Restriction Spectrum Imaging-Magnetic Resonance Imaging to Improve Prostate Cancer Imaging in Men on Active...

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Active surveillance is a strategy for managing low-risk prostate cancer.
• Predicting Gleason upgrading is crucial for active surveillance decisions.
• Current methods like PI-RADS may have limitations in accurately predicting upgrading.

Purpose of the Study:

• To evaluate the utility of restriction spectrum imaging-magnetic resonance imaging (RSI-MRI) in detecting Gleason upgrading.
• To assess if RSI-MRI can improve the accuracy of upgrading detection in prostate cancer patients on active surveillance.

Main Methods:

• Prospective enrollment of men on active surveillance undergoing repeat biopsy.
• Prostate multiparametric MRI and RSI-MRI were performed and reviewed for PI-RADS lesions.
• RSI-MRI analysis generated a restricted signal map to predict upgrading compared to apparent diffusion coefficient values.

Main Results:

• RSI-MRI's restricted signal map significantly improved true-positive lesion detection compared to PI-RADS.
• RSI-MRI demonstrated superior sensitivity, specificity, PPV, and NPV for Gleason upgrading compared to PI-RADS ≥3.
• RSI-MRI significantly improved the area under the curve (AUC) for predicting upgrading from 0.70 to 0.90.

Conclusions:

• Restriction spectrum imaging-magnetic resonance imaging enhances the standard PI-RADS system.
• RSI-MRI provides a noninvasive radiological biomarker for predicting upgrading in active surveillance.
• This technique shows promise for improving the management of prostate cancer on active surveillance.