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

Abstract

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.

Diagnostic Value of Magnetic Resonance Susceptibility-Weighted Imaging Scanning in Different Types of Early Prostate Cancer

“…After the second dynamic phase of dynamic contrast-enhanced scanning, the contrast agent GD DTPA was injected through elbow vein with high-pressure syringe at the injection rate of 2 ml/s and the dose of 0.2 mmol/kg, and then, 20 ml normal saline was injected intravenously at the same rate [ 16 ] Image analysis method SWI image processing and analysis: two senior doctors in the imaging department of our hospital jointly evaluate the film. Their opinions are not unified at one time, and a unified opinion is reached through negotiation [ 17 ]. According to the SWI image obtained by the patient, the internal bleeding focus of the focus was evaluated by SUSE score.…”

“…Image analysis method SWI image processing and analysis: two senior doctors in the imaging department of our hospital jointly evaluate the film. Their opinions are not unified at one time, and a unified opinion is reached through negotiation [ 17 ]. According to the SWI image obtained by the patient, the internal bleeding focus of the focus was evaluated by SUSE score.…”

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

“…Recent literature indeed focuses on the overlapping diagnostic validity using bp and mp protocols in detecting csPCa (62).…”

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

“…Evidence from a study has shown that PI‐RADS, even with shortened imaging sequences, can provide high negative predictive value in lesions with a score of 1–2 and high positive predictive value in lesions with a score of 4–5 16 . Therefore, application of biparametric (Bp) MRI by omitting DCE imaging was recently proposed 17,18 . The results have demonstrated that Bp‐MRI does not compromise the detection of harmful disease and increases MRI capacity at lower direct costs when compared with Mp‐MRI 19 .…”

“…The results have demonstrated that Bp‐MRI does not compromise the detection of harmful disease and increases MRI capacity at lower direct costs when compared with Mp‐MRI 19 . However, omitting DCE may increase the risk of missing clinically significant disease, especially in PI‐RADS 3 findings in the peripheral zone 18,20 . Recently, it was suggested that Bp‐MRI should not be applied routinely and should be reserved for experienced expert centers only 21 .…”