Visibility of significant prostate cancer on multiparametric magnetic resonance imaging (MRI)—do we still need contrast media?

Abstract

Objectives To assess the visibility of clinically significant prostate cancer (PCA) lesions on the sequences multiparametric MRI of the prostate (mpMRI) and to evaluate whether the addition of dynamic contrast–enhanced imaging (DCE) improves the overall visibility. Methods We retrospectively evaluated multiparametric MRI images of 119 lesions in 111 patients with biopsy-proven clinically significant PCA. Three readers assigned visual grading scores for visibility on each sequence, and a visual grading characteristic analysis was performed. Linear regression was used to explore which factors contributed to visibility in individual sequences. Results The visibility of lesions was significantly better with mpMRI when compared to biparametric MRI in visual grading characteristic (VGC) analysis, with an AUCVGC of 0.62 (95% CI 0.55–0.69; p < 0.001). This benefit was seen across all readers. Multivariable linear regression revealed that a location in the peripheral zone was associated with better visibility on T2-weighted imaging (T2w). A higher Prostate Imaging-Reporting and Data System (PI-RADS) score was associated with better visibility on both diffusion-weighted imaging (DWI) and DCE. Increased lesion size was associated with better visibility on all sequences. Conclusions Visibility of clinically significant PCA is improved by using mpMRI. DCE and DWI images independently improve lesion visibility compared to T2w images alone. Further research into the potential of DCE to impact on clinical decision-making is suggested. Key Points • DCE and DWI images independently improve clinically significant prostate cancer lesion visibility compared to T2w images alone. • Multiparametric MRI (DCE, DWI, T2w) achieved significantly higher visibility scores than biparametric MRI (DWI, T2w). • Location in the transition zone is associated with poor visibility on T2w, while it did not affect visibility on DWI or DCE.

Diagnostic Accuracy of Abbreviated Bi-Parametric MRI (a-bpMRI) for Prostate Cancer Detection and Screening: A Multi-Reader Study

“…Conversely, we observed lower interobserver agreement of a-bpMRI compared to previous reports [ 11 , 36 ]. One possible explanation is that T2WI, DWI, and DCE have an incremental value on lesion visibility, and the absence of multiplanar T2WI and ADC maps from our a-bpMRI protocol may have decreased the confidence of readers in determining MRI scores [ 37 ]. Furthermore, the use of Likert instead of PI-RADS for a-bpMRI could have played a role ( Supplementary Table S5 ) [ 38 ].…”

Impact of PI-QUAL on PI-RADS and cancer yield in an MRI-TRUS fusion biopsy population

“…Patients underwent mpMRI for further work-up of elevated serum PSA values or because of a suspicious digital rectal examination. All patients underwent MRI-TRUS biopsy, as described previously [18], specifically targeting the mpMRI detected lesion, as well as systematic prostate sampling. Lesions suspicious on routine mpMRI assessment were recalled and marked prior to biopsy by an expert genitourinary radiologist (16 years of experience, >1500 scans per year [9]) using the DynaCAD Software (Invivo, PHILIPS).…”

Effects of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1

“…[10][11][12] Therefore, the value of DCE-MRI as a routine sequence has been debated. 10,[13][14][15][16][17] Prompt intervention is needed for clinically significant prostate cancer (Gleason score ≥ 3 + 4), which usually has poor differentiation, a damaged gland structure, a high degree of malignancy, and strong invasiveness. 9 This study used three sequence combinations (T2WI + DWI, T2WI + DCE, and T2WI + DWI + DCE) to analyse the diagnostic value of DCE-MRI for detecting tzPCa and clinically significant transitional-zone prostate cancer (cs-tzPCa) in PI-RADS Version 2.1, using transperineal ultrasound-guided prostate biopsy as the reference standard.…”

“… 10 , 11 , 12 Therefore, the value of DCE-MRI as a routine sequence has been debated. 10 , 13 , 14 , 15 , 16 , 17 …”