Comparison between multiparametric MRI with and without post - contrast sequences for clinically significant prostate cancer detection

Abstract

Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion. Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.

Diagnostic accuracy of bi-parametric magnetic resonance imaging in suspected prostate cancer: Correlation of scan results with biopsy findings in a series of 266 patients

“…Growing concerns about the safety of gadolinium-based contrast, including immediate hypersensitivity reactions, nephrogenic systemic fibrosis in patients with poor renal function and toxicities arising from gadolinium ion deposition in various tissues, 16 make the possibility of avoiding or limiting its use very attractive. In addition to this, given the increased costs and time taken to perform and report scans limiting patient throughput, the added value of DCE sequences [17][18][19][20] is in question: whilst increasing accuracy for PIRADS 3 lesions in the peripheral zone (PZ), the DWI sequence is the dominant factor here that determines the overall PIRADS score and T2W for the transitional zone (TZ). 21 Therefore, the added value of DCE is minor in assessing the PZ and unhelpful for the TZ.…”

“…They found similar reporting, regardless of inclusion of DCE images. 18 Iwazawa et al compared DWI and DCE sequences for 178 patients with biopsy correlation and found that DWI outperformed DCE imaging. 17 Kuhl et al compared initial reporting of bpMRI sequences, with the subsequent reports after the reader was also shown the DCE sequences, of scans initially performed as mpMRI in 542 patients.…”

Diagnostic value of integrated 18F-PSMA-1007 PET/MRI compared with that of biparametric MRI for the detection of prostate cancer

“… 4 , 5 However, the usefulness of DCE MRI in diagnosing PCa is controversial. 6 , 7 In prostate imaging reporting and data system (PI-RADS), T2WI and DWI are proposed as the dominant sequence for transition zone and peripheral zone lesions. DCE MRI plays a supplementary role when DWI is not sufficient for diagnosis, and DCE positivity only upgrades DWI score three lesions in the peripheral zone to score 4.…”