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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
A Multireader Exploratory Evaluation of Individual Pulse Sequence Cancer Detection on Prostate Multiparametric
Sonia Gaur1, Stephanie Harmon2, Rajan T Gupta3
1Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD 20814.
Rationale And Objectives:
To determine independent contribution of each prostate multiparametric magnetic resonance imaging (mpMRI) sequence to cancer detection when read in isolation.
Materials And Methods:
Prostate mpMRI at 3-Tesla with endorectal coil from 45 patients (n = 30 prostatectomy cases, n = 15 controls with negative magnetic resonance imaging [MRI] or biopsy) were retrospectively interpreted. Sequences (T2-weighted [T2W] MRI, diffusion-weighted imaging [DWI], and dynamic contrast-enhanced [DCE] MRI; N = 135) were separately distributed to three radiologists at different institutions. Readers evaluated each sequence blinded to other mpMRI sequences. Findings were correlated to whole-mount pathology. Cancer detection sensitivity, positive predictive value for whole prostate (WP), transition zone, and peripheral zone were evaluated per sequence by reader, with reader concordance measured by index of specific agreement. Cancer detection rates (CDRs) were calculated for combinations of independently read sequences.
Results:
44 patients were evaluable (cases median prostate-specific antigen 6.83 [ range 1.95-51.13] ng/mL, age 62 [45-71] years; controls prostate-specific antigen 6.85 [2.4-10.87] ng/mL, age 65.5 [47-71] years). Readers had highest sensitivity on DWI (59%) vs T2W MRI (48%) and DCE (23%) in WP. DWI-only positivity (DWI+/T2W-/DCE-) achieved highest CDR in WP (38%), compared to T2W-only (CDR 24%) and DCE-only (CDR 8%). DWI+/T2W+/DCE- achieved CDR 80%, an added benefit of 56.4% from T2W-only and of 42% from DWI-only (P < .0001). All three sequences interpreted independently positive gave highest CDR of 90%. Reader agreement was moderate (index of specific agreement: T2W = 54%, DWI = 58%, DCE = 33%).
Conclusions:
When prostate mpMRI sequences are interpreted independently by multiple observers, DWI achieves highest sensitivity and CDR in transition zone and peripheral zone. T2W and DCE MRI both add value to detection; mpMRI achieves highest detection sensitivity when all three mpMRI sequences are positive.
Insights
Diffusion-weighted imaging (DWI) offers the highest sensitivity for prostate cancer detection when read alone. Combining all three prostate multiparametric MRI sequences (T2-weighted, DWI, and dynamic contrast-enhanced) maximizes cancer detection rates.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer diagnosis relies on accurate imaging.
- Multiparametric MRI (mpMRI) combines sequences to improve detection.
- Understanding the independent contribution of each sequence is crucial.
Purpose of the Study:
- To evaluate the individual diagnostic performance of prostate mpMRI sequences.
- To determine how each sequence contributes to cancer detection when interpreted in isolation.
- To assess the combined efficacy of mpMRI sequences for prostate cancer detection.
Main Methods:
- Retrospective analysis of 45 patients undergoing 3-Tesla prostate mpMRI.
- Independent interpretation of T2-weighted (T2W) MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) MRI by three radiologists.
- Correlation of imaging findings with whole-mount prostate pathology.
- Calculation of cancer detection rates (CDRs) for individual sequences and combinations.
Main Results:
- Diffusion-weighted imaging (DWI) demonstrated the highest sensitivity (59%) for cancer detection in the whole prostate (WP).
- DWI-only interpretation yielded the highest cancer detection rate (38%) compared to T2W-only (24%) or DCE-only (8%).
- Combining all three sequences (T2W+DWI+DCE) achieved the highest CDR of 90%.
Conclusions:
- Diffusion-weighted imaging (DWI) is the most sensitive individual sequence for detecting prostate cancer.
- T2-weighted (T2W) and dynamic contrast-enhanced (DCE) MRI sequences add significant value to cancer detection.
- Optimal prostate cancer detection is achieved when all three mpMRI sequences are utilized and interpreted together.
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