The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS Version 2 in the diagnosis of clinically significant prostate cancer

Zhao, Chen; Gao, Ge; Fang, Dong; Li, Feiyu; Yang, Xuedong; Wang, He; He, Qun; Wang, Xiaoying

doi:10.1016/j.clinimag.2016.04.010

Cited by 71 publications

(38 citation statements)

References 16 publications

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“…Conversely, most patients with a PI-RADSv2 score ≤3, should be considered eligible for continued active surveillance, obviating the need for a repeat, confirmatory biopsy with its associated risks. Our results are also concordant with recent literature, where PI-RADSv2 approach has been shown to improve the diagnostic accuracy to detect PCA and standardize the interpretation of mpMRI [33; 34]. Our study has several limitations.…”

Section: Discussionsupporting

confidence: 91%

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

et al. 2017

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Purpose To assess the performance of the updated Prostate Imaging Reporting and Data System (PI-RADSv2) and the Apparent Diffusion Coefficient (ADC) for predicting confirmatory biopsy results in patients considered for active surveillance of prostate cancer (PCA). Methods IRB-approved, retrospective study of 371-consecutive men with clinically low-risk PCA (initial biopsy Gleason score≤6, prostate-specific-antigen<10ng/ml, clinical stage≤T2a) who underwent 3T-prostate MRI before confirmatory biopsy. Two independent radiologists recorded the PI-RADSv2 scores and measured the corresponding ADC values in each patient. A composite score was generated to assess the performance of combining PI-RADSv2+ADC. Results PCA was upgraded on confirmatory biopsy in 107/371 (29%) patients. Inter-reader agreement was substantial (PI-RADSv2: k=0.73; 95%CI [0.66–0.80]; ADC: r=0.74; 95%CI [0.69–0.79]). Accuracies, sensitivities, specificities, positive, negative predicted values of PI-RADSv2 were 85%, 89%, 83%, 68%, 95% and 78%, 82%, 76%, 58%, 91% for ADC. PI-RADSv2 accuracy was significantly higher than that of ADC for predicting biopsy upgrade (p=0.014). The combined PI-RADSv2+ADC composite score did not perform better than PI-RADSv2 alone. Obviating biopsy in patients with PI-RADSv2 score ≤3 would have missed Gleason Score upgrade in 12/232 (5%) of patients. Conclusion PI-RADSv2 was superior to ADC measurements for predicting PCA upgrading on confirmatory biopsy.

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Section: Discussionsupporting

confidence: 91%

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

et al. 2017

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“…The high sensitivity and very low specificity of PI-RADS-v2 across the three methods in Table 3 suggests that this tool is good to identify csPC in a selected population of patients with known PCa, as a negative test will be useful to rule out csPC, but it should not be used as a confirmatory test. This contrasts with a recent study where PI-RADS-v2 was found to have a sensitivity and specificity of over 80% for detection csPC [30]. The difference in performance characteristics may be explained by their use of a PI-RADS-v2 score of 3 (“the presence of clinically significant cancer is equivocal”) as a cutoff point for detection of csPC, whereas we used a score of 4 (“clinically significant cancer is likely to be present”) as a cutoff.…”

Section: Discussioncontrasting

confidence: 82%

Comparison of quantitative apparent diffusion coefficient parameters with prostate imaging reporting and data system V2 assessment for detection of clinically significant peripheral zone prostate cancer

et al. 2017

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Purpose To compare diagnostic performance of PI-RADSv2 with ADC parameters to identify clinically significant prostate cancer (csPC) and to determine the impact of csPC definitions on diagnostic performance of ADC and PI-RADSv2. Methods We retrospectively identified treatment-naïve pathology-proven peripheral zone PC patients who underwent 3T prostate MRI, using high b-value diffusion-weighted imaging from 2011–2015. Using 3D slicer, areas of suspected tumor (T) and normal tissue (N) on ADC (b=0,1400) were outlined volumetrically. Mean ADCT, mean ADCN, ADCratio (ADCT/ADCN) were calculated. PI-RADSv2 was assigned. Three csPC definitions were used: (A) Gleason score (GS)≥4+3; (B) GS≥3+4; (C) MRI-based tumor volume>0.5cc. Performances of ADC parameters and PI-RADSv2 in identifying csPC were measured using nonparametric comparison of receiver operating characteristic curves using the area under the curve (AUC). Results 85 cases met eligibility requirements. Diagnostic performances (AUC) in identifying csPC using 3 definitions were: (A) ADCT (0.83) was higher than PI-RADSv2 (0.65, p=0.006); (B) ADCT (0.86) was higher than ADCratio (0.68, p<0.001), and PI-RADSv2 (0.70, p=0.04); (C) PI-RADSv2 (0.73) performed better than ADCratio (0.56, p=0.02). ADCT performance was higher when csPC was defined by A or B versus C (p=0.038 and p=0.01, respectively). ADCratio performed better when csPC was defined by A versus C (p=0.01). PI-RADSv2 performance was not affected by csPC definition. Conclusions When csPC was defined by GS, ADC parameters provided better csPC discrimination than PI-RADSv2, with ADCT providing best result. When csPC was defined by MRI-calculated volume, PI-RADSv2 provided better discrimination than ADCratio. csPC definition did not affect PI-RADSv2 diagnostic performance.

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“…Our results are concordant with previous studies on PIRADSv2, and our testing is more representative than these studies of evaluating prostate mpMRI in the clinical setting. Zhao et al found a sensitivity and specificity over 80% for two readers, but was limited as TRUS‐guided biopsy alone was used as the reference standard, where we used prostatectomy as a standard. Vargas et al evaluated a “best achievable” performance of PIRADSv2 by identifying high‐grade lesions on whole‐mount prostatectomy specimens and scoring the correlated mpMRI lesions with PIRADSv2.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: A multireader study

Greer

Brown

Shih

et al. 2016

J. Magn. Reson. Imaging

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The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS Version 2 in the diagnosis of clinically significant prostate cancer

Cited by 71 publications

References 16 publications

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

Comparison of quantitative apparent diffusion coefficient parameters with prostate imaging reporting and data system V2 assessment for detection of clinically significant peripheral zone prostate cancer

Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: A multireader study

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