Is dynamic contrast enhancement still necessary in multiparametric magnetic resonance for diagnosis of prostate cancer: a systematic review and meta-analysis

Abstract

Background: The purpose of this study is to systematically review the literatures assessing the value of dynamic contrast enhancement (DCE) in the multiparametric magnetic resonance imaging (mpMRI) for the diagnosis of prostate cancer (PCa).Methods: We searched Embase, PubMed and Web of science until January 2019 to extract articles exploring the possibilities whether the pre-biopsy biparametric magnetic resonance imaging (bpMRI) can replace the position of mpMRI in the diagnosis of PCa. The sensitivity and specificity of bpMRI were all included. The study quality was assessed by QUADAS-2. Bivariate random effects meta-analyses and a hierarchical summary receiver operating characteristic plot were performed for further study through Revman 5 and Stata12.Results: After searching, we acquired 752 articles among which 45 studies with 5,217 participants were eligible for inclusion. The positive likelihood ratio for the detection of PCa was 2.40 (95% CI: 1.50-3.80) and the negative likelihood ratio was 0.31 (95% CI: 0.18-0.53). The sensitivity and specificity were 0.77 (95% CI: 0.73-0.81) and 0.81 (95% CI: 0.76-0.85) respectively. Based on our result, pooled specificity demonstrated little difference between bpMRI and mpMRI [bpMRI, 0.81 (95% CI, 0.76-0.85); mpMRI, 0.82 (95% CI, 0.72-0.88); P=0.169]. The sensitivity, however, indicated a significant difference between these two groups [bpMRI, 0.77 (95% CI, 0.73-0.81); mpMRI, 0.84 (95% CI, 0.78-0.89); P=0.001].Conclusions: bpMRI with high b-value is a sensitive tool for diagnosing PCa. Consistent results were found in multiple subgroup analysis.

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

“…Rosenkrantz et al found that T2WI combined with DWI had higher sensitivity than T2WI alone, but the addition of DCE did not improve the diagnostic sensitivity (36). A meta-analysis reported that bpMRI was only 7% less sensitive than mpMRI in the diagnosis of PCa (37). In another meta-analysis, Woo et al found that the performance of bpMRI was similar to that of mpMRI in the diagnosis of PCa (38).…”

MRI Based Radiomics Compared With the PI-RADS V2.1 in the Prediction of Clinically Significant Prostate Cancer: Biparametric vs Multiparametric MRI

“…To date, many studies have investigated the power of the simplified bpMRI protocol, especially in terms of its diagnostic efficiency in PCa. A recent meta-analysis (12) assessed whether the prebiopsy bpMRI could replace mpMRI in the diagnosis of PCa and showed that the pooled specificity demonstrated little difference between bpMRI and mpMRI, but the sensitivity indicated a significant difference. Another two meta-analyses carried out by Alabousi They both proved that the pooled summary statistics demonstrated no significant difference in sensitivity or specificity between bpMRI and mpMRI.…”

Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

“…High accuracy of unenhanced prostate MRI, combined with PSA evaluation, was shown for the detection of clinically significant PCa [ 8 , 12 , 21 , 22 ], and a meta-analysis showed that bpMRI, with a high b-value, is a sensitive tool for diagnosing PCa [ 23 ]. We considered previous studies, both those in favor of the added value of DCE [ 24 , 25 ] and those against it [ 21 , 26 ], arguing that different results may have been caused by heterogeneity in technical issues, study populations, and interpretation criteria.…”