Dynamic contrast-enhanced imaging has limited added value over T2-weighted imaging and diffusion-weighted imaging when using PI-RADSv2 for diagnosis of clinically significant prostate cancer in patients with elevated PSA. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: De Visschere, P.; Lumen, N.; Ost, P.; Decaestecker, K.; Pattyn, E.; Villeirs, G.
• Is Part Of: Clinical radiology. Volume 72:Issue 1(2017)
• Page Start: 23
• Page End: 32
• Publication Date: 2017-01
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2016.09.011
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : Aim: To determine the added value of dynamic contrast-enhanced imaging (DCE) over T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for detection of clinically significant prostate cancer (csPC) in patients with elevated prostate-specific antigen (PSA). Methods and materials: Two hundred and forty-five patients with elevated PSA underwent multiparametric (mp) magnetic resonance imaging (MRI) of the prostate before biopsy. mpMRI was performed using a 3 T MRI system without an endorectal coil. Patients underwent transrectal ultrasound-guided systematic 12 core biopsy followed by radical prostatectomy ( n =68), radiation therapy ( n =91), or clinical follow-up for at least 2 years ( n =86). csPC was defined as Gleason score ≥3+4 and/or tumour volume of ≥0.5 ml, and/or tumour stage ≥T3a. The MRI findings were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and an alternative overall assessment category (PI-RADSv2Alt) based on only T2-WI and DWI. Results: In 144 patients (58.8%), csPC was found within 2 years after MRI. With scoring according to the PI-RADSv2 guidelines, DCE was not needed for determination of the overall assessment category in 80.8% (198/245) of patients. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.79 (95% confidence interval [CI]: 0.74–0.85) for PI-RADSv2 and 0.79 (95% CI: 0.73–0.85) for PI-RADSv2Alt. Conclusion: The added value of DCE over T2-WI and DWI is limited when using PI-RADSv2 for diagnosis of csPC in patients with elevated PSA before biopsy. An alternative overall assessment score using only T2-WI and DWI yielded similar performance to PI-RADSv2. Highlights: PI-RADSv2 is a useful scoring system for detection of csPC with MRI. In 80.8% of patients DCE is not needed for overall assessment score determination. In case of a score 3 on DWI in the PZ, T2-WI may be used as alternative to DCE. PI-RADSv2alt exhibited similar performance as PI-RADSv2.