Accuracy in local staging of prostate cancer by adding a three-dimensional T2-weighted sequence with radial reconstructions in magnetic resonance imaging

Abstract

BackgroundThe evidence supporting the use of magnetic resonance imaging (MRI) in prostate cancer detection has been established, but its accuracy in local staging is questioned.PurposeTo investigate the additional value of multi-planar radial reconstructions of a three-dimensional (3D) T2-weighted (T2W) MRI sequence, intercepting the prostate capsule perpendicularly, for improving local staging of prostate cancer.Material and MethodsPreoperative, bi-parametric prostate MRI examinations in 94 patients operated between June 2014 and January 2015 where retrospectively reviewed by two experienced abdominal radiologists. Each patient was presented in two separate sets including diffusion-weighted imaging, without and with the 3D T2W set that included radial reconstructions. Each set was read at least two months apart. Extraprostatic tumor extension (EPE) was assessed according to a 5-point grading scale. Sensitivity and specificity for EPE was calculated and presented as receiver operating characteristics (ROC) with area under the curve (AUC), using histology from whole-mount prostate specimen as gold standard. Inter-rater agreement was calculated for the two different reading modes using Cohen’s kappa.ResultsThe AUC for detection of EPE for Readers 1 and 2 in the two-dimensional (2D) set was 0.70 and 0.68, respectively, and for the 2D + 3D set 0.62 and 0.65, respectively. Inter-rater agreement (Reader 1 vs. Reader 2) on EPE using Cohen’s kappa for the 2D and 2D + 3D set, respectively, was 0.42 and 0.17 (i.e. moderate and poor agreement, respectively).ConclusionThe addition of 3D T2W MRI with radial reconstructions did not improve local staging in prostate cancer.

<p>Apparent diffusion coefficient in extraprostatic extension of prostate cancer: a systematic review and diagnostic meta-analysis</p>

“…Sample size of these studies ranged from 43 to 379 patients, and nearly all of them had a mean age ≥60 years. In most of studies, GS ≥5 except the study by Jäderling et al,20 in which there were 9 patients had GS <6 20. PSA level among these studies ranged from 0.02 to 123, with a mean value from 5.9 to 12.24 ng/mL.…”

“…There were 6 studies that investigated the diagnosis performance on ECE,21,23–25,27,28 and the remaining 12 studies reported the diagnostic accuracy on EPE 4,10,17–20,22,26,29–31. Sample size of these studies ranged from 43 to 379 patients, and nearly all of them had a mean age ≥60 years.…”

“…Only 4 studies reported the data of prostate volume, in spite of the fact that some studies suggested it is possible to play a part in the diagnosis 17,18,21,32. Five studies performed the MRI with 1.5T scanners17,18,21,23,28 and the remaining 13 studies used 3.0T scanners 2,4,10,19,20,22,24,25,27,29–32. Except 5 studies,2,23,24,27,29,31 all of the others were used at least one type of endorectal, pelvic phased array (PPA), or body coil; moreover, 2 studies used two types of them (endorectal coil and PPA) 28,30.…”

“…For scoring system or assessment, there were several types existed across these studies. There were 3 studies that used PI-RADSv1 and 2 that used PI-RADSv2, and most of them adopted scored 3 or 4 as the cutoff value 4,20,30,31. Four studies used the ADC values alone for assessment, with cutoff threshold ranging from 0.72 to 0.89 17–19,27.…”

“…Five of 9 studies did not report whether the readers were blinded to the reference test results 4,17,21,31,32. Regarding the other 4 studies, readers were aware of the PSA level or/and GS of patients, though they were blinded to the histopathological findings 20,23,25,30. As for reference domain, there were no concerns because all studies used the RP specimens as the reference standard.…”