MRI combined with the prostate health index has high diagnostic value in differentiating benign and malignant prostate-specific antigen-positive prostate lesions
Objective To evaluate the effectiveness of integrating MRI qualitative and quantitative parameters with the prostate health index(PHI)to differentiate between benign and malignant prostate lesions in patients with elevated prostate-specific antigen(PSA)levels.Methods The study involved 346 patients with elevated PSA levels who underwent prostate MRI at the North China University of Science and Technology Affiliated Hospital from April 2022 to June 2024.These patients had prostate imaging reporting and data system(PI-RADS)scores ranging from 3 to 5.Based on biopsy pathology results,which served as the gold standard,patients were categorized into benign group(n=118)and malignant group(n=228).The PI-RADS score,apparent diffusion coefficient(ADC),slow ADC(D),fast ADC(D*),perfusion-related volume fraction(f),and PHI between these groups were compared.Logistic regression and decision tree classification were employed to develop models using these parameters,and the diagnostic performance of each model was assessed through ROC curves,calibration curves and decision analysis curves.Results The malignant group exhibited higher PI-RADS 5 proportion,pro-2 PSA,and PHI,while the values of ADC,D,D*,and f were lower compared to the benign group(P<0.05).The area under the ROC curve for model 4B,a decision tree classification model initially including PI-RADS,PHI,ADC,D,D*,and f,but ultimately retaining PHI,ADC,D,and D*,was comparable to model 3B,which incorporated PI-RADS,ADC,D,D*,f(P>0.05).However,model 4B outperformed other models(models 1A-4A,1B,2B)(P<0.05).The calibration curves for models 3B and 4B closely aligned with the diagonal,indicating high calibration accuracy,whereas the other models showed greater deviation.Model 4B demonstrated the highest net benefit across all threshold ranges.Conclusion The decision tree classification model constructed with PHI,ADC,D and D* exhibited superior discriminative ability,calibration accuracy,and clinical utility in distinguishing between benign and malignant prostate lesions in patients with elevated PSA and PI-RADS scores of 3 to 5.
MRIprostate health indexprostate-specific antigenprostate cancermodel
国家科技期刊平台
NSTL
万方数据
