基于PI-RADSv2.1的双参数磁共振成像联合fPSA/tPSA在鉴别前列腺移行带良恶性结节中的应用

doi:10.3969/j.issn.1006-6233.2025.07.026

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摘要 目的: 探究基于第2.1版前列腺影像报告和数据系统(PI-RADSv2.1)的双参数磁共振成像(bp-MRI)联合游离前列腺特异性抗原(PSA)/总PSA(fPSA/tPSA)在鉴别前列腺移行带良恶性结节中的应用价值。方法: 回顾性分析2021年3月至2024年10月本院收治的107例前列腺移行带结节患者,根据病理学诊断结果分为前列腺癌(PCa)组(37例)、前列腺增生组(70例)。对比两组fPSA/tPSA、PI-RADSv2.1评分、一般资料和临床资料,二元Logistic回归分析影响因素,并分析fPSA/tPSA、PI-RADSv2.1评分及其联合对前列腺移行带良恶性结节的诊断价值,绘制受试者工作(ROC)曲线分析诊断价值。结果: PCa组fPSA/tPSA值小于前列腺增生组(P<0.05),两组PI-RADSv2.1评分分级差异具有统计学意义(P<0.05);PCa组fPSA及tPSA水平均大于前列腺增生组(P<0.05),但两组年龄、高血压、糖尿病患者比例无统计学意义(P>0.05),二元Logistic回归分析显示,fPSA/tPSA、PI-RADSv2.1评分是前列腺移行带结节的影响因素(P<0.05);fPSA/tPSA与PI-RADSv2.1评分诊断前列腺移行带结节时,以PI-RADSv2.1评分的曲线下面积(AUC)值最高,为0.889,以3分为最佳截断值,PI-RADSv2.1评分诊断前列腺移行带结节的敏感度、特异度分别为86.49%、88.57%;以二元Logistic回归分析构建联合诊断模型为:logit(p)=-4.327+1.825*PI-RADSv2.1评分-15.730*fPSA/tPSA,经Hosmer-Lemeshow检验,χ²=7.585、P=0.475,ROC曲线显示,联合诊断前列腺移行带结节的AUC为0.936,以0.48为最佳截断值,联合诊断的敏感度、特异度分别为83.78%、94.29%。结论: fPSA/tPSA、PI-RADSv2.1评分均可用于前列腺移行带良恶性结节的临床诊断,但联合诊断价值更高。

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关键词 ：前列腺移行带结节, 双参数磁共振成像, 游离前列腺特异性抗原, 总前列腺特异性抗原

Abstract：Objective: To investigate the application value of biparametric magnetic resonance imaging (bp-MRI) based on the Prostate Imaging-Reporting and Data System version 2.1 (PI-RADSv2.1) combined with free prostate-specific antigen (PSA)/total PSA (fPSA/tPSA) in identifying benign and malignant nodules in prostate transitional zone. Methods: A total of 107 patients with nodules in prostate transitional zone who were admitted to the hospital from March 2021 to October 2024 were reviewed. According to the results of pathological diagnosis, the patients were divided into prostate cancer (PCa) group (37 cases) and prostate hyperplasia group (70 cases). fPSA/tPSA, PI-RADSv2.1 scores, general and clinical data were compared between the two groups. Binary logistic regression analysis was used to screen influencing factors. The value of fPSA/tPSA, PI-RADSv2.1 score, and combination of the two in diagnosing benign and malignant nodules in prostate transitional zone was analyzed using the receiver operating characteristic (ROC) curves. Results: There was a statistically significant difference in the grading of PI-RADSv2.1 scores between the two groups (P<0.05). fPSA and tPSA levels of the PCa group were higher than those of the BPH group (P<0.05). However, the proportions of patients with age, hypertension and diabetes in the two groups were similar (P>0.05). Binary logistic regression analysis showed that fPSA/tPSA and PI-RADSv2.1 score were influencing factors of nodules in prostate transitional zone (P<0.05). When fPSA/tPSA and PI-RADSv2.1 score were used to diagnose nodules in prostate transitional zone separately, the area under the curve (AUC) of PI-RADSv2.1 score was the greatest, which was 0.889. With 3 points as the optimal cutoff value, its diagnostic sensitivity and specificity were 86.49% and 88.57%. Based on binary logistic regression analysis, a joint diagnosis model was constructed as follows: logit(p)=-4.327+1.825 * PI-RADSv2.1 score -15.730 * fPSA/tPSA. Hosmer-Lemeshow test showed χ²=7.585, P=0.475. ROC curve showed that the AUC of joint diagnosis was 0.936. With 0.48 as the optimal cutoff value, the sensitivity and specificity of joint diagnosis were 83.78% and 94.29%. Conclusion: Both fPSA/tPSA and PI-RADSv2.1 score can be used for clinical diagnosis of benign and malignant nodules in prostate transitional zone, and diagnostic value of combination of the two is higher.

Key words： Nodule in prostate transitional zone Biparametric magnetic resonance imaging Free prostate-specific antigen Total prostate-specific antigen

基金资助:安徽省高校科研项目,(编号:2024AH050704);宿州市卫健委科研项目,(编号:SZWJ2022028)

通讯作者: 彭传勇

引用本文:

项杨, 彭传勇, 范菊. 基于PI-RADSv2.1的双参数磁共振成像联合fPSA/tPSA在鉴别前列腺移行带良恶性结节中的应用[J]. 河北医学, 2025, 31(7): 1195-1200.
XIANG Yang, PENG Chuanyong, FAN Ju. Application of Biparametric Magnetic Resonance Imaging Based on PI-RADSv2.1 Combined with fPSA/tPSA in Identifying Benign and Malignant Nodules in Prostate Transitional Zone. HeBei Med, 2025, 31(7): 1195-1200.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.07.026 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I7/1195

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