Comparison of biparametric and multiparametric MRI in the diagnosis of prostate cancer

Abstract

PurposeTo compare the diagnostic accuracy of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) and to explore the application value of dynamic contrast-enhanced (DCE) MRI in prostate imaging.Methods and materialsThis study retrospectively enrolled 235 patients with suspected PCa in our hospital from January 2016 to December 2017, and all lesions were histopathologically confirmed. The lesions were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADS V2). The bpMRI (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC]) and mpMRI (T2WI, DWI/ADC and DCE) scores were recorded to plot the receiver operating characteristic (ROC) curves. The area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for each method were calculated and compared. The patients were further stratified according to bpMRI scores (bpMRI ≥3, and bpMRI = 3, 4, 5) to analyse the difference in DCE MRI between PCa and non-PCa lesions (as well as between csPCa and non-csPCa).ResultsThe AUC values for the bpMRI and mpMRI protocols for PCa were comparable (0.790 [0.732–0.840] and 0.791 [0.733–0.841], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for PCa were 76.2, 79.5, 72.6, 75.8, and 76.6%, respectively, and the values for mpMRI were 77.4, 84.4, 69.9, 75.2, and 80.6%, respectively. The AUC values for the bpMRI and mpMRI protocols for the diagnosis of csPCa were similar (0.781 [0.722–0.832] and 0.779 [0.721–0.831], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for csPCa were 74.0, 83.8, 66.9, 64.8, and 85.0%, respectively; and 73.6, 87.9, 63.2, 63.2, and 87.8%, respectively, for mpMRI. For patients with bpMRI scores ≥3, positive DCE results were more common in PCa and csPCa lesions (both P = 0.001). Further stratification analysis showed that for patients with a bpMRI score = 4, PCa and csPCa lesions were more likely to have positive DCE results (P = 0.003 and P < 0.001, respectively).ConclusionThe diagnostic accuracy of bpMRI is comparable with that of mpMRI in the detection of PCa and the identification of csPCa. DCE MRI is helpful in further identifying PCa and csPCa lesions in patients with bpMRI ≥3, especially bpMRI = 4, which may be conducive to achieving a more accurate PCa risk stratification. Rather than omitting DCE, we think further comprehensive studies are required for prostate MRI.

Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI‐RADS Version 2.1

“…7,8 Additionally, DCE-MRI with gadolinium chelate increases the burdens on the patient in terms of potential for gadolinium retention and nephrogenic systemic fibrosis, examination time, and cost. [9][10][11][12][13][14] Therefore, interest is growing in performing abbreviated prostate MRI protocols without DCE-MRI, as a procedure termed "biparametric MRI" (bpMRI). 8 A number of studies on bpMRI using PI-RADS v2 have reported that the diagnostic accuracy of bpMRI for detecting csPC is comparable to that of mpMRI.…”

“…8 A number of studies on bpMRI using PI-RADS v2 have reported that the diagnostic accuracy of bpMRI for detecting csPC is comparable to that of mpMRI. [10][11][12][13][14][15] Han et al 16 compared the diagnostic performance between bpMRI and mpMRI using PI-RADS v2.1; however, the pathologic results in that study were obtained by systematic transrectal ultrasonography (TRUS)-guided biopsy or systematic TRUSguided biopsy plus TRUS-guided cognitive-targeted biopsy. A recent multicenter, randomized, noninferiority trial has shown that in men with a clinical suspicion of PC, the detection ability of csPC was significantly higher in MRI-US fusion-guided prostate-targeted biopsy (MRGB) than in standard systematic TRUS-guided biopsy.…”

<p>Added Value of Biparametric MRI and TRUS-Guided Systematic Biopsies to Clinical Parameters in Predicting Adverse Pathology in Prostate Cancer</p>

“…13,14 Interestingly, biparametric MRI (bp-MRI), consisting of T2-weighted imaging and diffusion-weighted imaging without dynamic contrastenhanced imaging, has shown comparable efficacy in detecting clinically significant PCa by mp-MRI. 13,15 It could be speculated that bp-MRI may also have potential value in predicting adverse pathological features in PCa patients.…”

Editorial for “Prostate Cancer Risk Stratification in Men With a Clinical Suspicion of Prostate Cancer Using a Unique Biparametric MRI and Expression of 11 Genes in Apparently Benign Tissue: Evaluation Using Machine‐Learning Techniques”

“…For this reason, there has been investigation of the efficacy of abbreviated noncontrast MRI examinations in the detection and risk stratification of PCa. Biparametric MRI (bpMRI), which only employs anatomical (T 2 ‐weighted) and diffusion‐weighted sequences, is showing great promise …”

“…One study applied the IMPROD bpMRI protocol to 364 men with csPCa (defined as Gleason score ≥3 + 4). All patients received systematic biopsies, but high Likert scores initiated additional cognitively guided MRI targeted biopsies. Their method achieved an accuracy of 70% and negative predictive value of 95% in detecting csPCa.…”