Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data...

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Multiparametric magnetic resonance imaging (MP-MRI) is a standard tool for prostate cancer diagnosis.
• Recent studies question the necessity of advanced imaging sequences, such as dynamic contrast-enhanced (DCE) MRI.

Purpose of the Study:

• To evaluate if dynamic contrast-enhanced (DCE) MRI enhances the diagnostic accuracy of T2 and diffusion-weighted sequences for prostate cancer detection.
• To determine the added value of DCE in multiparametric MRI protocols.

Main Methods:

• A multicentre trial involving 497 biopsy-naïve men using standardized 1.5T MP-MRI (T2, diffusion, and DCE).
• Transperineal prostate mapping (TPM) biopsy at 5mm intervals was performed.
• Radiologists assigned Likert scores (1-5) for significant tumor presence, first using T2 + diffusion, then adding DCE.

Main Results:

• Sensitivity (95% vs 94%), specificity (38% vs 37%), PPV (51% vs 51%), and NPV (91% vs 90%) showed no significant difference with or without DCE.
• The number of patients avoiding biopsy was similar (121/497 vs 123/497).
• No dominant Gleason 4+ tumors were missed with DCE, compared to one case missed with T2 + diffusion alone.

Conclusions:

• Dynamic contrast-enhanced imaging provides minimal additional benefit to T2 and diffusion sequences in multiparametric MRI for excluding significant prostate cancer.
• The routine use of contrast agents in MP-MRI for prostate cancer may not be necessary for accurate diagnosis.