目的:调查读者之间的协议,对于接受局灶性高强度聚焦超声(HIFU)治疗的局限性前列腺癌患者,应用多参数MRI(mpMRI)的局灶性消融后前列腺成像(PI-FAB)评分的诊断性能。
方法:在本回顾性研究中,IRB批准,单中心研究,73人,他们接受了局灶性HIFU治疗,并接受了随后的前列腺活检的MPMRI随访,包括在内。由具有不同经验水平的两名放射科医师在HIFU后6、12和36个月将PI-FAB评分应用于随访MRI。使用Gwet'sAC1评估读者间的一致性,并评估PI-FAB评分的诊断性能与每位读者随后前列腺活检的组织病理学结果的关系。
结果:PI-FAB分数显示出实质性到几乎完美的读者之间的一致性(AC1:0.80-0.95),并显示出高特异性(读者1:90-98%,读者2:87-98%)和NPV(读者1:91-100%,读者2:88-97%)排除HIFU后残留或复发的野外前列腺癌。灵敏度(阅读器1:≥43%,读者2:≥14%)和PPV(读者1:≥33%,读者2:≥14%)大多相对较低,两位读者之间存在显著差异,表明放射科医生经验的潜在影响。
结论:PI-FAB评分为使用mpMRI监测HIFU后前列腺癌提供了一致且可靠的工具。它显示出实质性到几乎完美的读者之间的一致性,并且在排除HIFU治疗后的现场残留或复发性前列腺癌方面特别有效。它的应用可能会增强治疗后的患者护理,强调其作为前列腺局灶性消融治疗后基于MRI的非侵入性监测方法的价值。
OBJECTIVE: To investigate inter-reader agreement, and diagnostic performance of the Prostate Imaging after Focal Ablation (PI-FAB) score applied to multiparametric MRI (mpMRI) in patients who underwent focal high-intensity focused ultrasound (
HIFU) therapy for localized prostate cancer.
METHODS: In this retrospective, IRB-approved, single-center study, 73 men, who underwent focal
HIFU treatment and received follow-up mpMRIs with subsequent prostate biopsies, were included. The PI-FAB score was applied to follow-up MRIs at 6, 12, and 36 months post-
HIFU by two radiologists with different experience levels. Inter-reader agreement was assessed using Gwet\'s AC1, and the diagnostic performance of the PI-FAB score was assessed in relation to histopathologic results of subsequent prostate biopsies for each reader.
RESULTS: PI-FAB scores showed substantial to almost perfect inter-reader agreement (AC1: 0.80-0.95) and demonstrated high specificity (Reader 1: 90-98 %, Reader 2: 87-98 %) and NPVs (Reader 1: 91-100 %, Reader 2: 88-97 %) in ruling out residual or recurrent in-field prostate cancer post-
HIFU. Sensitivity (Reader 1: ≥43 %, Reader 2: ≥14 %) and PPVs (Reader 1: ≥33 %, Reader 2: ≥14 %) were mostly relatively lower, with notable disparities between the two readers, indicating the potential influence of radiologist experience.
CONCLUSIONS: The PI-FAB score provides a consistent and reliable tool for post-
HIFU monitoring of prostate cancer using mpMRI. It demonstrates substantial to almost perfect inter-reader agreement and is particularly effective in excluding in-field residual or recurrent prostate cancer post-HIFU treatment. Its application can potentially enhance post-treatment patient care, emphasizing its value as a non-invasive MRI-based monitoring approach after focal ablative therapy of the prostate.