Multiparametric MRI Features and Pathologic Outcome of Wedge-Shaped Lesions in the Peripheral Zone on T2-Weighted Images of the Prostate

Chatterjee, Aritrick; Tokdemir, Sevil; Gallan, Alexander J.; Yousuf, Ambereen; Antic, Tatjana; Karczmar, Gregory S.; Oto, Aytekin

doi:10.2214/ajr.18.19742

Cited by 20 publications

(10 citation statements)

References 29 publications

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“…This study used a cutoff of category 4 or greater and it was observed that the sensitivity of PI-RADSv2.1 was lower compared to that of PI-RADSv2.0. A recent investigation that analyzed surgical cases reported the proportion of csPCa (ISUP grade ≥ 2) in wedge-shaped PZ lesions as approximately 30% [ 24 ]. However, since the proportion of csPCa in surgical cases is much higher compared to biopsy cases, the actual proportion of wedge-shaped csPCa may be lower in the scenarios involving biopsies.…”

Section: Discussionmentioning

confidence: 99%

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

et al. 2021

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Objective To compare the diagnostic performance between Prostate Imaging-Reporting and Data System version 2.0 (PI-RADSv2.0) and version 2.1 (PI-RADSv2.1) for clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). Materials and Methods This retrospective study included 317 patients who underwent multiparametric magnetic resonance imaging and targeted biopsy for PZ lesions. Definition of csPCa was International Society of Urologic Pathology grade ≥ 2 cancer. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for csPCa were analyzed by two readers. The cancer detection rate (CDR) for csPCa was investigated according to the PI-RADS categories. Results AUC of PI-RADSv2.1 (0.856 and 0.858 for reader 1 and 2 respectively) was higher than that of PI-RADSv2.0 (0.795 and 0.747 for reader 1 and 2 respectively) (both p < 0.001). Sensitivity, specificity, PPV, NPV, and accuracy for PI-RADSv2.0 vs. PI-RADSv2.1 were 93.2% vs. 88.3% ( p = 0.023), 52.8% vs. 76.6% ( p < 0.001), 48.7% vs. 64.5% ( p < 0.001), 94.2% vs. 93.2% ( p = 0.504), and 65.9% vs. 80.4% ( p < 0.001) for reader 1, and 96.1% vs. 92.2% ( p = 0.046), 34.1% vs. 72.4% ( p < 0.001), 41.3% vs. 61.7% ( p < 0.001), 94.8% vs. 95.1% ( p = 0.869), and 54.3% vs. 78.9% ( p < 0.001) for reader 2, respectively. CDRs of PI-RADS categories 1–2, 3, 4, and 5 for PI-RADSv2.0 vs. PI-RADSv2.1 were 5.9% vs. 5.9%, 5.8% vs. 12.5%, 39.8% vs. 56.2%, and 88.9% vs. 88.9% for reader 1; and 4.5% vs. 4.1%, 6.1% vs. 11.1%, 32.5% vs. 53.4%, and 85.0% vs. 86.8% for reader 2, respectively. Conclusion Our data demonstrated improved AUC, specificity, PPV, accuracy, and CDRs of category 3 or 4 of PI-RADSv2.1, but decreased sensitivity, compared with PI-RADSv2.0, for csPCa in PZ.

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Section: Discussionmentioning

confidence: 99%

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

et al. 2021

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“…According to PI‐RADS v2.1, in the TZ a lenticular noncircumscribed nodule is scored as category 4 or 5, whereas a round circumscribed nodule is scored as category 2 or category 1 when encapsulated (ie, when there is a complete T 2 W hypointense rim) 9 . Similarly, using PI‐RADS v2.1 in the PZ, a linear or wedge‐shaped lesion is scored as a category 2 observation 9,115 . However, subjective assessment of shape has been shown to have only a moderate degree of interreader agreement 116 .…”

Section: Quantitative Features That May Improve Subjective Features I...mentioning

confidence: 99%

“…9 Similarly, using PI-RADS v2.1 in the PZ, a linear or wedge-shaped lesion is scored as a category 2 observation. 9,115 However, subjective assessment of shape has been shown to have only a moderate degree of interreader agreement. 116 Krishna et al showed that quantitative shape features of circularity and convexity were accurate to differentiate between transition zone PCa and BPH nodules (Fig.…”

