Background/Purpose: to assess the inter-reader agreement of the PIFAB (Prostate Imaging after Focal Ablation) score, a new MRI-based standardized system for evaluating post-focal therapy prostate mpMRI, among radiologists in a single large cohort of patients treated with focal therapy (HIFU) in a tertiary care referral University Hospital. Methods: In total, 68 consecutive patients who underwent HIFU were included in this single-center retrospective observational study. A total of 109 post-HIFU follow-up mpMRIs were evaluated by three radiologists with varying levels of experience (12, 8, and 3 years, respectively). All patients underwent their first follow-up mpMRI at 6 months post-treatment, with 30 patients receiving additional evaluations at 18 months and 11 at 30 months. Results: The patients had a mean age of 70.6 ± 8.31 years, a mean pre-treatment PSA (prostate-specific antigen) of 7.85 ± 1.21 ng/mL, and a mean post-treatment PSA of 4.64 ± 4.2 ng/mL. The inter-reader agreement for PI-FAB among the three radiologists showed a Gwet’s AC2 value of 0.941 (95% confidence interval: 0.904–0.978,p< 0.0001). For the most experienced radiologist, at the 6-month follow-up 64 (94.14%) patients were scored as PI-FAB 1, 1 (1.47%) as PI-FAB 2, and 3 (4.41%) as PI-FAB 3. At the 18-month and 30-month follow-ups all patients were scored as PI-FAB 1 (no suspicion of recurrence). Conclusions: Our study demonstrates excellent inter-reader agreement among radiologists with varying levels of experience, confirming that the PI-FAB score is highly reproducible when evaluating post-treatment mpMRI scans. The low rate of PI-FAB 2 and PI-FAB 3 lesions observed at the first follow-up, coupled with the absence of significant recurrence in subsequent evaluations, suggests that HIFU is a reliable technique for prostate cancer treatment in selected patients.
背景/目的：本研究旨在评估PIFAB（前列腺局灶性消融术后影像）评分系统——一种基于MRI的标准化评估体系，用于评价局灶性治疗后前列腺多参数磁共振成像（mpMRI）——在三级转诊大学医院接受高强度聚焦超声（HIFU）局灶治疗的单一大型患者队列中，不同放射科医师之间的阅片一致性。方法：本单中心回顾性观察研究共纳入68例连续接受HIFU治疗的患者。由三位经验水平不同的放射科医师（分别具有12年、8年和3年经验）对109次HIFU术后随访mpMRI影像进行评估。所有患者均在治疗后6个月接受首次随访mpMRI检查，其中30例患者在18个月、11例患者在30个月接受了额外评估。结果：患者平均年龄为70.6±8.31岁，治疗前平均前列腺特异性抗原（PSA）为7.85±1.21 ng/mL，治疗后平均PSA为4.64±4.2 ng/mL。三位放射科医师对PI-FAB评分的阅片一致性分析显示，Gwet's AC2值为0.941（95%置信区间：0.904–0.978，p<0.0001）。经验最丰富的放射科医师在6个月随访时评估显示：64例（94.14%）患者评为PI-FAB 1级，1例（1.47%）评为PI-FAB 2级，3例（4.41%）评为PI-FAB 3级。在18个月和30个月随访时，所有患者均被评为PI-FAB 1级（无复发迹象）。结论：本研究证明不同经验水平的放射科医师之间具有极佳的阅片一致性，证实PI-FAB评分在评估治疗后mpMRI时具有高度可重复性。首次随访时PI-FAB 2级和3级病灶的低发生率，结合后续评估中未发现显著复发，表明HIFU是治疗特定前列腺癌患者的可靠技术。
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