Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice

Zawaideh, Jeries Paolo; Sala, Evis; Shaida, Nadeem; Koo, Brendan; Warren, Anne Y.; Carmisciano, Luca; Saeb‐Parsy, Kasra; Gnanapragasam, Vincent; Kastner, Christof; Barrett, Tristan

doi:10.1007/s00330-020-06782-0

Cited by 60 publications

(54 citation statements)

References 35 publications

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“…However, the role of DCE MRI in PCa imaging is currently under heavy discussion, as bi-parametric MRI (T2w and diffusion-weighted sequences including apparent diffusion coefficient (ADC) map) is gaining foothold [3]. Several recent studies found only slight additional value of the qualitative PIRADS DCE analysis compared with bi-parametric MRI for highly experienced readers [3,4], while others described larger additional value of DCE [5]. Removing DCE from the protocol can reduce examination time and cost, and remove the contrast agent-related morbidity, which could be helpful as more and more prostate MRI scans are requested [3].…”

Section: Introductionmentioning

confidence: 99%

Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na+/K+-ATPase-density

Jochumsen

Sörensen

Pedersen

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose Tumour blood flow (TBF) is a crucial determinant of cancer growth. Recently, we validated Rubidium-82 (82 Rb) positron emission tomography (PET) for TBF measurement in prostate cancer (PCa) and found TBF and cancer aggressiveness positively correlated. The aims of the present study were to determine the ability of TBF for separating significant from insignificant PCa and to examine the relation to underlying Na + /K +-ATPase density, which is relevant as 82 Rb is transported intracellularly via the Na + /K +-ATPase. Methods One hundred and two patients were included for pelvic 82 Rb PET scan prior to magnetic resonance imaging (MRI)guided prostate biopsy. Findings constituted 100 PCa lesions (86 patients) and 25 benign lesions (16 patients). Tumours were defined on MRI and transferred to 82 Rb PET for TBF measurement. Immunohistochemical Na + /K +-ATPase staining was subsequently performed on biopsies. Results TBF was the superior predictor (rho = 0.68, p < 0.0001, inflammatory lesions excluded) of MRI-guided biopsy grade group (GG) over lowest apparent diffusion coefficient (ADC) value (rho = −0.23, p = 0.01), independent of ADC value and tumour volume (p < 0.0001). PET could separate GG-2-5 from GG-1 and benign lesions with an area under the curve (AUC), sensitivity, and specificity of 0.79, 96%, and 59%, respectively. For separating GG-3-5 from GG-1-2 and benign lesions the AUC, sensitivity, and specificity were 0.82, 95%, and 63%, respectively. Na + /K +-ATPase density per PCa cell profile was 38% lower compared with that of the benign prostate cell profiles. Neither cell density nor Na + /K +-ATPase density determined tumour 82 Rb uptake. Conclusion TBF is an independent predictor of PCa aggressiveness and deserves more attention, as it may be valuable in separating clinically significant from insignificant PCa.

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Section: Introductionmentioning

confidence: 99%

Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na+/K+-ATPase-density

Jochumsen

Sörensen

Pedersen

et al. 2020

Eur J Nucl Med Mol Imaging

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“…For prostate imaging, understanding the potential added value and robustness of post-GBCA MRF is of considerable practical interest for two major reasons. Firstly, should MRF be incorporated into the clinical mpMRI protocol, the decision on its running order in relation to DCE-MRI should be evidenced and balanced against the increasing trend towards reducing scanning time [18][19][20][21] . Secondly, post-GBCA MRF T 1 mapping may improve the performance of DCE-MRI in TZ lesions, where it is currently of limited use in the context of adequate T 2 -weighted imaging and diffusion-weighted imaging 22,23 .…”

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confidence: 99%

The effect of gadolinium-based contrast agent administration on magnetic resonance fingerprinting-based T1 relaxometry in patients with prostate cancer

