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Updated: May 2, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Prostate focal peripheral zone lesions: characterization at multiparametric MR imaging--influence of a computer-aided
Emilie Niaf1, Carole Lartizien, Flavie Bratan
1From Inserm, U1032, LabTau, Lyon, F-69003, France; Université de Lyon, Lyon, F-69003, France; Université Lyon 1, Lyon, F-69003, France (E.N., F.B., O.R.); Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France (E.N., C.L.); Hospices Civils de Lyon, Department of Urinary and Vascular Radiology (F.B., O.R.) and Department of Pathology (F.M.), Hôpital Edouard Herriot, Lyon, F-69437, France; Hospices Civils de Lyon, Department of Biostatistics, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon; Université Lyon 1; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, F-69622, Villeurbanne, France (L.R., M.R.); and Université de Lyon, Lyon, F-69003, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, F-69003, France (O.R.).
Purpose:
To assess the impact of a computer-aided diagnosis (CAD) system in the characterization of focal prostate lesions at multiparametric magnetic resonance (MR) imaging.
Materials And Methods:
Formal institutional review board approval was not required. Thirty consecutive 1.5-T multiparametric MR imaging studies (with T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced imaging) obtained before radical prostatectomy in patients between September 2008 and February 2010 were reviewed. Twelve readers assessed the likelihood of malignancy of 88 predefined peripheral zone lesions by using a five-level (level, 0-4) subjective score (SS) in reading session 1. This was repeated 5 weeks later in reading session 2. The CAD results were then disclosed, and in reading session 3, the readers could amend the scores assigned during reading session 2. Diagnostic accuracy was assessed by using a receiver operating characteristic (ROC) regression model and was quantified with the area under the ROC curve (AUC).
Results:
Mean AUCs were significantly lower for less experienced (<1 year) readers (P < .02 for all sessions). Seven readers improved their performance between reading sessions 1 and 2, and 12 readers improved their performance between sessions 2 and 3. The mean AUCs for reading session 1 (83.0%; 95% confidence interval [CI]: 77.9%, 88.0%) and reading session 2 (84.1%; 95% CI: 78.1%, 88.7%) were not significantly different (P = .76). Although the mean AUC for reading session 3 (87.2%; 95% CI: 81.0%, 92.0%) was higher than that for session 2, the difference was not significant (P = .08). For an SS positivity threshold of 3, the specificity of reading session 2 (79.0%; 95% CI: 71.1%, 86.4%) was not significantly different from that of session 1 (78.7%; 95% CI: 70.5%, 86.8%) but was significantly lower than that of session 3 (86.2%; 95% CI: 77.1%, 93.1%; P < .03). The sensitivity of reading session 2 (68.4%; 95% CI: 57.5%, 77.7%) was significantly higher than that of session 1 (64.0%; 95% CI: 52.9%, 73.9%; P = .003) but was not significantly different from that of session 3 (71.4%; 95% CI: 58.3%, 82.7%).
Conclusion:
A CAD system may improve the characterization of prostate lesions at multiparametric MR imaging by increasing reading specificity.
Insights
A computer-aided diagnosis (CAD) system enhanced the accuracy of prostate lesion characterization using multiparametric MRI. The CAD system improved reading specificity, aiding in better identification of focal prostate lesions.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Multiparametric magnetic resonance (MR) imaging is crucial for characterizing focal prostate lesions.
- Accurate characterization of prostate lesions impacts treatment decisions and patient outcomes.
Purpose of the Study:
- To evaluate the effect of a computer-aided diagnosis (CAD) system on the characterization of focal prostate lesions.
- To assess if CAD improves diagnostic accuracy in multiparametric MR imaging of the prostate.
Main Methods:
- Thirty multiparametric MR imaging studies of the prostate were reviewed by twelve readers.
- Readers assessed lesion malignancy likelihood using a subjective score before and after CAD system review.
- Diagnostic accuracy was quantified using receiver operating characteristic (ROC) analysis and area under the curve (AUC).
Main Results:
- Reader performance, particularly for less experienced individuals, showed improvement with CAD assistance.
- While overall AUC did not significantly change between initial readings and CAD-assisted readings, specificity improved significantly in the CAD-assisted session.
- Sensitivity also showed improvement with CAD, though not always statistically significant.
Conclusions:
- A computer-aided diagnosis (CAD) system can enhance the characterization of prostate lesions.
- CAD systems may improve the specificity of reading multiparametric MR imaging for prostate cancer detection.
- Further integration of CAD may refine diagnostic accuracy in prostate MR imaging.
