Optimized MRI Assessment for Clinically Significant Prostate Cancer: A STARD-Compliant Two-Center Study

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• A need exists for personalized MRI strategies to improve accessibility for men with suspected clinically significant prostate cancer (CSPC).
• Current MRI protocols include biparametric (Bp)-MRI and multiparametric (Mp)-MRI, but optimization may enhance diagnostic performance.

Purpose of the Study:

• To evaluate an optimized MRI (Op-MRI) protocol against Bp-MRI and Mp-MRI for diagnosing CSPC.
• To assess the diagnostic accuracy and efficiency of Op-MRI in a multi-center setting.

Main Methods:

• A retrospective study involving 638 patients across two centers using 3.0T scanners.
• Bp-MRI (T2-weighted imaging [T2 WI] and diffusion-weighted imaging [DWI]) and Mp-MRI (T2 WI, DWI, and dynamic contrast-enhanced [DCE] imaging) were interpreted using PI-RADS.
• Op-MRI utilized an adjusted decision rule on Bp-MRI PI-RADS 3 lesions, incorporating DCE findings, with biopsy/prostatectomy as the reference standard.

Main Results:

• Interreader agreement was excellent for all MRI types (κ >0.80).
• Op-MRI demonstrated comparable sensitivity and higher specificity than Mp-MRI and Bp-MRI for CSPC diagnosis.
• Op-MRI spared 80.7% of unnecessary DCE scans compared to Mp-MRI with similar accuracy and outperformed Bp-MRI by reclassifying PI-RADS lesions.

Conclusions:

• Op-MRI, employing an adjusted PI-RADS decision rule, achieves high diagnostic accuracy for CSPC.
• This optimized approach significantly reduces the need for DCE scans and spares biopsies, improving efficiency.
• Op-MRI offers a valuable alternative, potentially enhancing MRI accessibility and reducing healthcare costs.