Prospective comparison of a fast 1.5‐T biparametric with the 3.0‐T multiparametric ESUR magnetic resonance imaging protocol as a triage test for men at risk of prostate cancer

Abstract

Objective To compare prospectively the diagnostic performance of a biparametric (T2‐weighted imaging [T2WI] and diffusion‐weighted imaging [DWI]) 1.5‐T fast magnetic resonance imaging (fMRI) protocol with the standard 3.0‐T multiparametric MRI (mpMRI) protocol of the European Society of Urological Imaging (ESUR) in men referred for a prostate biopsy. Patients and Methods Ninety patients with a prostate cancer (PCa) risk of ≥10% according to the SWOP calculator 4 underwent first fMRI and then the reference mpMRI. Patients with Prostate Imaging Reporting and Data System (PI‐RADS) v.2 lesions ≥3/5 on the mpMRI were scheduled for MRI/ultrasonography (US) fusion‐guided prostate biopsy. Performance of fMRI was assessed using receiver‐operating characteristic curve analysis and mpMRI as reference. Calculation of inter‐technique agreement on PI‐RADS v.2 score by Cohen's κ. Results The diagnostic accuracy of fMRI shown by the lesion‐based analysis was excellent: area under the curve (AUC) 0.961 (P < 0.001), sensitivity 95%, specificity 97%, positive predictive value (PPV) 99%, negative predictive value (NPV) 89%. The patient‐based analysis showed an AUC for fMRI of 0.975 (P < 0.001), a sensitivity of 98%, a specificity of 97%, a PPV of 98% and an NPV of 97%. Agreement on the PI‐RADS score between both protocols was found to be good (κ = 0.78 [0.57; 0.99]); fMRI missing PI‐RADS 4 lesions in three patients. Biopsy results showed no cancer in two patients (two cores per nodule) and Gleason 6 cancer in one patient. There was only one false‐positive fMRI, with a PI‐RADS score of 4, whose biopsy was negative. Conclusion In the triage of men with a high risk of PCa for prostate biopsy, an f MRI protocol (1.5‐T magnet, T2WI + DWI, <15 min) may safely replace the traditional ESUR 3.0‐T mpMRI protocol, saving time and contrast injection.

Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review

“…Further studies reported promising results, although being affected by significant bias mainly concerning the MRI interpretation process (mpMRI and bpMRI read by the same radiologist during the same session) [85] and the reference standard (no biopsy result in men with negative MRI) [86]. The similar diagnostic performance of these two techniques was confirmed in other series [87][88][89] that attempted to better identify the eventual differences.…”

Short review of biparametric prostate MRI

“…Therefore, the authors conclude that bpMRI has the same diagnostic performance as mpMRI for the detection of PCa [29]. Recent single-center studies from 2018 published similar results [7, 9, 11, 12, 30].…”

“…Junker et al. reported a time reduction of 12 min using bpMRI [11] and another group found a time reduction of only 2.30 min [12]. A very fast biparametric MRI protocol that takes only 8.45 min has been published by Kuhl et al.…”

Kontrastmittelfreie Bildgebung der Prostata

“…Bei Scannen der T2w-Bilder in 3 Ebenen mit zusätzlicher DWI dauert eine biparametrische MRT ca. 15 min [17,28]. Eine rezente Publikation berichtet über ein abgekürztes biparametrisches Protokoll, welches ca.…”

“…Die ESUR-Guidelines empfehlen für die Bildgebung Hochfeld-MRT, jedoch konnten Studien zeigen, dass zwischen Untersuchungen mit 1,5 bzw. 3 T kein Unterschied in der diagnostischen Genauigkeit bei der Anwendung von biparametrischen Protokollen besteht [28]. (.…”