Abstract
The study goal was to test whether the improved accuracy in quantitative dynamic contrast-enhanced magnetic resonance imaging measurement using a point-of-care portable perfusion phantom (P4) leads to better stratification of prostate cancer grade. A prospective clinical study was conducted recruiting 44 patients scheduled for multi-parameter MRI prostate exams. All participants were imaged with the P4 placed under their pelvic regions. Tissue sampling was carried out for 25 patients at 22 ± 18 (mean ± SD) days after multi-parameter MRI. On histologic examination, a total of 31 lesions were confirmed as prostate cancer. Tumors were classified into low grade (n = 14), intermediate grade (n = 10), and high grade (n = 7). Tumor perfusion was assessed by volume transfer constant, Ktrans, before and after P4-based error correction, and the Ktrans of low, intermediate and high-grade tumors were statistically compared. After P4-based error correction, the Ktrans of low, intermediate, and high-grade tumors were 0.109 ± 0.026 min-1 (95% CI: 0.0094 to 0.124 min-1), 0.163 ± 0.049 min-1 (95% CI: 0.129 to 0.198 min-1) and 0.356 ± 0.156 min-1 (95% CI: 0.215 to 0.495 min-1), respectively, with statistically significant difference among the groups (low vs intermediate: p = 0.002; intermediate vs high: p = 0.002; low vs high: p < 0.001). The sensitivity and specificity of Ktrans value, 0.14 min-1, to detect the clinically significant prostate cancer were 88% and 93%, respectively, after P4 based error correction, but those before error correction were 88% and 86%, respectively. The P4 allows to reduce errors in quantitative dynamic contrast-enhanced magnetic resonance imaging measurement, enhancing accuracy in stratification of prostate cancer grade.
Highlights
Prostate cancer (PCa) is the most common noncutaneous cancer, and the second leading cause of cancer-related death in men in the United States [1]
As increased perfusion is associated with tumor aggressiveness, Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) Magnetic resonance imaging (MRI) has been investigated for early prostate cancer detection [5], grade stratification [6] and therapy monitoring [7]
Interscanner variability impedes the comparison of data among institutes, which prevents standardizing DCE-MRI values for quantitative analysis, while intra-scanner variability leads to errors in therapy monitoring
Summary
Prostate cancer (PCa) is the most common noncutaneous cancer, and the second leading cause of cancer-related death in men in the United States [1]. DCEMRI is currently utilized as a qualitative technique merely assisting the clinical interpretation of diffusion weighted imaging (DWI) or T2 weighted (T2W) MRI in a standardof-care multi-parametric MRI (mpMRI) of the prostate based on Prostate Imaging Reporting and Data System version 2.1 [9]. This yields reasonable diagnostic accuracy, but it has fundamental limitation due to its nature of subjective assessment, leading to inter-observer variation [10]
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