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MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy

  • Urogenital
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Abstract

Purpose

This study evaluated the accuracy of MR sequences [T2-, diffusion-weighted, and dynamic contrast-enhanced (T2WI, DWI, and DCE) imaging] at 3T, based on the European Society of Urogenital Radiology (ESUR) scoring system [Prostate Imaging Reporting and Data System (PI-RADS)] using MR-guided in-bore prostate biopsies as reference standard.

Methods

In 235 consecutive patients [aged 65.7 ± 7.9 years; median prostate-specific antigen (PSA) 8 ng/ml] with multiparametric prostate MRI (mp-MRI), 566 lesions were scored according to PI-RADS. Histology of all lesions was obtained by targeted MR-guided in-bore biopsy.

Results

In 200 lesions, biopsy revealed prostate cancer (PCa). The area under the curve (AUC) for cancer detection was 0.70 (T2WI), 0.80 (DWI), and 0.74 (DCE). A combination of T2WI + DWI, T2WI + DCE, and DWI + DCE achieved an AUC of 0.81, 0.78, and 0.79. A summed PI-RADS score of T2WI + DWI + DCE achieved an AUC of 0.81. For higher grade PCa (primary Gleason pattern ≥ 4), the AUC was 0.85 for T2WI + DWI, 0.84 for T2WI + DCE, 0.86 for DWI + DCE, and 0.87 for T2WI + DWI + DCE. The AUC for T2WI + DWI + DCE for transitional-zone PCa was 0.73, and for the peripheral zone 0.88. Regarding higher-grade PCa, AUC for transitional-zone PCa was 0.88, and for peripheral zone 0.96.

Conclusion

The combination of T2WI + DWI + DCE achieved the highest test accuracy, especially in patients with higher-grade PCa. The use of ≤2 MR sequences led to lower AUC in higher-grade and peripheral-zone cancers.

Key Points

• T2WI + DWI + DCE achieved the highest accuracy in patients with higher grade PCa

• T2WI + DWI + DCE was more accurate for peripheral- than for transitional-zone PCa

• DCE increased PCa detection accuracy in the peripheral zone

• DWI was the leading sequence in the transitional zone

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Abbreviations

ESUR:

European Society of Urogenital Radiology

PI-RADS:

Prostate Imaging Reporting and Data System

mp-MRI:

Multiparametric magnetic resonance imaging

DCE:

Dynamic contrast-enhanced imaging

MRSI:

Magnetic resonance spectroscopic imaging

DWI:

Diffusion-weighted imaging

ROC:

Receiver operating characteristic

AUC:

Area under the curve

PCa:

Prostate cancer

PSA:

Prostate-specific antigen

TRUS:

Transrectal ultrasound

References

  1. Murphy G, Haider M, Ghai S et al (2013) The expanding role of MRI in prostate cancer. AJR 201:1229–1238

    Article  PubMed  Google Scholar 

  2. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    Article  PubMed Central  PubMed  Google Scholar 

  3. Mozer P, Cornud F, Renard-Penna R, Misrai V, Thoulouzan M, Malavaud B (2012) Validation of the European Society of Urogenital Radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients. Eur Urol 62:986–996

    Article  PubMed  Google Scholar 

  4. Kuru TH, Roethke MC, Rieker P, Roth W, Fenchel M, Hohenfellner M, Schlemmer HP, Hadaschik BA (2013) Histology core-specific evaluation of the European Society of Urogenital Radiology (ESUR) standardised scoring system of multiparametric magnetic resonance imaging (mpMRI) of the prostate. BJU Int 112:1080–1087

    Article  CAS  PubMed  Google Scholar 

  5. Schimmöller L, Quentin M, Arsov C, Lanzman RS, Hiester A, Rabenalt R, Antoch G, Albers P, Blondin D (2013) Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard. Eur Radiol 23:3185–3190

    Article  PubMed  Google Scholar 

  6. Rosenkrantz AB, Lim RP, Haghighi M, Somberg MB, Babb JS, Taneja SS (2013) Comparison of interreader reproducibility of the prostate imaging reporting and data system and Likert scales for evaluation of multiparametric prostate MRI. AJR 201:601–618

    Google Scholar 

  7. Westphalen AC, Rosenkartz AB (2014) Prostate Imaging Reporting and Data System (PI-RADS): reflections on early experience with a standardized interpretation scheme for multiparametric prostate MRI. AJR 202:121–123

    Article  PubMed  Google Scholar 

  8. Mazaheri Y, Shukla-Dave A, Muellner A et al (2008) MR imaging of the prostate in clinical practice. MAGMA 21:379–392

    Article  PubMed  Google Scholar 

  9. Osugi K, Tanimoto A, Nakashima J, Shinoda K, Hashiguchi A, Oya M, Jinzaki M, Kuribayashi S (2013) What is the most effective tool for detecting prostate cancer using a standard MR scanner? Magn Reson Med Sci 12:271–280

