目的:随着前列腺磁共振成像(MRI)的广泛应用,在前列腺MR中对病变检测和准确诊断的需求不断增加,这在很大程度上依赖于令人满意的图像质量。重点关注前列腺成像报告和数据系统(PI-RADS)中涉及的主要序列,这项研究评估了临床实践中常见的质量问题(如信噪比(SNR)、神器,边界,和增强)。该研究的目的是确定图像质量对临床意义的前列腺癌(csPCa)检测的影响,阳性预测值(PPV)和放射科医生在不同序列和前列腺区的诊断。
方法:本回顾性研究包括2021年2月至2022年12月进行前列腺MRI检查并有明确病理报告的306例患者。所有组织病理学标本均根据国际泌尿外科病理学会(ISUP)的建议进行评估。ISUP等级组≥2被认为是csPCa。来自不同中心的三个放射科医生分别从以下十个方面对图像质量进行了二进制分类评估:(1)轴平面中的T2WI:SNR,前列腺边界条件,伪影的存在;(2)矢状面或冠状面中的T2WI:前列腺边界条件;(3)DWI:SNR,外围区和过渡区之间的轮廓,文物的存在,DWI和T2WI图像的匹配;(4)DCE:闭孔动脉增强的评价,动态对比度增强的评价。Fleiss\'Kappa用于确定读者之间的协议。使用Wilson的95%置信区间(95%CI)计算PPV。采用卡方检验计算统计学意义。P值<0.05被认为是统计学上显著的。
结果:高质量的图像在轴向T2WI中具有更高的csPCa检出率(56.5%至64.3%),DWI,DCE,轴向T2WI的SNR有显著的统计学差异(p0.002),轴向T2WI中存在伪影(p0.044),DWI中存在伪影(p<0.001),DWI和T2WI图像的匹配(p<0.001)。高质量图像具有较高的PPV(72.5%至78.8%),并且在轴向T2WI中显示出显着的统计学意义,DWI,DCE。此外,我们发现PI-RADS3(24.0%至52.9%)比PI-RADS4-5(20.6%至39.3%)包含更多的低质量图像,在轴向T2WI(p0.048)和DWI中存在伪影(p0.001)的前列腺边界条件方面存在显着统计学差异。关于不同前列腺区的csPCa检测与图像质量之间的关系,这项研究发现,仅在外周区(PZ)的高图像(63.5%~75.7%)和低质量图像(30.0%~50.0%)之间观察到显著的统计学差异.
结论:前列腺MRI质量可能对诊断性能有影响。较差的图像质量与较低的csPCa检测率和PPV相关,这可能导致放射科医生诊断模糊的增加(PI-RADS3),尤其是位于PZ的病变。
OBJECTIVE: With the widespread clinical application of
prostate magnetic resonance imaging (MRI), there has been an increasing demand for lesion detection and accurate diagnosis in
prostate MR, which relies heavily on satisfactory image quality. Focusing on the primary sequences involved in Prostate Imaging Reporting and Data System (PI-RADS), this study have evaluated common quality issues in clinical practice (such as signal-to-noise ratio (SNR), artifacts, boundaries, and enhancement). The aim of the study was to determine the impact of image quality on clinically significant
prostate cancer (csPCa) detection, positive predictive value (PPV) and radiologist\'s diagnosis in different sequences and
prostate zones.
METHODS: This retrospective study included 306 patients who underwent prostate MRI with definitive pathological reports from February 2021 to December 2022. All histopathological specimens were evaluated according to the recommendations of the International Society of Urological Pathology (ISUP). An ISUP Grade Group ≥ 2 was considered as csPCa. Three radiologists from different centers respectively performed a binary classification assessment of image quality in the following ten aspects: (1) T2WI in the axial plane: SNR, prostate boundary conditions, the presence of artifacts; (2) T2WI in the sagittal or coronal plane: prostate boundary conditions; (3) DWI: SNR, delineation between the peripheral and transition zone, the presence of artifacts, the matching of DWI and T2WI images; (4) DCE: the evaluation of obturator artery enhancement, the evaluation of dynamic contrast enhancement. Fleiss\' Kappa was used to determine the inter-reader agreement. Wilson\'s 95% confidence interval (95% CI) was used to calculate PPV. Chi-square test was used to calculate statistical significance. A p-value < 0.05 was considered statistically significant.
RESULTS: High-quality images had a higher csPCa detection rate (56.5% to 64.3%) in axial T2WI, DWI, and DCE, with significant statistical differences in SNR in axial T2WI (p 0.002), the presence of artifacts in axial T2WI (p 0.044), the presence of artifacts in DWI (p < 0.001), and the matching of DWI and T2WI images (p < 0.001). High-quality images had a higher PPV (72.5% to 78.8%) and showed significant statistical significance in axial T2WI, DWI, and DCE. Additionally, we found that PI-RADS 3 (24.0% to 52.9%) contained more low-quality images compared to PI-RADS 4-5 (20.6% to 39.3%), with significant statistical differences in the prostate boundary conditions in axial T2WI (p 0.048) and the presence of artifacts in DWI (p 0.001). Regarding the relationship between csPCa detection and image quality in different prostate zones, this study found that significant statistical differences were only observed between high- (63.5% to 75.7%) and low-quality (30.0% to 50.0%) images in the peripheral zone (PZ).
CONCLUSIONS: Prostate MRI quality may have an impact on the diagnostic performance. The poorer image quality is associated with lower csPCa detection rates and PPV, which can lead to an increase in radiologist\'s ambiguous diagnosis (PI-RADS 3), especially for the lesions located at PZ.