Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations?

Junker, Daniel; Steinkohl, Fabian; Fritz, Veronika; Bektic, Jasmin; Tokas, Theodoros; Aigner, Friedrich; Herrmann, Thomas; Rieger, Michael; Nagele, Udo

doi:10.1007/s00345-018-2428-y

Cited by 67 publications

(79 citation statements)

References 32 publications

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“…The addition of DWI and DCE led to a reduction in LIKERT 3 lesions from 44.6% to 33.5% and a corresponding increase in LIKERT 5 lesions from 12.0% to 37.9%. This shift has also been observed in similar studies using PI-RADSv2 where DCE had a role in distinguishing equivocal lesions in the peripheral zone [28]. It has been suggested that the higher proportion of equivocal lesions could be addressed by only performing the additional sequences in those cases where such a lesion is identified; however, this would require scans to be immediately reported or the patient to return for a second scan at a later date.…”

Section: Discussionsupporting

confidence: 59%

Added value of diffusion‐weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

et al. 2019

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Objective To determine the additional diagnostic value of diffusion‐weighted imaging (DWI) and dynamic contrast‐enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. Patients and Methods PICTURE was a paired‐cohort confirmatory study in which 249 men who required further risk stratification after a previous non‐magnetic resonance imaging (MRI)‐guided transrectal ultrasonography‐guided biopsy underwent a 3‐Tesla (3T) multiparametic (mp)MRI consisting of T2‐weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver‐operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. Results Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68–0.80), T2W+DWI at 0.76 (95% CI 0.71–0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71–0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). Conclusions Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions.

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Section: Discussionsupporting

confidence: 59%

Added value of diffusion‐weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

et al. 2019

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“…An initial 3502 studies underwent title and abstract screening, of which 127 studies were retrieved for full‐text review. In all, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for meta‐analysis; 25 studies reported on mpMRI DTA (7000 patients, 2954 with prostate cancer), 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer), and six studies directly compared mpMRI and bpMRI (2047 patients, 1063 with prostate cancer). Table provides a summary of the included studies [22,34––63], while Table provides a risk of bias summary of the included studies [22,34––63].…”

Section: Resultsmentioning

confidence: 99%

“…Table provides a summary of the included studies [22,34––63], while Table provides a risk of bias summary of the included studies [22,34––63]. Seven studies were at high risk of bias , four were at low risk of bias , and the remaining 18 studies had an unclear risk of bias due to at least one of the four domains .…”

Section: Resultsmentioning

confidence: 99%

“…1 Table 2 provides a risk of bias summary of the included studies [22,34--63]. Seven studies were at high risk of bias [37,[41][42][43]47,48,51], four were at low risk of bias [22,53,55,58], and the remaining 18 studies had an unclear risk of bias due to at least one of the four domains [34][35][36][38][39][40][44][45][46]49,50,52,54,57,[60][61][62][63].…”

Section: Resultsmentioning

confidence: 99%

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Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Alabousi¹,

Salameh

Gusenbauer

et al. 2019

BJU International

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Objective To perform a diagnostic test accuracy (DTA) systematic review and meta‐analysis comparing multiparametric (diffusion‐weighted imaging [DWI], T2‐weighted imaging [T2WI], and dynamic contrast‐enhanced [DCE] imaging) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer in treatment‐naïve patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched to identify relevant studies published after 1 January 2012. Articles underwent title, abstract, and full‐text screening. Inclusion criteria consisted of patients with suspected prostate cancer, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodological and DTA data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool. DTA metrics were pooled using bivariate random‐effects meta‐analysis. Subgroup analysis was conducted to assess for heterogeneity. Results From an initial 3502 studies, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for the meta‐analysis; 25 studies reported on mpMRI (7000 patients, 2954 with prostate cancer) and 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 86%, 95% confidence interval [CI] 81–90; bpMRI: 90%, 95% CI 83–94) or specificity (mpMRI: 73%, 95% CI 64–81; bpMRI: 70%, 95% CI 42–83). The summary receiver operating characteristic curves were comparable for mpMRI (0.87) and bpMRI (0.90). Conclusions No significant difference in DTA was found between mpMRI and bpMRI in diagnosing prostate cancer in treatment‐naïve patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium‐free alternative to mpMRI.

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“…Whether DCE should be included in the multiparametric standard has always been a controversial issue [28], showing both supporters and opposers. Pros and cons of DCE are summarised in Table 3 [13,28,[30][31][32][33].…”

Section: Non-contrast Biparametric Mrimentioning

confidence: 99%

Evolution of prostate MRI: from multiparametric standard to less-is-better and different-is better strategies

et al. 2019

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Multiparametric magnetic resonance imaging (mpMRI) has become the standard of care to achieve accurate and reproducible diagnosis of prostate cancer. However, mpMRI is quite demanding in terms of technical rigour, patient's tolerability and safety, expertise in interpretation, and costs. This paper reviews the main technical strategies proposed as less-is-better solutions for clinical practice (non-contrast biparametric MRI, reduction of acquisition time, abbreviated protocols, computer-aided diagnosis systems), discussing them in the light of the available evidence and of the concurrent evolution of Prostate Imaging Reporting and Data System (PI-RADS). We also summarised research results on those advanced techniques representing an alternative different-is-better line of the still ongoing evolution of prostate MRI (quantitative diffusion-weighted imaging, quantitative dynamic contrast enhancement, intravoxel incoherent motion, diffusion tensor imaging, diffusional kurtosis imaging, restriction spectrum imaging, radiomics analysis, hybrid positron emission tomography/MRI).

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Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations?

Cited by 67 publications

References 32 publications

Added value of diffusion‐weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

Added value of diffusion‐weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Evolution of prostate MRI: from multiparametric standard to less-is-better and different-is better strategies

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