Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI‐RADS Version 2.1

Abstract

Background: Biparametric MRI (bpMRI) without dynamic contrast-enhanced MRI (DCE-MRI) results in an elimination of adverse events, shortened examination time, and reduced costs, compared to multiparametric MRI (mpMRI). The ability of bpMRI to detect clinically significant prostate cancer (csPC) with the Prostate Imaging and Reporting Data System version 2.1 (PI-RADS v2.1) compared to standard mpMRI has not been studied extensively. Purpose: To compare the interobserver reliability and diagnostic performance for detecting csPC of bpMRI and mpMRI using PI-RADS v2.1. Study Type: Retrospective. Population: In all, 103 patients with elevated prostate-specific antigen (PSA) levels who underwent mpMRI and subsequent MRI-ultrasonography fusion-guided prostate-targeted biopsy (MRGB) with or without prostatectomy. Field Strength/Sequences: T 2-weighted imaging (T 2 WI), diffusion-weighted imaging (DWI), and DCE-MRI at 3T. Assessment: Three readers independently assessed each suspected PC lesion, assigning a score of 1-5 for T 2 WI, a score of 1-5 for DWI, and positive and negative for DCE-MRI according to PI-RADS v2.1 and determined the overall PI-RADS assessment category of bpMRI (T 2 WI and DWI) and mpMRI (T 2 WI, DWI, and DCE-MRI). The reference standard was MRGB or prostatectomy-derived histopathology. Statistical Testing: Statistical analysis was performed using the kappa statistic and McNemar and Delong tests. Results: Of the 165 suspected PC lesions in 103 patients, 81 were diagnosed with csPC and 84 with benign conditions. Interobserver variability of PI-RADS assessment category showed good agreement for bpMRI (kappa value = 0.642) and mpMRI (kappa value = 0.644). For three readers, the diagnostic sensitivity was significantly higher for mpMRI than for bpMRI (P < 0.001 to P = 0.016, respectively), whereas diagnostic specificity was significantly higher for bpMRI than for mpMRI (P < 0.001 each). For three readers, the area under the receiver operating characteristic curve (AUC) was higher for bpMRI than for mpMRI; however, the difference was significant only for Reader 1 and Reader 3 (Reader 1: 0.823 vs. 0.785, P = 0.035; Reader 2: 0.852 vs. 0.829, P = 0.099; and Reader 3: 0.828 vs. 0.773, P = 0.002). Data Conclusion: For detecting csPC using PI-RADS v2.1, the interobserver reliability and diagnostic performance of bpMRI was comparable with those of mpMRI. Level of Evidence: 4 Technical Efficacy Stage: 2

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta‐Analysis

“…Nine studies were retrospective, [10][11][12]15,[22][23][24][25][26] and one study was prospective. 13 Five studies made evaluations on a per-lesion basis, 10,11,13,22,25 and five studies made them on a per-patient basis. 12,15,23,24,26 MRI was performed using 3-T scanners in nine studies 10-13,15,23-26 and using 1.5-T scanners in one study.…”

“…one study, 26 and either targeted biopsy and systematic biopsy or radical prostatectomy in one study. 25…”

“…Full-text reviews were conducted for 29 articles, and 19 articles were further excluded. Finally, 10 original articles were included in this meta-analysis, [10][11][12][13]15,[22][23][24][25][26] five of which described head-to-head comparisons between PI-RADS v2 and v2.1. [10][11][12]15,26…”

A Risk Model for Detecting Clinically Significant Prostate Cancer Based on Clinical Parameters and the Prostate Imaging Reporting and Data System using Bi-parametric Magnetic Resonance Imaging in a Japanese Cohort.

“…In a Japanese cohort, the e cacy of mpMRI and bpMRI for detecting sPC as a triage test was also reported [25][26][27]. However, no multivariate risk prediction models for detecting sPC based on PI-RADS scores of mpMRI or bpMRI as ordinal variables among Japanese populations have been reported previously.…”

Autosegmentation of Prostate Zones and Cancer Regions from Biparametric Magnetic Resonance Images by Using Deep-Learning-Based Neural Networks

“…Also DCE-MRI with gadolinium chelate increases the burden on patients in terms of examination time, cost, and them potentially developing nephrogenic systemic fibrosis. A study showed that the diagnostic performance of biparametric MRI (bpMRI), which is an abbreviated prostate MRI protocol without DCE-MRI, was comparable to that of mpMRI [4]. Prostate MRI assessment relies on human experts, specialized training, and experience [5] with considerable inter-reader variability.…”