Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment / 亚洲男科学杂志(英文版)

Prostate cancer (PCa) is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) to classify men with PCa, clinically significant PCa (CSPCa), or no PCa, especially among those with serum total prostate-specific antigen (tPSA) levels in the "gray zone" (4-10 ng ml-1). A total of 308 patients (355 lesions) were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density (PSAD) were independent predictors of PCa and CSPCa. A PI-RADS v2 score ≥4 provided high negative predictive values (91.39% for PCa and 95.69% for CSPCa). A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group (PI-RADS score = 5 and PSAD ≥0.15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score ≥4 with high tPSA level) with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.

Diagnostic Performance and Interobserver Consistency of the Prostate Imaging Reporting and Data System Version 2: A Study on Six Prostate Radiologists with Different Experiences from Half a Year to 17 Years / 中华医学杂志(英文版)

<p><b>Background</b>One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic performance of PI-RADS v2 scores in the detection of clinically significant prostate cancer (PCa).</p><p><b>Methods</b>From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale (1-5 scores) from six blinded readers (with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2). The correlation among the readers' scores and the Gleason score (GS) was determined with the Kendall test. Intra-/inter-observer agreement was evaluated using κ statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores.</p><p><b>Results</b>Based on the PI-RADS v2, the median κ score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively; the average correlation between the six readers' scores and the GS was positive, exhibiting weak-to-moderate strength (r = 0.391, P = 0.006). The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively.</p><p><b>Conclusion</b>The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.</p>

Diagnostic value of prostate image report and data system (PIRADS version 2) in prostate cancer with grey zone of prostate specific antigen / 重庆医学

Objective To access the diagnostic value of Prostate Imaging Reporting and Data System (PIRADS version 2)for prostate cancer (PCa) in prostate specific antigen (PSA) grey zone(4-10 ng/mL).Methods Treatment naive PCa and BPH patients with an increase of PSA 4-10 ng/mL from 2200 patients underwent prostate MRI from 2012 to 2016 were included,multiparameter magnetic resonance imaging (mp-MRI) prior biopsy or prostatectomy and clinical data were obtained,mp-MRI were retrospectively analyzed quantitatively by a radiology expert with 15 years experience in urogenital system imaging diagnosis and a doctor with 5 years experience in radiology diagnosis blind to the pathology results according to PIRADS v2,PIRADS v2 score and lesion zone were recorded respectively,in case of disagreement,dicision was made through discuss.TRUS guided biopsy or prostatectomy pathology serves as gold reference.Diagnostic value of PIRADS v2 for PSA grey zone PCa was calculated by receiver operating characteristic (ROC) curve,logistic regression analysis was used to access the risk factors of PCa.Results 15 PCa and 30 BPH patients were in eluded.There was no significant difference between these two groups in age,tPSA,fPSA,f/tPSA,prostate volume and PSA density.The area under ROC curve of PIRADS v2 in diagnosing PCa was 0.932[95 ％ CI 0.822-0.984],P＜0.01.Using a cutoff PIRADS＞4,the diagnosis sensitivity was 88.89 ％,specificity 87.10 ％,and positive predictive value 80 ％,negative predictive value 93.10％,respectively.Logistic regression analysis showed that PIRADS v2 score was an independent risk factor for predicting PCa,with a hazard ratio 17.847[3.745-85.078],P＜0.01.There was a positive correlation between PIRADS v2score and gleason score,r=0.585,P=0.022.Conclusion PIRADS v2 has a significantly high diagnosis value in diagnosing PSA grey zone PCa and a good correlation with pathology results.

Diffusion-weighted imaging of the scrotum：readout-segmented echo-planar imaging versus single-shot echo-planar imaging / 中华放射学杂志

Objective The purpose of this study was to compare the image quality of readout-segmented EPI (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in patients with scrotal diseases. Methods Initial diagnosis of scrotal diseases were included in the prospective study, all patients underwent scrotum routine MRI and RS-EPI, SS-EPI sequence at 3.0 T. A total of 38 patients were recruited qualitative assessment ,and 29 patients proved by operation and pathology (malignant 21 cases and benign 8 cases) were included quantitative analysis.For qualitative comparison of image quality, two readers independently assessed the two sets of DWI, which consisted of identification of structure and geometric distortion of scrotum (epididymis,testes, lesion) using a 5-point Likert scale. For assessment of image parameters, signal-to-noise ratio (SNR), contrast, contrast-to-noise ratio (CNR),apparent diffusion coefficient value of normal testis and testis distortion ratio of anatomical(T2WI)/DWI fusion image were calculated. Inter-observer agreement was assessed with the Kappa statistics, the differences of scores of RS-EPI and SS-EPI were compared by using Wilcoxon rank-sum test, and image parameters were compared by using paired sample t test. Results There was good reader agreement in the scores, the Kappa value were 0.77, 0.74, 0.80, 0.87. The difference of identification of structure and geometric distortion on RS-EPI and SS-EPI had statistic significance, the RS-EPI was superior to SS-EPI in image quality (all P<0.05).The SNR, contrast of benign lesion for two sequences had no statistic significance(P values were 0.352, 0.124, respectively), but the difference of CNR had statistic significance(P<0.05). The SNR,contrast and CNR of malignant lesion for two sequences had statistic significance (all P<0.05). The mean size of the testis was (35.61 ± 9.78)mm, the mean distance in fusion image of RS-EPI or SS-EPI with T2WI were (3.80 ± 1.32)mm and (7.54 ± 2.62)mm, and the mean distortion ratios of the two set were (11.1 ± 0.6)% and (22.4 ± 19.2)%, respectively, the difference of two sets had statistic significance(P<0.05). There was no significant difference in the ADC obtained by using either DWI method(t=0.396,P=0.796), the mean ADC values of normal testes for RS-EPI and SS-EPI, respectively, were (1.18 ± 0.06) × 10-3mm2/s, (1.24 ± 0.11) × 10-3mm2/s.Conclusion RS-EPI DWI images is a feasible technique in the scrotum for producing high-resolution DWI with reduced geometric distortion and offers potentially superior image quality compared to SS-EPI at 3.0 T.