Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD‐Compliant Two‐Center Study
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. Stud...
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| Veröffentlicht in: | Journal of magnetic resonance imaging Jg. 53; H. 4; S. 1210 - 1219 |
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| Hauptverfasser: | , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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Hoboken, USA
John Wiley & Sons, Inc
01.04.2021
Wiley Subscription Services, Inc |
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| ISSN: | 1053-1807, 1522-2586, 1522-2586 |
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| Abstract | 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 |
|---|---|
| AbstractList | There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC).
To evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC.
Two-center, retrospective.
A total of 346 patients from center 1 and 292 patients from center 2.
3.0T scanners, T
-weighted imaging (T
WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging.
Four radiologists interpreted the Bp-MRI (T
WI and DWI) and Mp-MRI (T
WI, 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.
Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability.
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.
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.
4 TECHNICAL EFFICACY STAGE: 2. BackgroundThere is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC).PurposeTo evaluate an optimized (Op)‐MRI compared with biparametric (Bp)‐MRI and multiparametric (Mp)‐MRI for the diagnosis of CSPC.Study TypeTwo‐center, retrospective.SubjectsA total of 346 patients from center 1 and 292 patients from center 2.Field Strength/Sequence3.0T scanners, T2‐weighted imaging (T2WI), diffusion‐weighted imaging (DWI), and dynamic contrast‐enhanced (DCE) imaging.AssessmentFour 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 TestsPerformance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability.ResultsInterreader 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 ConclusionThe 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 Evidence4Technical Efficacy Stage2 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 There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC).BACKGROUNDThere is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC).To evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC.PURPOSETo evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC.Two-center, retrospective.STUDY TYPETwo-center, retrospective.A total of 346 patients from center 1 and 292 patients from center 2.SUBJECTSA total of 346 patients from center 1 and 292 patients from center 2.3.0T scanners, T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging.FIELD STRENGTH/SEQUENCE3.0T scanners, T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging.Four radiologists interpreted the Bp-MRI (T2 WI and DWI) and Mp-MRI (T2 WI, 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.ASSESSMENTFour radiologists interpreted the Bp-MRI (T2 WI and DWI) and Mp-MRI (T2 WI, 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.Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability.STATISTICAL TESTSPerformance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability.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.RESULTSInterreader 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.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.DATA CONCLUSIONThe 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.4 TECHNICAL EFFICACY STAGE: 2.LEVEL OF EVIDENCE4 TECHNICAL EFFICACY STAGE: 2. |
| Author | Zhang, Jing Wu, Chen‐Jiang Wang, Xi‐Ming Hou, Ying Zhang, Yu‐Dong Bao, Jie Zhi, Rui |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33075177$$D View this record in MEDLINE/PubMed |
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| Copyright | 2020 International Society for Magnetic Resonance in Medicine 2020 International Society for Magnetic Resonance in Medicine. 2021 International Society for Magnetic Resonance in Medicine |
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| Keywords | multiparametric MRI biparametric MRI optimized MRI prostate imaging reporting and data system clinically significant prostate cancer |
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There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer... There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC). To... BackgroundThere is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer... There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer... |
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| SubjectTerms | Biopsy biparametric MRI Cancer surgery Clinical significance clinically significant prostate cancer Diagnosis Diffusion Magnetic Resonance Imaging Field strength Humans Lesions Magnetic Resonance Imaging Male Medical imaging multiparametric MRI optimized MRI Prostate cancer prostate imaging reporting and data system Prostatectomy Prostatic Neoplasms - diagnostic imaging Retrospective Studies Scanners Statistical analysis Statistical tests |
| Title | Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD‐Compliant Two‐Center Study |
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