Abstract
(1) Background: There is currently limited evidence on the diagnostic accuracy of abbreviated biparametric MRI (a-bpMRI) protocols for prostate cancer (PCa) detection and screening. In the present study, we aim to investigate the performance of a-bpMRI among multiple readers and its potential application to an imaging-based screening setting. (2) Methods: A total of 151 men who underwent 3T multiparametric MRI (mpMRI) of the prostate and transperineal template prostate mapping biopsies were retrospectively selected. Corresponding bpMRI (multiplanar T2WI, DWI, ADC maps) and a-bpMRI (axial T2WI and b 2000 s/mm2 DWI only) dataset were derived from mpMRI. Three experienced radiologists scored a-bpMRI, standard biparametric MRI (bpMRI) and mpMRI in separate sessions. Diagnostic accuracy and interreader agreement of a-bpMRI was tested for different positivity thresholds and compared to bpMRI and mpMRI. Predictive values of a-bpMRI were computed for lower levels of PCa prevalence to simulate a screening setting. The primary definition of clinically significant PCa (csPCa) was Gleason ≥ 4 + 3, or cancer core length ≥ 6 mm. (3) Results: The median age was 62 years, the median PSA was 6.8 ng/mL, and the csPCa prevalence was 40%. Using a cut off of MRI score ≥ 3, the sensitivity and specificity of a-bpMRI were 92% and 48%, respectively. There was no significant difference in sensitivity compared to bpMRI and mpMRI. Interreader agreement of a-bpMRI was moderate (AC1 0.58). For a low prevalence of csPCa (e.g., <10%), higher cut offs (MRI score ≥ 4) yield a more favourable balance between the predictive values and positivity rate of MRI. (4) Conclusion: Abbreviated bpMRI protocols could match the diagnostic accuracy of bpMRI and mpMRI for the detection of csPCa. If a-bpMRI is used in low-prevalence settings, higher cut-offs for MRI positivity should be prioritised.
Highlights
Multiparametric magnetic resonance imaging plays a well-established role in the diagnostic workup of prostate cancer (PCa) [1]
The optimal scoring approach for abbreviated biparametric MRI (bpMRI) (a-bpMRI) protocols should be defined and tailored to the screening setting in terms of optimal cut-off scores and interpretation strategies [12]. To address these open questions, the aim of the present study is to investigate the diagnostic accuracy of a-bpMRI (
Materials & Methods This study was conducted retrospectively on datasets acquired between 2012 and 2014 in the Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) study [13], a paired-cohort confirmatory study designed to assess the diagnostic accuracy of multiparametric MRI (mpMRI) in men undergoing TTPM and targeted biopsy
Summary
Multiparametric magnetic resonance imaging (mpMRI) plays a well-established role in the diagnostic workup of prostate cancer (PCa) [1]. Shorter non-contrast protocols (i.e., bi-parametric MRI, bpMRI) may represent a potential solution to address these issues of mpMRI. Interest has recently grown over prostate MRI as a tool for PCa screening [6,7,8,9,10] In this scenario, where shorter scan lengths would have important health economic implications, abbreviated bpMRI (a-bpMRI) protocols could further improve MRI accessibility and reduce costs [11]. Evidence on their diagnostic performance is limited, and potential limitations of abbreviated protocols (such as an increased number of indeterminate findings) should be considered. The optimal scoring approach for a-bpMRI protocols should be defined and tailored to the screening setting in terms of optimal cut-off scores and interpretation strategies (e.g., single versus double reading) [12]
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