Impact of qualitative, semi-quantitative, and quantitative analyses of dynamic contrast-enhanced magnet resonance imaging on prostate cancer detection.

Farid Ziayee,Christian Arsov,Tim Ullrich,Michael Quentin,Dirk Blondin,Lars Schimmöller,Hannes Irmer,Gerald Antoch,Pascal A T Baltzer

doi:10.1371/journal.pone.0249532

Farid Ziayee, Christian Arsov + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0249532

Copy DOI

Journal: PloS one	Publication Date: Apr 5, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: Heinrich Heine University Düsseldorf

Abstract

Dynamic contrast enhanced imaging (DCE) as an integral part of multiparametric prostate magnet resonance imaging (mpMRI) can be evaluated using qualitative, semi-quantitative, or quantitative assessment methods. Aim of this study is to analyze the clinical benefits of these evaluations of DCE regarding clinically significant prostate cancer (csPCa) detection and grading. 209 DCE data sets of 103 consecutive patients with mpMRI (T2, DWI, and DCE) and subsequent MRI-(in-bore)-biopsy were retrospectively analyzed. Qualitative DCE evaluation according to PI-RADS v2.1, semi-quantitative (curve type; DCE score according to PI-RADS v1), and quantitative Tofts analyses (Ktrans, kep, and ve) as well as PI-RADS v1 and v2.1 overall classification of 209 lesions (92 PCa, 117 benign lesions) were performed. Of each DCE assessment method, cancer detection, discrimination of csPCa, and localization were assessed and compared to histopathology findings. All DCE analyses (p<0.01–0.05), except ve (p = 0.02), showed significantly different results for PCa and benign lesions in the peripheral zone (PZ) with area under the curve (AUC) values of up to 0.92 for PI-RADS v2.1 overall classification. In the transition zone (TZ) only the qualitative DCE evalulation within PI-RADS (v1 and v2.1) could distinguish between PCa and benign lesions (p<0.01; AUC = 0.95). None of the DCE parameters could differentiate csPCa from non-significant (ns) PCa (p ≥ 0.1). Qualitative analysis of DCE within mpMRI according to PI-RADS version 2.1 showed excellent results regarding (cs)PCa detection. Semi-quantitative and quantitative parameters provided no additional improvements. DCE alone wasn’t able to discriminate csPCa from nsPCa.

Highlights

Prostate cancer (PCa) shows increased perfusion compared to normal tissue due to higher micro-vessel density, arteriovenous shunts, and higher vascular permeability
International Society of Urological Pathology (ISUP) grades were as folows: ISUP 1: 18 lesions of 8 patients, ISUP 2: 54 lesions of 30 patients, ISUP 3: 13 lesions of 11 patients, ISUP 4: 3 lesions of 2 patients, and ISUP 5: 4 lesions of 2 patients. 119 lesions were located in transition zone (TZ), 75 in peripheral zone (PZ), 15 in the AFS/CZ. 117 lesions and 50 patients showed negative biopsy results
In Receiver operating characteristic (ROC) analysis Prostate Imaging Reporting and Data System (PI-RADS) v2.1 overall classification demonstrated the highest area under the curve (AUC = 0.94), whereas among the other dynamic contrast enhanced MRI (DCE) analysis AUC of DCE v2.1 was highest (AUC = 0.91)

Summary

Introduction

Prostate cancer (PCa) shows increased perfusion compared to normal tissue due to higher micro-vessel density, arteriovenous shunts, and higher vascular permeability. Analyses of dynamic contrast-enhanced magnet resonance imaging dynamic contrast enhanced MRI (DCE) represents an additional tool for the detection of PCa, especially in the peripheral zone (PZ) [1]. The benefit of a qualitative DCE analysis is its relatively simple and timesaving usage. This approach represents a subjective judgment of the reader and the gathered information of the exact perfusion is limited [3,4]

Objectives

Methods

Results

Conclusion