    Article  PubMed  Google Scholar 

  10. Puech P, Sufana-Iancu A, Renard B, Lemaitrea L (2013) Prostate MRI: can we do without DCE sequences in 2013? Diagn Interv Imaging 94:1299–1311

    Article  CAS  PubMed  Google Scholar 

  11. Sabach A, Babb JS, Matza BW, Taneja SS, Deng FM (2013) Prostate cancer: comparison of dynamic contrast-enhanced MRI techniques for localization of peripheral zone tumor. AJR 201:471–478

    Article  Google Scholar 

  12. Hoeks CMA, Hambrock T, Yakar D, Hulsbergen-van de Kaa CA, Feuth T, Witjes JA, Fütterer JJ, Barentsz JO (2013) Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology 266:207–217

    Article  PubMed  Google Scholar 

  13. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B et al (2011) Magnetic resonance imaging for the detection, localization and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 59:477–494

    Article  PubMed  Google Scholar 

  14. Quentin M, Schimmöller L, Arsov C, Rabenalt R, Antoch G, Albers P, Blondin D (2013) Increased signal intensity of prostate lesions on high b-value diffusion-weighted images as a predictive sign of malignancy. Eur Radiol 24:209–213

    Article  PubMed  Google Scholar 

  15. Röthke M, Blondin D, Schlemmer HP, Franiel T (2013) PI-RADS classification: structured reporting for MRI of the prostate. Röfo 185:253–261

    PubMed  Google Scholar 

  16. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin P, Kirkham AP, Padhani AR, Persad R, Puech P, Punwani S, Sohaib A, Tombal B, Villers A, Emberton M (2013) Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? J Magn Reson Imaging 37:48–58

    Article  PubMed  Google Scholar 

  17. Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, Hoang AN, Walton-Diaz A, Shuch B, Weintraub M, Kruecker J, Amalou H, Turkbey B, Merino MJ, Choyke PL, Wood BJ, Pinto PA (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64:713–719

    Article  PubMed  Google Scholar 

  18. Delongchamps NB, Rouanne M, Flam T et al (2011) Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int 107:1411–1418

    Article  PubMed  Google Scholar 

  19. Nagel KN, Schouten MG, Hambrock T, Litjens GJ, Hoeks CM, ten Haken B, Barentsz JO, Fütterer JJ (2013) Differentiation of prostatitis and prostate cancer by using diffusion-weighted MR imaging and MR-guided biopsy at 3 T. Radiology 267:164–172

    Article  PubMed  Google Scholar 

  20. Donati OF, Jung SI, Vargas HA, Gultekin DH, Zheng J, Moskowitz CS, Hricak H, Zelefsky MJ, Akin O (2013) Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 268:440–450

    Article  PubMed  Google Scholar 

  21. Isebaert S, Van den Bergh L, Haustermans K et al (2013) Multiparametric MRI for prostate cancer localization in correlation to whole-mount histopathology. J Magn Reson Imaging 37:1392–1401

    Article  PubMed  Google Scholar 

  22. Chesnais AL, Niaf E, Bratan F, Mège-Lechevallier F, Roche S, Rabilloud M, Colombel M, Rouvière O (2013) Differentiation of transitional zone prostate cancer from benign hyperplasia nodules: evaluation of discriminant criteria at multiparametric MRI. Clin Radiol 68:323–330

    Article  Google Scholar 

  23. Hoeks CMA, Vos EK, Bomers JGR, Barentsz JO, Hulsbergen-van de Kaa CA, Scheenen TW (2013) Diffusion-weighted magnetic resonance imaging in the prostate transition zone. Histopathological validation using magnetic resonance guided biopsy specimens. Investig Radiol 48:693–701

    Article  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Dirk Blondin. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. No study participants or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany

    Lars Schimmöller, Michael Quentin, Christian Buchbender, Gerald Antoch & Dirk Blondin

  2. Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany

    Christian Arsov, Andreas Hiester, Robert Rabenalt & Peter Albers

Authors
  1. Lars Schimmöller
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  2. Michael Quentin
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  3. Christian Arsov
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  4. Andreas Hiester
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  5. Christian Buchbender
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  6. Robert Rabenalt
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  7. Peter Albers
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  8. Gerald Antoch
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  9. Dirk Blondin
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Correspondence to Michael Quentin.

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Schimmöller, L., Quentin, M., Arsov, C. et al. MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol 24, 2582–2589 (2014). https://doi.org/10.1007/s00330-014-3276-9

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  • DOI: https://doi.org/10.1007/s00330-014-3276-9

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