Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2‐weighted, dynamic contrast‐enhanced and diffusion‐weighted imaging

Abstract

techniques combined were scored for the likelihood of tumour in each area and results were compared with whole-mount analysis.• The area under the receiver operating characteristic curve ( A z ) was used to evaluate accuracy for tumour detection. The association between MR accuracy and Gleason score was statistically assessed. RESULTS• Of the 456 prostate octants analysed, 145 showed cancer on whole-mount analysis, 120 (83%) of them with a diameter assumed to correspond to a volume > 0.2 cm 3 . Gleason score was ≥ 7 in 68 (47%) tumours.• In the PZ, the A z value was significantly higher for T2W + DWI, T2W + DCE and all three techniques combined than for T2W alone ( P < 0.05).• In the TZ, the A z value was higher for T2W + DWI than for T2W alone, but the difference was not significant.• The A z value for T2W + DWI was significantly higher than that for T2W + DCE or for the three sequences combined.• Gleason score was significantly associated with cancer detection in the PZ. CONCLUSIONS• Adding DWI and DCE to T2W imaging increased MRI performance in cancer detection in the PZ significantly.• However, this multiparametric model failed to improve performance in the TZ.• Gleason score significantly influenced cancer detection in the PZ but not in the TZ.

Biparametric MRI of the prostate

“…[40] The value of bpMRI in the detection of PCa using 1.5T MRI with endorectal coil has been reported. [23,41] Recently, it has been demonstrated that the sensitivity of bpMRI at 3T without endorectal coil in the detection PCa is similar to that of mpMRI. [20,24,27,28,[42][43][44] The diagnostic value of bpMRI in men with or without prior biopsy and combined with PSA has been validated, resulting in an improved accuracy for detecting clinically significant PCa (sPCa) and representing an effective technique to direct biopsy needles under TRUS guidance, after MRI-ultrasonography fusion.…”

Improving non-invasive detection of prostate cancer using diffusion-weighted MRI

“…The result is an improvement in specificity from 68% to 87%. As benign prostatic hyperplasia (BPH) is similar to prostate tumour tissue in that they both strongly enhance, it was previously thought that these could be differentiated on DCE-MRI since BPH regions do not wash out as quickly [51,52] and that DCE-MRI could play a role in the identification of transition zone cancers from BPH. This benefit in the transition zone has been refuted in PI-RADS v2.0, and DCE is now only deemed useful in the peripheral zone when DW-MRI has been assigned a score of 3.…”

Practical aspects of prostate MRI: hardware and software considerations, protocols, and patient preparation

“…Multiparametric prostate imaging was initially implemented on 1.5-Tesla (1.5T) scanners [21][22][23][24][25][26][27][28][29]. To acquire scans with diagnostic value, both a pelvic phased array and an endorectal coil (ERC) were used in combination [30].…”