Visibility of significant prostate cancer on multiparametric magnetic resonance imaging (MRI)\u2014do we still need contrast media?

Nicolai Alexander Huebner,Paola Clauser,Tobias Gross,Andrea Haitel,Irene Resch,Nina Poetsch,Gero Kramer,Shahrokh F Shariat,Harun Fajkovic,Pascal A Baltzer,Robert Gale,Stephan Korn,Bernhard Grubmüller

doi:10.1007/s00330-020-07494-1

Abstract

ObjectivesTo assess the visibility of clinically significant prostate cancer (PCA) lesions on the sequences multiparametric MRI of the prostate (mpMRI) and to evaluate whether the addition of dynamic contrast–enhanced imaging (DCE) improves the overall visibility.MethodsWe retrospectively evaluated multiparametric MRI images of 119 lesions in 111 patients with biopsy-proven clinically significant PCA. Three readers assigned visual grading scores for visibility on each sequence, and a visual grading characteristic analysis was performed. Linear regression was used to explore which factors contributed to visibility in individual sequences.ResultsThe visibility of lesions was significantly better with mpMRI when compared to biparametric MRI in visual grading characteristic (VGC) analysis, with an AUCVGC of 0.62 (95% CI 0.55–0.69; p < 0.001). This benefit was seen across all readers. Multivariable linear regression revealed that a location in the peripheral zone was associated with better visibility on T2-weighted imaging (T2w). A higher Prostate Imaging-Reporting and Data System (PI-RADS) score was associated with better visibility on both diffusion-weighted imaging (DWI) and DCE. Increased lesion size was associated with better visibility on all sequences.ConclusionsVisibility of clinically significant PCA is improved by using mpMRI. DCE and DWI images independently improve lesion visibility compared to T2w images alone. Further research into the potential of DCE to impact on clinical decision-making is suggested.Key Points• DCE and DWI images independently improve clinically significant prostate cancer lesion visibility compared to T2w images alone.• Multiparametric MRI (DCE, DWI, T2w) achieved significantly higher visibility scores than biparametric MRI (DWI, T2w).• Location in the transition zone is associated with poor visibility on T2w, while it did not affect visibility on DWI or DCE.

Highlights

Multiparametric magnetic resonance imaging of the prostate, consisting of at least T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast– enhanced imaging (DCE) sequences, has become an important imaging modality in the diagnosis of clinically significant prostate cancer (PCA) [1]
DCE and DWI images independently improve clinically significant prostate cancer lesion visibility compared to T2w images alone
Location in the transition zone is associated with poor visibility on T2w, while it did not affect visibility on DWI or DCE

Summary

Introduction

Multiparametric magnetic resonance imaging (mpMRI) of the prostate, consisting of at least T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast– enhanced imaging (DCE) sequences, has become an important imaging modality in the diagnosis of clinically significant prostate cancer (PCA) [1]. As of 2019, the European Association of Urology (EAU) guidelines recommend mpMRI to be used before prostate biopsy in patients with suspicion of PCA based on elevated prostate-specific antigen (PSA) or a suspicious digital rectal examination (DRE) [4]. These high-quality data and the adoption in guideline recommendations have led to a substantial increase in the demand for prostate mpMRI examinations with its associated increase in expenditure of time and cost. A promising such approach, referred to as biparametric MRI (bpMRI), omits the DCE sequence, thereby shortening the image capture duration and avoiding the intravenous injection of contrast agents.

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