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Published on: April 9, 2019
Utility of Quantitative T2-Mapping Compared to Conventional and Advanced Diffusion Weighted Imaging Techniques for
Paul Sathiadoss1, Nicola Schieda1, Mohammad Haroon1
1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Background:
Diffusion weighted imaging (DWI) is fundamental for prostate cancer (PCa) detection with MRI; however, limited by susceptibility artifact from hip prosthesis.
Purpose:
To evaluate image quality and ability to detect PCa with quantitative T2-mapping and DWI in men with hip prosthesis undergoing prostate MRI.
Study Type:
Prospective, cross-sectional study.
Population:
Thirty consecutive men with hip replacement (18 unilateral, 12 bilateral) undergoing prostate MRI from 2019 to 2021.
Field Strength/Sequence:
3-T; multiparametric MRI (T2W, DCE-MRI, echo-planar [EPI]-DWI), T2-mapping (Carr-Purcell-Meiboom-Gill), FOCUS-EPI-DWI, PROPELLER-DWI.
Assessment:
Five blinded radiologists independently evaluated MRI image quality using a 5-point Likert scale. PI-RADS v2.1 scores were applied in four interpretation strategies: 1) T2W-FSE+DCE-MRI+EPI-DWI, 2) T2W-FSE+DCE-MRI+EPI-DWI+FOCUS-EPI-DWI, 3) T2W-FSE+DCE-MRI+EPI-DWI+PROPELLER-DWI, 4) T2W-FSE+DCE-MRI+EPI-DWI+T2-maps. Five-point confidence scores were recorded.
Statistical Analysis:
ANOVA, Kruskal-Wallis with pair-wise comparisons by Wilcoxon sign-rank, and paired t-tests, P < 0.05 was considered significant. Cohen's Kappa (k) for PI-RADSv2.1 scoring and proportion of correctly classified lesions tabulated for pathology-confirmed cases with 95% confidence intervals (CIs).
Results:
For all radiologists, T2-map image quality was significantly higher than EPI-DWI, FOCUS-EPI-DWI, and PROPELLER-DWI and similar (P = 0.146-0.706) or significantly better (for two readers) than T2W-FSE and DCE-MRI. PI-RADS v2.1 agreement improved comparing strategy A (k = 0.46) to strategy B (k = 0.58) to strategy C (k = 0.58) and was highest with strategy D which included T2-maps (k = 1.00). Radiologists' confidence was significantly highest with strategy D. Strategies B and C had similar confidence (P = 0.051-0.063) both significantly outperforming strategy A. Twelve men with 17 lesions had pathology confirmed diagnoses (13 PCa, 4 benign). Strategy D had the highest proportion of correctly classified lesions (76.5-82.4%) with overlapping 95% confidence intervals.
Data Conclusion:
T2-mapping may be a valuable adjunct to prostate MRI in men with hip replacement resulting in improved image quality, higher reader confidence, interobserver agreement, and accuracy in PI-RADS scoring.
Level Of Evidence:
1 TECHNICAL EFFICACY STAGE: 2.
Insights
Quantitative T2-mapping improves prostate MRI quality and accuracy for detecting prostate cancer (PCa) in patients with hip prostheses. This technique enhances image quality, reader confidence, and diagnostic agreement, aiding in better PCa detection.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Diffusion-weighted imaging (DWI) is crucial for prostate cancer (PCa) detection via MRI.
- Hip prostheses can cause susceptibility artifacts, limiting DWI effectiveness.
- Prostate MRI in patients with hip replacements presents unique imaging challenges.
Purpose of the Study:
- To assess the utility of quantitative T2-mapping and DWI in improving prostate MRI quality and PCa detection in patients with hip prostheses.
- To compare different multiparametric MRI (mpMRI) interpretation strategies including T2-mapping.
- To evaluate the impact of T2-mapping on radiologist confidence and diagnostic accuracy.
Main Methods:
- Prospective study of 30 men with hip replacements undergoing 3-T prostate MRI.
- Utilized multiparametric MRI sequences including echo-planar (EPI)-DWI, FOCUS-EPI-DWI, PROPELLER-DWI, and T2-mapping.
- Radiologists evaluated image quality and assigned PI-RADS v2.1 scores using four interpretation strategies, with and without T2-mapping.
Main Results:
- T2-mapping demonstrated significantly higher image quality compared to EPI-DWI, FOCUS-EPI-DWI, and PROPELLER-DWI.
- PI-RADS v2.1 interobserver agreement (Cohen's Kappa) was highest with the T2-mapping strategy (k=1.00).
- The T2-mapping strategy also yielded the highest radiologist confidence and the greatest proportion of correctly classified lesions (76.5-82.4%).
Conclusions:
- Quantitative T2-mapping is a valuable addition to prostate MRI protocols for patients with hip replacements.
- T2-mapping enhances image quality, reader confidence, and diagnostic accuracy for PCa detection in this challenging population.
- Incorporating T2-mapping improves PI-RADS scoring agreement and lesion classification accuracy.
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