The Added Value of Dynamic Contrast-enhanced Sequences in Prostate MRI.

Abstract

HomeRadiology: Imaging CancerVol. 2, No. 5 PreviousNext Research HighlightsFree AccessThe Added Value of Dynamic Contrast-enhanced Sequences in Prostate MRISamuel J Withey, Ashik AmlaniSamuel J Withey, Ashik AmlaniSamuel J WitheyAshik AmlaniPublished Online:Sep 25 2020https://doi.org/10.1148/rycan.2020209031MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To assess the additional value of dynamic contrast-enhanced (DCE) sequences above T2-weighted and diffusion-weighted imaging (DWI) at MRI for suspected prostate cancer.■ Key Result: Addition of DCE to T2-weighted and DWI did not improve diagnostic accuracy.■ Impact: Noncontrast biparametric prostate MRI appears to be an acceptable alternative to multiparametric MRI in assessment of suspected prostate cancer.Prostate MRI has become an established test in assessing patients suspected of having prostate cancer and is performed prior to biopsy. Imaging allows biopsy to be targeted to areas of concern and safely avoided in patients with a low probability of clinically significant cancer. However, the use of contrast agent, while recommended in Prostate Imaging Reporting and Data System (PI-RADS) v2.1, remains contentious. If MRI could be performed without contrast agent without it having a substantial impact on diagnostic performance, it would lead to quicker, cheaper, and safer imaging.El-Shater Bosaily and colleagues compared the performance of biparametric MRI (T2-weighted and DWI) with multiparametric MRI (T2-weighted, DWI, and DCE) using systematic prostate biopsies as the ground truth. This was a large, multicenter, prospective study including 497 biopsy-naive men referred for investigation of suspected prostate cancer. Patients underwent prostate MRI with a 1.5-T system using a pelvic phased-array coil. Radiology assessment was on the likelihood of clinically significant prostate cancer being present. The prostate was divided into 12 segments, each of which was scored using a five-point Likert scale. Scores were assigned to the following imaging groups: (a) T2-weighted alone, (b) T2-weighted with DWI, and (c) T2-weighted, DWI, and DCE, with no retrospective revisions allowed. Overall Likert score was based on the highest segment score given. A limitation of the study was that MRI examinations received only a single read at their local center by radiologists of varying experience. While the radiologists were blinded to the histopathologic results, they had knowledge of the serum prostate specific antigen level, which could inflate the performance of MRI.A major strength of this work was the robust reference standard, with transperineal mapping biopsies performed at 5-mm intervals in all patients. Two pathologic definitions for clinically significant cancer were used: (a) Gleason score of greater than or equal to 4 + 3 or greater than or equal to 6-mm maximum length of any grade, and a lower threshold and (b) Gleason score of greater than or equal to 3 + 4 or greater than or equal to 4-mm maximum length of any grade.For both pathologic criteria, there was no significant difference in sensitivity, specificity, positive predictive value, or negative predictive value when using biparametric MRI versus multiparametric MRI. All (n = 53) dominant Gleason pattern 4 lesions were identified (scored Likert ≥3) with multiparametric MRI compared with 98.1% (52 of 53) without use of DCE. There were fewer Likert 3 reports using multiparametric MRI compared with biparametric MRI (28% and 32%, respectively), indicating that there can be a role for DCE, particularly in more equivocal cases.This well-designed study encourages us to question the necessity of performing DCE sequences as part of standard prostate MRI. Further work is required to determine if similar results will be seen when using PI-RADS v2.1, as one would expect.Highlighted ArticleEl-Shater Bosaily A, Frangou E, Ahmed HU, et al. Additional value of dynamic contrast-enhanced sequences in multiparametric prostate magnetic resonance imaging: data from the PROMIS study. Eur Urol 2020;78(4):503–513. doi: https://doi.org/10.1016/j.eururo.2020.03.002Highlighted ArticleEl-Shater Bosaily A, Frangou E, Ahmed HU, et al. Additional value of dynamic contrast-enhanced sequences in multiparametric prostate magnetic resonance imaging: data from the PROMIS study. Eur Urol 2020;78(4):503–513. doi: https://doi.org/10.1016/j.eururo.2020.03.002 Crossref, Medline, Google ScholarArticle HistoryPublished online: Sept 25 2020 FiguresReferencesRelatedDetailsRecommended Articles The Current State of MR Imaging–targeted Biopsy Techniques for Detection of Prostate CancerRadiology2017Volume: 285Issue: 2pp. 343-356Abbreviated Biparametric Prostate MR Imaging in Men with Elevated Prostate-specific AntigenRadiology2017Volume: 285Issue: 2pp. 493-505Cost-effectiveness of MR Imaging–guided Strategies for Detection of Prostate Cancer in Biopsy-Naive MenRadiology2017Volume: 285Issue: 1pp. 157-166Focal Therapy for Prostate Cancer with In-Bore MR–guided Focused Ultrasound: Two-Year Follow-up of a Phase I Trial—Complications and Functional OutcomesRadiology2017Volume: 285Issue: 2pp. 620-628Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant CancersRadiology2016Volume: 280Issue: 1pp. 108-116See More RSNA Education Exhibits When There is No Rectum: CT-Guided Targeted and Sextant Prostate Biopsy Digital Posters2019Everything a Radiologist Should Know About European Prostate Cancer Guidelines: A Multimodal ReviewDigital Posters2020Clinical Implementation of MRI-Ultrasound Fusion-Guided Prostate Biopsy in the Management of Prostate Cancer: What Radiologists Should KnowDigital Posters2019 RSNA Case Collection Anterior transition zone prostate adenocarcinomaRSNA Case Collection2020Peripheral Zone Prostate Cancer with PseudocapsuleRSNA Case Collection2022Locally advanced, metastatic prostate adenocarcinomaRSNA Case Collection2020 Vol. 2, No. 5 Metrics Altmetric Score PDF download