Contribution of dynamic contrast-enhanced and diffusion MRI to PI-RADS for detecting clinically significant prostate cancer

• Verfasst von: Tavakoli, Andrej [VerfasserIn]
• Verfasst von: Hielscher, Thomas [VerfasserIn]
• Verfasst von: Badura, Patrick [VerfasserIn]
• Verfasst von: Görtz, Magdalena [VerfasserIn]
• Verfasst von: Kuder, Tristan Anselm [VerfasserIn]
• Verfasst von: Gnirs, Regula [VerfasserIn]
• Verfasst von: Schwab, Constantin [VerfasserIn]
• Verfasst von: Hohenfellner, Markus [VerfasserIn]
• Verfasst von: Schlemmer, Heinz-Peter [VerfasserIn]
• Verfasst von: Bonekamp, David [VerfasserIn]
• Titel: Contribution of dynamic contrast-enhanced and diffusion MRI to PI-RADS for detecting clinically significant prostate cancer
• Verf.angabe: Anoshirwan Andrej Tavakoli, Thomas Hielscher, Patrick Badura, Magdalena Görtz, Tristan Anselm Kuder, Regula Gnirs, Constantin Schwab, Markus Hohenfellner, Heinz-Peter Schlemmer, David Bonekamp
• Jahr: 2023
• Umfang: 14 S.
• Fussnoten: Online veröffentlicht: Aug 16 2022 ; Gesehen am 15.03.2023
• Titel Quelle: Enthalten in: Radiology
• Ort Quelle: Oak Brook, Ill. : Soc., 1923
• Jahr Quelle: 2023
• Band/Heft Quelle: 306(2023), 1, Seite 186-199
• ISSN Quelle: 1527-1315
• DOI: doi:10.1148/radiol.212692
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1839249846

Abstract

Background - - Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 requires multiparametric MRI of the prostate, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging sequences; however, the contribution of DCE imaging remains unclear. - - Purpose - - To assess whether DCE imaging in addition to apparent diffusion coefficient (ADC) and normalized T2 values improves PI-RADS version 2.0 for prediction of clinically significant prostate cancer (csPCa). - - Materials and Methods - - In this retrospective study, clinically reported PI-RADS lesions in consecutive men who underwent 3-T multiparametric MRI (T2-weighted, DWI, and DCE MRI) from May 2015 to September 2016 were analyzed quantitatively and compared with systematic and targeted MRI-transrectal US fusion biopsy. The normalized T2 signal (nT2), ADC measurement, mean early-phase DCE signal (mDCE), and heuristic DCE parameters were calculated. Logistic regression analysis indicated the most predictive DCE parameters for csPCa (Gleason grade group ≥2). Receiver operating characteristic parameter models were compared using the Obuchowski test. Recursive partitioning analysis determined ADC and mDCE value ranges for combined use with PI-RADS. - - Results - - Overall, 260 men (median age, 64 years [IQR, 58-69 years]) with 432 lesions (csPCa [n = 152] and no csPCa [n = 280]) were included. The mDCE parameter was predictive of csPCa when accounting for the ADC and nT2 parameter in the peripheral zone (odds ratio [OR], 1.76; 95% CI: 1.30, 2.44; P = .001) but not the transition zone (OR, 1.17; 95% CI: 0.81, 1.69; P = .41). Recursive partitioning analysis selected an ADC cutoff of 0.897 × 10−3 mm2/sec (P = .04) as a classifier for peripheral zone lesions with a PI-RADS score assessed on the ADC map (hereafter, ADC PI-RADS) of 3. The mDCE parameter did not differentiate ADC PI-RADS 3 lesions (P = .11), but classified lesions with ADC PI-RADS scores greater than 3 with low ADC values (less than 0.903 × 10−3 mm2/sec, P < .001) into groups with csPCa rates of 70% and 97% (P = .008). A lesion size cutoff of 1.5 cm and qualitative DCE parameters were not defined as classifiers according to recursive partitioning (P > .05). - - Conclusion - - Quantitative or qualitative dynamic contrast-enhanced MRI was not relevant for Prostate Imaging Reporting and Data System (PI-RADS) 3 lesion risk stratification, while quantitative apparent diffusion coefficient (ADC) values were helpful in upgrading PI-RADS 3 and PI-RADS 4 lesions. Quantitative ADC measurement may be more important for risk stratification than current methods in future versions of PI-RADS. - - © RSNA, 2022 - - Online supplemental material is available for this article - - See also the editorial by Goh in this issue.