Standardisation of prostate multiparametric MRI across a hospital network: a London experience

Marianthi-Vasiliki Papoutsaki,Clare Allen,Jacob Goodman,Francesco Giganti,David Atkinson,Tristan Barrett,Shonit Punwani,Helen Saunders,Louise Dickinson

doi:10.1186/s13244-021-00990-y

Abstract

ObjectivesNational guidelines recommend prostate multiparametric (mp) MRI in men with suspected prostate cancer before biopsy. In this study, we explore prostate mpMRI protocols across 14 London hospitals and determine whether standardisation improves diagnostic quality.MethodsAn MRI physicist facilitated mpMRI set-up across several regional hospitals, working together with experienced uroradiologists who judged diagnostic quality. Radiologists from the 14 hospitals participated in the assessment and optimisation of prostate mpMRI image quality, assessed according to both PiRADSv2 recommendations and on the ability to “rule in” and/or “rule out” prostate cancer. Image quality and sequence parameters of representative mpMRI scans were evaluated across 23 MR scanners. Optimisation visits were performed to improve image quality, and 2 radiologists scored the image quality pre- and post-optimisation.Results20/23 mpMRI protocols, consisting of 111 sequences, were optimised by modifying their sequence parameters. Pre-optimisation, only 15% of T2W images were non-diagnostic, whereas 40% of ADC maps, 50% of high b-value DWI and 41% of DCE-MRI were considered non-diagnostic. Post-optimisation, the scores were increased with 80% of ADC maps, 74% of high b-value DWI and 88% of DCE-MRI to be partially or fully diagnostic. T2W sequences were not optimised, due to their higher baseline quality scores.ConclusionsTargeted intervention at a regional level can improve the diagnostic quality of prostate mpMRI protocols, with implications for improving prostate cancer detection rates and targeted biopsies.

Highlights

Worldwide, there were an estimated 359,000 prostate cancer (PCa) deaths in 2018 [1]
After applying the standardisation process across the several prostate multiparametric MRI protocols, the majority of the scores were increased resulting in 80% of apparent diffusion coefficient (ADC) maps, 74% of high b-value diffusionweighted images and 88% of dynamic contrastenhanced MRI to be partially or fully diagnostic
A range of challenges are evident in implementing prostate multiparametric MRI (mpMRI) nationally, many of which were discussed in the 2018 United Kingdom (UK) Prostate Cancer Consensus Meeting [6]

Summary

Introduction

The introduction of prostate multiparametric MRI (mpMRI) has revolutionised the management of PCa, improving diagnosis [2] and risk stratification of patients, and allowing appropriate subsequent management [3, 4]. In 2019, the National Institute of Health and Care Excellence (NICE) updated prostate cancer guidelines endorsing the routine use of mpMRI in biopsy-naive men with suspected PCa [5]. A range of challenges are evident in implementing prostate mpMRI nationally, many of which were discussed in the 2018 United Kingdom (UK) Prostate Cancer Consensus Meeting [6]. Several studies have highlighted that mpMRI quality varies substantially between centres and scanners, which is vulnerable to patient-related degradations, and that poor image quality is associated with greater uncertainty and lower accuracy [7–9]. The acquisition of mpMRI images of good diagnostic quality is crucial. Any interpretations made by radiologists (no matter how experienced) is likely to be flawed and could subsequently lead to incorrect patient management

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