The value of diffusion-weighted imaging in the detection of prostate cancer: a meta-analysis

Abstract

ObjectivesTo evaluate the diagnostic performance of diffusion-weighted imaging (DWI) as a single non-invasive method in detecting prostate cancer (PCa) and to deduce its clinical utility.MethodsA systematic literature search was performed to identify relevant original studies. Quality of included studies was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Data were extracted to calculate sensitivity and specificity as well as running the test of heterogeneity and threshold effect. The summary receiver operating characteristic (SROC) curve was drawn and area under SROC curve (AUC) served as a determination of the diagnostic performance of DWI for the detection of PCa.ResultsA total of 21 studies were included, with 27 subsets of data available for analysis. The pooled sensitivity and specificity with corresponding 95 % confidence interval (CI) were 0.62 (95 % CI 0.61–0.64) and 0.90 (95 % CI 0.89–0.90), respectively. Pooled positive likelihood ratio and negative likelihood ratio were 5.83 (95 % CI 4.61–7.37) and 0.30 (95 % CI 0.23–0.39), respectively. The AUC was 0.8991. Significant heterogeneity was observed. There was no notable publication bias.ConclusionsDWI is an informative MRI modality in detecting PCa and shows moderately high diagnostic accuracy. General clinical application was limited because of the absence of standardized DW-MRI techniques.Key points• DWI provides incremental information for the detection and evaluation of PCa• DWI has moderately high diagnostic accuracy in detecting PCa• Patient condition, imaging protocols and study design positively influence diagnostic performance• General clinical application requires optimization of image acquisition and interpretation

When no treatment is the best treatment: Active surveillance strategies for low risk prostate cancers

“…This technique allows the integration of anatomical, biological and functional information. Most studies using histopathology specimens as reference standards have shown that mpMRI outperforms conventional anatomical imaging alone for the detection of prostate cancer [33][34][35][36]. There is also evidence that unfavorable findings on mpMRI, especially low ADC values, are associated with adverse histological features [37,38].…”

MRT der Prostata: Empfehlungen zur Vorbereitung und Durchführung

“…The sensitivity and specificity of DWI alone for the detection of carcinoma of the prostate are specified in a current meta-analysis including a total of 1204 patients as 62 % and 90 %, respectively [24]. In a meta-analysis including a total of 698 patients with a previous negative prostate biopsy, the average sensitivity of DWI for detecting a carcinoma of the prostate is 38 % and the average specificity is 95 % [25].…”

Improving non-invasive detection of prostate cancer using diffusion-weighted MRI

“…This may be due to the low positive predictive value of PSA, which accounts for a high proportion of unnecessary biopsies [4][5][6] . However, the negative predictive value (NPV) of TRUS-guided biopsy has been reported as between 36% and 89% [7] , with some patients being intolerant of this invasive procedure [8] . Where a negative biopsy is associated with continued suspicious clinical symptoms (continued rising PSA > 4.0 ng/mL, suspicious digital rectal examination, abnormal PSA velocity), repeat biopsies pose an even greater risk of negative rate for cancer detection than the initial biopsy (81%-83%) [9] , with second, third, and fourth re-biopsies detecting cancer in only 25% to 27%, 5% to 24%, and 4% to 21% of cases, respectively [10] .…”

“…Ultimately, the motion of water molecules is more restricted in tissues with high cellular density associated with numerous intact cell membranes, such as tumour tissue [20] . This decrease in water diffusion has been attributed to the increased cellularity of the malignant tumour, with a reduction of the extracellular space and restriction of the motion of extracellular water [8] .…”

“…Endorectal coils provide superior signal-to-noise ratio compared to pelvic phased-array coils but cause reduced patient compliance and increase susceptibility artefacts [21] . No standardised DW-MRI techniques currently exist and a large variety of imaging parameters exist for DW-MRI including the number and size of b-values, diagnostic threshold, and the type of coil [8] .…”