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Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice

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Abstract

Purpose

To assess the added value of dynamic contrast-enhanced (DCE) in prostate MR in clinical practice.

Methods

Two hundred sixty-four patients underwent prostate MRI, with T2 and DWI sequences initially interpreted, prior to full multiparametric magnetic resonance imaging (mpMRI) interpretation using a Likert 1–5 scale. A prospective opinion was given on likely benefit of contrast prior to review of the DCE sequence, and retrospectively following full mpMRI review. The final histology result following targeted and/or systematic biopsy of the prostate was used for outcome purposes.

Results

Biparametric magnetic resonance imaging (bpMRI) and mpMRI were assigned the same score in 86% of cases; when dichotomising to a negative or positive MRI (Likert score ≥ 3), concordance increased to 92.8%. At Likert score ≥ 3 bpMRI detected 89.9% of all cancers and 93.5% clinically significant prostate cancers (csPCa) and mpMRI 90.7% and 94.6%, respectively. mpMRI had fewer false positives than bpMRI (11.4% vs 18.9%) and a lower Likert 3 rate (8.3% vs 17%), conferring higher specificity (74% vs 67%), but similar sensitivity (95% versus 94%) and ROC-AUC (90% vs 89%). At a positive MRI threshold of Likert ≥ 4, mpMRI had a higher sensitivity than bpMRI (89% versus 80%) and detected more csPCa (89.2% versus 79.6%). DCE was prospectively considered of potential benefit in 27.3%, but readers would only recall 11% of patients for DCE sequences, mainly to assess score 3 peripheral zone lesions. Following full mpMRI review, DCE was considered helpful in 28.4% of cases; in 23/75 (30.6%) of these cases this only became apparent after reviewing the sequence, reasons included increased confidence, presence of “safety-net” lesions or inflammatory lesions.

Conclusion

BpMRI has equivalent cancer detection rates to mpMRI; however, mpMRI had fewer Likert 3 call rates and increased specificity and was subjectively considered of benefit by readers in 28.4% of cases.

Key Points

• bpMRI has similar cancer detection rates to the full mpMRI protocol at a positive MRI threshold of Likert 3.

• mpMRI had fewer intermediate category 3 calls (8.3%) than bpMRI (17%) and fewer false positives than bpMRI (11.4% vs 18.9%), conferring higher specificity (74% vs 67%).

• Readers considered DCE beneficial in 28.4% of cases, but in a relatively high number (30.6%) this only became apparent after reviewing the sequence.

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Abbreviations

3D-FSPGR:

Three-dimensional fast spoiled gradient-echo

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

Bp:

Biparametric

csPCa:

Clinically significant prostate cancer

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

ESUR:

European Society of Urogenital Radiology

FOV:

Field-of-view

iPCa:

Insignificant prostate cancer

IQR:

Inter quartiles ranges

ISUP:

International Society of Urological Pathology

Mp:

Multiparametric

MRI:

Magnetic resonance imaging

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostate-specific antigen

PZ:

Peripheral zone

ROC:

Receiver operating characteristic

SD:

standard deviation

TE:

Time of echo

TR:

Time of repetition

TZ:

Transition zone

US:

Ultrasound

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK

    Jeries P. Zawaideh, Evis Sala, Nadeem Shaida, Brendan Koo & Tristan Barrett

  2. Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy

    Jeries P. Zawaideh

  3. CamPARI Prostate Cancer Group, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK

    Evis Sala, Nadeem Shaida, Brendan Koo, Anne Y. Warren, Kasra Saeb-Parsy, Vincent J. Gnanapragasam, Christof Kastner & Tristan Barrett

  4. Department of Pathology, Addenbrooke’s Hospital, Cambridge, UK

    Anne Y. Warren

  5. Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy

    Luca Carmisciano

  6. Department of Urology, Addenbrooke’s Hospital, Cambridge, UK

    Kasra Saeb-Parsy, Vincent J. Gnanapragasam & Christof Kastner

Authors
  1. Jeries P. Zawaideh
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  2. Evis Sala
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  10. Tristan Barrett
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Correspondence to Jeries P. Zawaideh.

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Zawaideh, J.P., Sala, E., Shaida, N. et al. Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice. Eur Radiol 30, 4039–4049 (2020). https://doi.org/10.1007/s00330-020-06782-0

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  • DOI: https://doi.org/10.1007/s00330-020-06782-0

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