Sushentsev

Kaggie

Buonincontri³

et al. 2020

Sci Rep

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Magnetic resonance fingerprinting (MRF) is a rapidly developing fast quantitative mapping technique able to produce multiple property maps with reduced sensitivity to motion. MRF has shown promise in improving the diagnosis of clinically significant prostate cancer but requires further validation as part of a prostate multiparametric (mp) MRI protocol. mpMRI protocol mandates the inclusion of dynamic contrast enhanced (DCE) imaging, known for its significant T1 shortening effect. MRF could be used to measure both pre- and post-contrast T1 values, but its utility must be assessed. In this proof-of-concept study, we sought to evaluate the variation in MRF T1 measurements post gadolinium-based contrast agent (GBCA) injection and the utility of such T1 measurements to differentiate peripheral and transition zone tumours from normal prostatic tissue. We found that the T1 variation in all tissues increased considerably post-GBCA following the expected significant T1 shortening effect, compromising the ability of MRF T1 to identify transition zone lesions. We, therefore, recommend performing MRF T1 prior to DCE imaging to maintain its benefit for improving detection of both peripheral and transition zone lesions while reducing additional scanning time. Demonstrating the effect of GBCA on MRF T1 relaxometry in patients also paves the way for future clinical studies investigating the added value of post-GBCA MRF in PCa, including its dynamic analysis as in DCE-MRF.

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“…Application of DCE imaging to all patients would spend more time and cost, while adding limited benefit to diagnostic accuracy 32,33 . However, completely omitting DCE from Mp‐MRI would increase the risk for underestimating these clinically significant diseases in PI‐RADS 3 category 34,35 . A real‐time Op‐MRI thus might be an alternative way for personalized medicine, where in a tertiary care medical center, the first‐step Bp‐MRI assessment can be done within 5 minutes during or after the Bp‐MRI scan.…”

Section: Discussionmentioning

confidence: 99%

Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD‐Compliant Two‐Center Study

Bao

Zhi

Hou

et al. 2020

Magnetic Resonance Imaging

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Background There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC). Purpose To evaluate an optimized (Op)‐MRI compared with biparametric (Bp)‐MRI and multiparametric (Mp)‐MRI for the diagnosis of CSPC. Study Type Two‐center, retrospective. Subjects A total of 346 patients from center 1 and 292 patients from center 2. Field Strength/Sequence 3.0T scanners, T2‐weighted imaging (T2WI), diffusion‐weighted imaging (DWI), and dynamic contrast‐enhanced (DCE) imaging. Assessment Four radiologists interpreted the Bp‐MRI (T2WI and DWI) and Mp‐MRI (T2WI, DWI, and DCE) independently according to the Prostate Imaging Reporting and Data System (PI‐RADS). For Op‐MRI, two radiologists used an adjusted decision rule on Bp‐MRI‐assessed PI‐RADS 3 lesions by determining early enhancement of DCE. Pathologies at biopsy and/or prostatectomy specimens were used as standard references. Statistical Tests Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability. Results Interreader agreement was excellent for all three MRI assessments (all κ values >0.80). Op‐MRI had comparable sensitivity (senior/junior: 90.9% [261/287] / 91.6% [263/287]) and higher specificity (78.1% [274/351] /74.4% [261/351]) compared with Mp‐MRI (sensitivity: 92.3% [265/287] / 93.7% [269/287]; specificity: 67.8% [238/351] / 68.1% [239/351]) and Bp‐MRI (sensitivity: 91.6% [263/287] / 93.4% [268/287]; specificity: 71.2% [250/351] / 70.1% [246/351]) for the diagnosis of CSPC. Compared to Mp‐MRI, Op‐MRI spared biopsy in 80.7% (515/638) of DCE scans with similar performance accuracy. Compared to Bp‐MRI, Op‐MRI downgraded 25.2% (31/123) of lesions at a cost of missing 6.5% (3/46) of malignancies, and upgraded 45.5% (56/123) of lesions with a positive predictive value of 62.5% (35/56) in 123 equivocal findings. Data Conclusion The Op‐MRI, using an adjusted PI‐RADS decision rule, did not compromise diagnostic accuracy with sparing biopsy in 80.7% of DCE scans compared to Mp‐MRI, and outperformed Bp‐MRI by regrading PI‐RADS lesions. Level of Evidence 4 Technical Efficacy Stage 2

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Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice

Cited by 60 publications

References 35 publications

Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na+/K+-ATPase-density

Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na+/K+-ATPase-density

The effect of gadolinium-based contrast agent administration on magnetic resonance fingerprinting-based T1 relaxometry in patients with prostate cancer

Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD‐Compliant Two‐Center Study

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