The Incremental Value of Contrast-Enhanced MRI in the Detection of Biopsy-Proven Local Recurrence of Prostate Cancer After Radical Prostatectomy: Effect of Reader Experience

Abstract

OBJECTIVE The purpose of this study is to retrospectively assess the incremental value of contrast-enhanced MRI (CE-MRI) to T2-weighted MRI in the detection of postsurgical local recurrence of prostate cancer by readers of different experience levels, using biopsy as the reference standard. MATERIALS AND METHODS Fifty-two men with biochemical recurrence after prostatectomy underwent 1.5-T endorectal MRI with multiphase contrast-enhanced imaging and had biopsy within 3 months of MRI. Two radiologists (reader 1 had 1 year and reader 2 had 6 years of experience) independently reviewed each MRI study and classified the likelihood of recurrent cancer on a 5-point scale. Areas under receiver operating characteristic curves (Az) were calculated to assess readers’ diagnostic performance with T2-weighted MRI alone and combined with CE-MRI. Interobserver agreement was assessed using Cohen kappa statistics. RESULTS Thirty-three patients (63%) had biopsy-proven local recurrence of prostate cancer. With the addition of CE-MRI to T2-weighted imaging, the Az for cancer detection increased significantly for reader 1 (0.77 vs 0.85; p = 0.0435) but not for reader 2 (0.86 vs 0.88; p = 0.7294). The use of CE-MRI improved interobserver agreement from fair (κ = 0.39) to moderate (κ = 0.58). CONCLUSION CE-MRI increased interobserver agreement and offered incremental value to T2-weighted MRI in the detection of locally recurrent prostate cancer for the relatively inexperienced reader.

Prostate Cancer Localization Using Multiparametric MR Imaging: Comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert Scales

“…Although prostate MR imaging offers the potential to assist clinical management of prostate cancer, MR images of the prostate can be difficult to interpret, with challenges in interreader variability repetitively documented in the literature (17)(18)(19). In other organs, standardized interpretation schemes that incorporate fixed criteria for stratifying risk of malignancy have been developed in an effort to improve consistency of interpretations among radiologists.…”

Detection of Recurrent Prostate Cancer After Radical Prostatectomy: Comparison of 11C-Choline PET/CT with Pelvic Multiparametric MR Imaging with Endorectal Coil

“…However, only limited data on the utility of 11 Ccholine PET/CT regarding the detection of local recurrence after RP are available in the literature (4,5). Conversely, the combination of T2-weighted imaging and dynamic contrast-enhanced (DCE) MR imaging with endorectal coil has been shown to have an 84%-97% sensitivity and 74%-89% specificity for detecting local recurrence in the prostatectomy bed (6)(7)(8). However, the diagnostic performance of MR imaging for metastasis to pelvic LN and bone was not addressed in these studies.…”

Magnetic Resonance Imaging/Positron Emission Tomography Provides a Roadmap for Surgical Planning and Serves as a Predictive Biomarker in Patients With Recurrent Gynecological Cancers Undergoing Pelvic Exenteration

“…The effect of reader experience on the incremental value of MRI/PET will require further investigation and validation. Previous studies have suggested that combining anatomical MRI with other MRI techniques (eg, contrast-enhanced and diffusion-weighted MRI) may improve the diagnostic accuracy of less experienced readers and thereby improve interreader agreement 16,17 ; the addition of PET to anatomic MRI may have a similar effect.…”