Financial implications of biparametric prostate MRI

Porter, Kristin K.; King, A.; Galgano, Samuel J.; Sherrer, R. Lynn; Gordetsky, Jennifer B.; Rais‐Bahrami, Soroush

doi:10.1038/s41391-019-0158-x

Cited by 50 publications

(34 citation statements)

References 22 publications

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“…In contrast, bpMRI excludes DCE mode using contrast media from mpMRI, it could reduce the time for image acquisition and even the side effects that may occur due to the use of contrast media. Therefore, bpMRI is faster (~15 min), cheaper, and simpler than mpMRI, while retaining a sufficient diagnostic value [13]. In this multivariable RC, bpMRI also showed the highest predictability for csPCa among the single factors.…”

Section: Discussionmentioning

confidence: 79%

“…However, the use of biomarkers and genomic markers is costly and laboratory-dependent, and mpMRI is time consuming (~40 min) and expensive. In contrast, bi-parametric (bp)MRI is rapid (~15 min) and simpler, while sufficiently retaining the diagnostic value of mpMRI [13]. The promising value of bpMRI for PCa diagnosis has recently been reported [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

et al. 2021

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This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. Materials and MethodsWe retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostatespecific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination [DRE]), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies (bpMRI-US transperineal FTSB) in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems (PI-RADS) scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [GS ≥ 3 + 4]) and compared by analyzing the areas under the curves and decision curves. ResultsA predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. ConclusionThis predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

et al. 2021

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“…Due to the low DCE sensitivity, adjunct costs [32], and side effects associated with i.v. gadolinium enhancers, an enhancer-free, bi-parametric (T2w and DWI) MRI protocol was recently suggested as an alternative in prostate imaging.…”

Section: Resultsmentioning

confidence: 99%

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

et al. 2019

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ObjectiveProstate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).Materials and methodsThe study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.ResultsSignificant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.ConclusionDCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

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“…Moreover, the bp protocol offers several advantages, considering that it is time-saving and cost-effective, and does not bring the potential risks associated with contrast medium administration (63)(64)(65)(66).…”

Section: Biparametric Mri (Bpmri) Vs Mpmrimentioning

confidence: 99%

Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement

et al. 2020

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Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity.Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.

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Financial implications of biparametric prostate MRI

Cited by 50 publications

References 22 publications

A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement

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