Section: Shape Analysismentioning

confidence: 99%

Quantitative Prostate MRI

Schieda

Lim

Zabihollahy

et al. 2020

Magnetic Resonance Imaging

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Prostate MRI is reported in clinical practice using the Prostate Imaging and Data Reporting System (PI‐RADS). PI‐RADS aims to standardize, as much as possible, the acquisition, interpretation, reporting, and ultimately the performance of prostate MRI. PI‐RADS relies upon mainly subjective analysis of MR imaging findings, with very few incorporated quantitative features. The shortcomings of PI‐RADS are mainly: low‐to‐moderate interobserver agreement and modest accuracy for detection of clinically significant tumors in the transition zone. The use of a more quantitative analysis of prostate MR imaging findings is therefore of interest. Quantitative MR imaging features including: tumor size and volume, tumor length of capsular contact, tumor apparent diffusion coefficient (ADC) metrics, tumor T1 and T2 relaxation times, tumor shape, and texture analyses have all shown value for improving characterization of observations detected on prostate MRI and for differentiating between tumors by their pathological grade and stage. Quantitative analysis may therefore improve diagnostic accuracy for detection of cancer and could be a noninvasive means to predict patient prognosis and guide management. Since quantitative analysis of prostate MRI is less dependent on an individual users' assessment, it could also improve interobserver agreement. Semi‐ and fully automated analysis of quantitative (radiomic) MRI features using artificial neural networks represent the next step in quantitative prostate MRI and are now being actively studied. Validation, through high‐quality multicenter studies assessing diagnostic accuracy for clinically significant prostate cancer detection, in the domain of quantitative prostate MRI is needed. This article reviews advances in quantitative prostate MRI, highlighting the strengths and limitations of existing and emerging techniques, as well as discussing opportunities and challenges for evaluation of prostate MRI in clinical practice when using quantitative assessment. Level of Evidence 5 Technical Efficacy Stage 2

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“…Most MRI studies of suspected cancer can also be identi ed using only T2-weighted MRI and DWI criteria, as can a signi cant proportion of large tumors and PI-RADS 4 lesions, especially those assigned to the PI-RADS 5 category. DCE-MRI can be useful in detecting small cancers that are less prominent or occult on T2-weighted images and DWI, or when DW images are affected by prostheses [9,25]. Local contrast enhancement increases the con dence of the reader and helps inexperienced readers nd MRI-positive scans [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Accuracy of Biparametric MRI/TRUS Fusion-Guided Biopsy for Index Tumor Evaluation using Postoperative Pathology Specimens

Shimizu

Morizane

Yamamoto

et al. 2023

Preprint

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Background Multiparametric MRI (mpMRI) is widely used for prostate cancer diagnosis, surveillance, and staging; however, it has some limitations, including higher cost, longer examination time, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of index tumor (IT) assessed preoperatively using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion prostate biopsy with radical prostatectomy (RP) specimens. Methods We included 69 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsy of lesions with Prostate Imaging Reporting & Data System (PI-RADS) category ≥ 3 and underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and December 2021. The localization of preoperative and postoperative IT, highest Gleason score (GS), and tumor diameter were examined in these patients. Results The preoperative cT stage matched the postoperative pT stage in 34 cases (48%), while 20 cases (30%) were upstaged, and 15 cases (22%) were downstaged (Weighted Kappa = 0.236). The preoperative and postoperative IT localization were consistent in 59 cases (85.5%). The concordance rate between Gleason groups in targeted biopsy and RP specimens was 48%, with an upgrade in 17 cases (24%) and a downgrade in 29 cases (28%) (Weighted Kappa = 0.424). The IT maximum diameter and maximum cancer core length on biopsy were correlated with RP tumor maximum diameter (p = 0.007, p = 0.008). Conclusion In conclusion, the diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to that of previous reports using mpMRI. The findings suggest that bpMRI/TRUS fusion biopsy can be a cost-effective and time-saving alternative.

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Multiparametric MRI Features and Pathologic Outcome of Wedge-Shaped Lesions in the Peripheral Zone on T2-Weighted Images of the Prostate

Cited by 20 publications

References 29 publications

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

Quantitative Prostate MRI

Assessment of the Accuracy of Biparametric MRI/TRUS Fusion-Guided Biopsy for Index Tumor Evaluation using Postoperative Pathology Specimens

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