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Restriction spectrum imaging improves MRI-based prostate cancer detection

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the diagnostic performance of restriction spectrum imaging (RSI), with that of conventional multi-parametric (MP) magnetic resonance imaging (MRI) for prostate cancer (PCa) detection in a blinded reader-based format.

Methods

Three readers independently evaluated 100 patients (67 with proven PCa) who underwent MP-MRI and RSI within 6 months of systematic biopsy (N = 67; 23 with targeting performed) or prostatectomy (N = 33). Imaging was performed at 3 Tesla using a phased-array coil. Readers used a five-point scale estimating the likelihood of PCa present in each prostate sextant. Evaluation was performed in two separate sessions, first using conventional MP-MRI alone then immediately with MP-MRI and RSI in the same session. Four weeks later, another scoring session used RSI and T2-weighted imaging (T2WI) without conventional diffusion-weighted or dynamic contrast-enhanced imaging. Reader interpretations were then compared to prostatectomy data or biopsy results. Receiver operating characteristic curves were performed, with area under the curve (AUC) used to compare across groups.

Results

MP-MRI with RSI achieved higher AUCs compared to MP-MRI alone for identifying high-grade (Gleason score greater than or equal to 4 + 3=7) PCa (0.78 vs. 0.70 at the sextant level; P < 0.001 and 0.85 vs. 0.79 at the hemigland level; P = 0.04). RSI and T2WI alone achieved AUCs similar to MP-MRI for high-grade PCa (0.71 vs. 0.70 at the sextant level). With hemigland analysis, high-grade disease results were similar when comparing RSI + T2WI with MP-MRI, although with greater AUCs compared to the sextant analysis (0.80 vs. 0.79).

Conclusion

Including RSI with MP-MRI improves PCa detection compared to MP-MRI alone, and RSI with T2WI achieves similar PCa detection as MP-MRI.

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Acknowledgments

This study was supported by NIH Grant R01EB000790, American Cancer Society, Institutional Research Grant Number 70-002, Department of Defense Prostate Cancer Research Program, Idea Development Award W81XWH-13-1-0391#PC120532, National Science Foundation Grant Number 1430082, and General Electric Investigator Initiated Research Award BOK92325.

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Authors and Affiliations

  1. Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA

    Kevin C. McCammack, Natalie M. Schenker-Ahmed, Nathan S. White, Shaun R. Best, Joshua M. Kuperman, Hauke Bartsch, Rahul S. Desikan, Rebecca A. Rakow-Penner, Anders M. Dale & David S. Karow

  2. Department of Radiology, Naval Medical Center San Diego, San Diego, USA

    Robert M. Marks & Jared Heimbigner

  3. Department of Urology, University of California San Diego School of Medicine, San Diego, USA

    Christopher J. Kane & J. Kellogg Parsons

  4. Department of Urology, University of Texas San Antonio School of Medicine, San Antonio, USA

    Michael A. Liss

  5. Department of Radiology, University of California Los Angeles Geffen School of Medicine, Los Angeles, USA

    Daniel J. A. Margolis & Steven S. Raman

  6. Department of Pathology, University of California San Diego School of Medicine, San Diego, USA

    Ahmed Shabaik

  7. Department of Neurosciences, University of California San Diego School of Medicine, San Diego, USA

    Anders M. Dale

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  1. Kevin C. McCammack
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Corresponding author

Correspondence to David S. Karow.

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Conflict of Interest

All authors declared that they have no conflict of interest.

Disclaimer

The views expressed in this presentation are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. The authors are military service members. This work was prepared as part of official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

The authors were funded by R01EB000790, American Cancer Society, Institutional Research Grant Number 70-002; DoD, Prostate Cancer Research Program; Idea Development Award W81XWH-13-1-0391, #PC120532; National Science Foundation, Grant Number 1430082; UCSD Clinician Scientist Program; and General Electric, Investigator Initiated Research Award BOK92325.

Informed Consent

Signed informed consent was waived by our Institutional Review Board as RSI has been integrated into the standard prostate MRI workflow at our institution as a diffusion tensor imaging product sequence-based technique with multiple b values, anteroposterior/posteroanterior distortion correction, and unique post-processing.

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McCammack, K.C., Schenker-Ahmed, N.M., White, N.S. et al. Restriction spectrum imaging improves MRI-based prostate cancer detection. Abdom Radiol 41, 946–953 (2016). https://doi.org/10.1007/s00261-016-0659-1

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