Abbreviated Biparametric Prostate MR Imaging in Men with Elevated Prostate-specific Antigen

Abstract

Purpose To determine the diagnostic accuracy for clinically significant prostate cancer achieved with abbreviated biparametric prostate magnetic resonance (MR) imaging in comparison with full multiparametric contrast material-enhanced prostate MR imaging in men with elevated prostate-specific antigen (PSA) and negative transrectal ultrasonography (US)-guided biopsy findings; to determine the significant cancer detection rate of biparametric versus full multiparametric contrast-enhanced MR imaging and between-reader agreement for interpretation of biparametric MR imaging. Materials and Methods In this institutional review board-approved retrospective review of prospectively acquired data, men with PSA greater than or equal to 3 ng/mL after negative transrectal US-guided biopsy findings underwent state-of-the-art, full multiparametric contrast-enhanced MR imaging at 3.0-T including high-spatial-resolution structural imaging in several planes, diffusion-weighted imaging at 0, 800, 1000, and 1400 mm/sec, and dynamic contrast-enhanced MR imaging, obtained without endorectal coil within 34 minutes 19 seconds. One of four radiologists with different levels of expertise (1-9 years) first reviewed only a fraction of the full multiparametric contrast-enhanced MR images, consisting of single-plane (axial) structural imaging (T2-weighted turbo spin-echo and diffusion-weighted imaging), acquired within 8 minutes 45 seconds (referred to as biparametric MR imaging), and established a diagnosis according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2; only thereafter, the remaining full multiparametric contrast-enhanced MR images were read. Men with PI-RADS categories 3-5 underwent MR-guided targeted biopsy. Men with PI-RADS categories 1-2 remained in urologic follow-up for at least 2 years, with rebiopsy (transrectal US-guided or transperineal saturation) where appropriate. McNemar test was used to compare diagnostic accuracies. To investigate between-reader agreement, biparametric MR images of 100 patients were read independently by all three radiologists. Results A total of 542 men, aged 64.8 years ± 8.2 (median PSA, 7 ng/mL), were included. Biparametric MR imaging helped detect clinically significant prostate cancer in 138 men. Full multiparametric contrast-enhanced MR imaging allowed detection of one additional clinically significant prostate cancer (a stage pT2a, intermediate-risk cancer with a Gleason score of 3+4) and caused 11 additional false-positive diagnoses. Diagnostic accuracy for detection of clinically significant cancer of biparametric MR imaging (89.1%, 483 of 542) was similar to that of full multiparametric contrast-enhanced MR imaging (87.2%, 473 of 542). Between-reader agreement of biparametric MR imaging interpretation was substantial (κ = 0.81). Conclusion Biparametric MR imaging allows detection of clinically significant prostate cancer missed by transrectal US-guided biopsy. Biparametric prostate MR imaging takes less than 9 minutes examination time, works without contrast agent i...

Biparametric MRI of the prostate

“…[23,41] Recently, it has been demonstrated that the sensitivity of bpMRI at 3T without endorectal coil in the detection PCa is similar to that of mpMRI. [20,24,27,28,[42][43][44] The diagnostic value of bpMRI in men with or without prior biopsy and combined with PSA has been validated, resulting in an improved accuracy for detecting clinically significant PCa (sPCa) and representing an effective technique to direct biopsy needles under TRUS guidance, after MRI-ultrasonography fusion. [20,23,28] For diagnosis of clinically sPCa in patients with elevated PSA before biopsy, DCE was found to be an unnecessary imaging technique in the majority of patients evaluated by PI-RADS v2.…”

“…[24] The sensitivity rates of bpMRI and mpMRI at 3T without ERC in the detection of PCa are 61.8-97.6%, and 72.9-97.6%, respectively ( Table 2). [20,24,27,28,[42][43][44] Biparametric MRI: lesion detection and localization According to the criteria and lexicon of the PI-RADS v2 guidelines [18] , the bpMRI images' analysis is based on the recognition of lesion patterns on T2WI and DWI and corresponding ADC maps. Because in our experience DWI represents the predominant sequence to detect lesions both in PZ and TZ with confirmed image quality, for routine clinical work we recommend starting viewing DWI with high b-values (and the same sequence inverted) on ADC maps and subsequently at T2WI.…”

The diagnostic accuracy of high b-value diffusion- and T2-weighted imaging for the detection of prostate cancer: a meta-analysis

“…We also note that all studies using b -values > 1000 s/mm 2 were limited to a maximum b -value of 2000 s/mm 2 , except the study by Kuhlet al [33]. Wang et al and Metens et al found b -values of 1500 s/mm 2 gave a better tumor contrast and image quality than b -values of 1,000 or 2000 s/mm 2 and Kuhl et al using a b -value of 1400 s/mm 2 , produced some of the highest sensitivities and specificities [33–35].…”

“…Wang et al and Metens et al found b -values of 1500 s/mm 2 gave a better tumor contrast and image quality than b -values of 1,000 or 2000 s/mm 2 and Kuhl et al using a b -value of 1400 s/mm 2 , produced some of the highest sensitivities and specificities [33–35]. However, more data on the diagnostic accuracy of b  ≈ 1,500 DWI are required.…”

Population net benefit of prostate MRI with high spatiotemporal resolution contrast‐enhanced imaging: A decision curve analysis

“…PI‐RADS v2 recommendations include DCE for this risk‐stratifying information, which could potentially serve to divert patients at lower risk from unnecessary biopsies. However, the value of DCE imaging as a standard component of prostate MRI has been questioned when compared with lesion detection on noncontrast (NC)‐MRI coupled with biopsy of all lesions with a score of at least PI‐RADS 3 . The comparative benefit of DCE images may also be of interest to patients concerned about receiving gadolinium; for example, due to deposition in native tissues …”