) 64 cases,among them,41 cases of PCa in the peripheral zone, 23 cases of PCa in the central gland,32 cases of prostatitis (located in the peripheral zone), 53 cases of BPH (located in the central gland).In this study, T2WI、DWI and DCE of the three single sequence PI-RADS 1-5 point in peripheral zone of the PCa detection rate respectively:T2WI 1-5 point were:0.00%、 37.50%、18.18%、70.37%、93.75%; DWI1-5 point were:0.00%、16.67%、15.79%、 65.51%、94.74%; DCE 1-5 point were:10.00%、30.00%、40.00%、64.29%、100.00%. T2WI、DWI and DCE of the three single sequence 1-5 point in central gland of the PCa detection rate respectively:T2WI 1-5 point were:0.00%、20.69%、28.00%、70.00%、 100.00%; DWI 1-5 point were:0.00%、7.69%、21.05%、70.58%、100.00%; DCE 1-5 point were:6.67%、23.53%、36.36%、33.33%、100.00%. In the peripheral zone lesion group, the area of ROC curve(Az) of T2WI, DWI and DCE were 0.800、0.840、0.826. The difference between the three single sequence was not statistically significant (P> 0.05).In the central gland lesion group, the Az of T2WI, DWI and DCE were:0.763、0.882、0.701,the Az value of DCE was the smallest of the three, the difference between DCE and T2WI、T2WI and DWI had no statistical significance (P> 0.05), the difference between DCE and DWI had statistical significance (P< 0.05).In this study, T2WI、DWI、DCE and the combination of the three sequences of PI-RADS 1-5 point in PCa detection rate respectively:T2WI 1-5 point were:0.00%、 24.32%、23.40%、70.27%、94.73%; DWI 1-5 point were:0.00%、9.38%、18.42%、 67.39%、95.83%; DCE 1-5 point were:8.00%、25.93%、37.50%、52.17%、100.00%; and the combination of the three sequences 1-5 point were:0.00%、6.25%、7.31%、83.72%、 95.83%. The Az of T2WI、DWI、DCEand the combination of these three sequences (T2WI+DWI+DCE) in the diagnosis of PCa were 0.804、0.875、0.787、0.931. The difference between T2WI and DWI、T2WI and DCE、DWI and DCE、DWI and the combination had no statistical significance (P> 0.05), the difference between T2WI and the combination、DCE and the combination had statistical significance (P<0.05). The sensitivity and specificity of T2WI、DWI、DCE and the combination of these three sequences (T2WI+DWI+DCE) were 68.8%、84.4%、67.2% and 92.2%; the specificity were 85.9%、81.2%、74.1% and 90.6%.Conclusion:In the condition of non endorectal coil,1.5T Mp-MRI examination of the prostate, the application of PI-RADS is useful in diagnosis early PCa, but there are some false positive and false negative cases in the single sequence from 1 to 5 point. Diagnostic value of T2WI、DWI、DCE sequence using PI-RADS for the peripheral zone PCa and the central gland PCa is medium; for the diagnosis of peripheral zone PCa, the diagnostic efficiency of the three single sequence are very similar; for the diagnosis of central gland PCa, diagnostic efficacy of DWI and T2WI is better than DCE. The diagnostic efficiency of the combination(T2WI+DWI+DCE) using PI-RADS for the diagnosis of PCa is good, the diagnostic performance is significantly higher than T2WI and DCE, slightly higher than DWI. Thus, under the condition of non endorectal coil,1.5T Mp-MRI examination of the prostate, the application of PI-RADS has good diagnostic performance, it has the practical possibility of clinical application in china. Of course, the clinical applicability of 1.5T Mp-MRI PI-RADS in diagnosis for early PCa remains to be further multi-center, large sample support of clinical study. |
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