Combined Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Imaging in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Context: Magnetic resonance imaging (MRI) combined with magnetic resonance spectroscopy imaging (MRSI) emerged as a promising test in the diagnosis of prostate cancer and showed encouraging results.Objective: The aim of this systematic review is to meta-analyse the diagnostic accuracy of combined MRI/MRSI in prostate cancer and to explore risk profiles with highest benefit. Evidence acquisition:The authors searched the MEDLINE and EMBASE databases and the Cochrane Library, and the authors screened reference lists and contacted experts. There were no language restrictions. The last search was performed in August 2008. Evidence synthesis: We identified 31 test-accuracy studies (1765 patients); 16 studies (17 populations) with a total of 581 patients were suitable for meta-analysis. Nine combined MRI/MRSI studies (10 populations) examining men with pathologically confirmed prostate cancer (297 patients; 1518 specimens) had a pooled sensitivity and specificity on prostate subpart level of 68% (95% CI, 56-78%) and 85% (95% CI, 78-90%), respectively. Compared with patients at high risk for clinically relevant cancer (six studies), sensitivity was lower in low-risk patients (four studies) (58% [46-69%] Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Conclusions: A limited number of small studies suggest that MRI combined with MRSI could be a rule-in test for low-risk patients. This finding needs further confirmation in larger studies and costeffectiveness needs to be established. NIH Public Access

MRT der Prostata: Empfehlungen zur Vorbereitung und Durchführung

“…Results of T1w/T2w imaging and 1 H-MRS that are consistently suspicious for prostate cancer indicate the presence of cancerous prostate tissue with a probability of approximately 50 % (positive predictive value) with the important differential diagnosis of focal circumscribed prostatitis. Conversely, results of T1w/T2w imaging and 1 H-MRS that are consistently negative indicate the presence of healthy prostate tissue with a probability of approximately 95 % (negative predictive value) with the differential diagnosis of diffuse prostatitis [34]. The sensitivity and specificity of 1 H-MRS combined with individual MRI sequences were 58 % and 93 %, respectively, for the detection of carcinoma of the prostate in a current meta-analysis of 14 studies including a total of 698 patients with a previous negative prostate biopsy [25].…”

When no treatment is the best treatment: Active surveillance strategies for low risk prostate cancers

“…This technique allows the integration of anatomical, biological and functional information. Most studies using histopathology specimens as reference standards have shown that mpMRI outperforms conventional anatomical imaging alone for the detection of prostate cancer [33][34][35][36]. There is also evidence that unfavorable findings on mpMRI, especially low ADC values, are associated with adverse histological features [37,38].…”

Thermoacoustic contrast of prostate cancer due to heating by very high frequency irradiation

“…Additionally, crosstalk between spectral peaks is problematic. A meta-analysis performed in 2008 found little evidence to recommend clinical adoption of MRSI for diagnosis or targeted biopsy (Umbehr et al, 2009), and more recently a cost-benefit meta-analysis performed in the United Kingdom found expected incremental life years of no more than 0.006 years due to any type of MR-guided biopsy over ultrasound guidance (Mowatt et al, 2013). More recently, good sensitivity (96.4%) but terrible specificity (7.6%) were reported in a MRI-ultrasound fusion guided prostate biopsy study (Salami et al, 2014) fraught with selection and detection bias (Warlick, 2014).…”