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Multiparametric MRI for Suspected Recurrent Prostate Cancer after HIFU:Is DCE still needed?

Raïssa Lotte1, Alexandre Lafourcade2, Pierre Mozer3

  • 1Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP, Sorbonne University, Paris, France. raissalotte@hotmail.com.

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Summary
This summary is machine-generated.

Adding dynamic contrast-enhanced (DCE) MRI sequences to T2-weighted (T2w) and diffusion-weighted imaging (DWI) did not significantly improve prostate cancer (PCa) recurrence detection after high-intensity focused ultrasound (HIFU). High sensitivity was achieved with T2w + DWI alone.

Keywords:
Contrast mediaDiffusion magnetic resonance imagingHigh-intensity focused ultrasound ablationNeoplasm recurrence, localProstate cancer

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Multi-parametric MRI (mpMRI) is crucial for monitoring prostate cancer (PCa) recurrence post-treatment.
  • High-intensity focused ultrasound (HIFU) is a focal therapy for PCa, necessitating accurate surveillance methods.
  • Assessing the added value of specific MRI sequences is key to optimizing diagnostic performance.

Purpose of the Study:

  • To evaluate the incremental diagnostic value of dynamic contrast-enhanced (DCE) MRI sequences.
  • To determine if DCE improves the detection of recurrent prostate cancer (PCa) when combined with T2-weighted (T2w) and diffusion-weighted imaging (DWI).
  • To assess PCa recurrence detection after high-intensity focused ultrasound (HIFU) treatment.

Main Methods:

  • Retrospective analysis of 45 male patients with suspected PCa recurrence post-HIFU.
  • All patients underwent multi-parametric MRI (mpMRI) including T2w, DWI, and DCE sequences prior to biopsy.
  • Two independent readers assessed cancer likelihood using Likert scores on T2w + DWI and T2w + DWI + DCE datasets.
  • Prostatic biopsies served as the gold standard for diagnosis.

Main Results:

  • Biopsy confirmed recurrent PCa in 37 patients (82%).
  • Receiver operating characteristic (ROC) analysis showed no significant difference in diagnostic areas under the curve (AUC) between T2w + DWI and T2w + DWI + DCE for both readers.
  • Sensitivity for PCa detection at the lobe level was high for both imaging combinations, with no statistically significant improvement observed with the addition of DCE for either junior or senior readers.

Conclusions:

  • The addition of DCE-MRI to T2w + DWI does not significantly enhance the accuracy of mpMRI for detecting prostate cancer recurrence after HIFU.
  • T2w + DWI sequences alone provide high sensitivity for identifying PCa recurrence in this clinical setting.
  • Reader experience did not influence the performance difference between the imaging protocols, suggesting DCE offers limited added value.