Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility.

Valentina Brancato,Liberatore Tramontano,Giuseppe Di Costanzo,Carlo Cavaliere,Marta Puglia,Luca Basso,Alfonso Ragozzino

doi:10.3390/diagnostics10030164

Abstract

The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen’s kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.

Highlights

Multiparametric MRI is an approach that involves the use of functional MRI methods, such as Diffusion Weighted Imaging (DWI) and Dynamic Contrast Enhanced (DCE) imaging, to supplement standard anatomical information provided by T1- and T2-weighted imaging [1,2]
The Prostate Imaging-Reporting and Data System (PI-RADS v1) score was developed and published in 2012 by the European Society of Urogenital Radiology (ESUR) in order to standardize the use of Multiparametric MRI (mpMRI) in imaging PCa due to mpMRI expanding role in prostate cancer (PCa) diagnosis [2,3,4,5], mainly in patients with prior negative biopsies and/or increased PSA levels [6]
Lesions that were negative to PCa, as well as all clinically significant PCa (CS-PCa) lesions, were all located in peripheral zone (PZ)

Summary

Introduction

Multiparametric MRI (mpMRI) is an approach that involves the use of functional MRI methods, such as Diffusion Weighted Imaging (DWI) and Dynamic Contrast Enhanced (DCE) imaging, to supplement standard anatomical information provided by T1- and T2-weighted imaging [1,2].The Prostate Imaging-Reporting and Data System (PI-RADS v1) score was developed and published in 2012 by the European Society of Urogenital Radiology (ESUR) in order to standardize the use of mpMRI in imaging PCa due to mpMRI expanding role in prostate cancer (PCa) diagnosis [2,3,4,5], mainly in patients with prior negative biopsies and/or increased PSA levels [6]. Diagnostics 2020, 10, 164 basis of PI-RADS v1 limitations, an updated PI-RADS version (PI-RADS v2) was developed in 2015 mainly due to the poor integration of the overall PI-RADS scoring leading to substantial variability in the system interpretation and use [7]. This update substantially strengthens the role of T2W and DWI MRI sequences, downgrading DCE-MRI contributes to a qualitative assessment through the presence/absence of focal enhancement [8]

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