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Published on: April 9, 2019
Comparison of Multiparametric and Fast MRI Protocols in Detecting Clinically Significant Prostate Cancer and a
Kadir Han Alver1, Ahmet Baki Yagci1, Ayse Ruksan Utebey1
1Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey.
Background:
Due to the long acquisition time and high cost of multiparametric magnetic resonance imaging (mpMRI), biparametric and, more recently, fast prostate magnetic resonance imaging (fpMRI) protocols have been described. However, there is insufficient data about the diagnostic performance and cost of fpMRI.
Purpose:
To compare the diagnostic performances and cost analysis of fpMRI and mpMRI in clinically significant prostate cancer (csPCA).
Study Type:
Retrospective.
Population:
A total of 103 patients (63 had csPCA) with a mean age of 66.83 (± 7.22) years were included.
Field Strength/Sequence:
A 1.5-T; T1- and T2-weighted turbo spin-echo imaging (T1WI and T2WI), echo-planar diffusion-weighted images, and dynamic contrast-enhanced T1W imaging.
Assessment:
Three readers independently evaluated the fpMRI and mpMRI images in different sessions blinded to all patient information. Diagnostic performances of fpMRI and mpMRI were evaluated. Kappa coefficient (κ) was used to determine the interreader and intrareader agreement. A detailed cost analysis was performed for each protocol.
Statistical Tests:
Receiver operating characteristics analysis, area under the curve (AUC), and κ test were used. Diagnostic performance parameters were also calculated.
Results:
Of the 63 malignant index lesions (csPCA), 53/63 of those (84.1%) originated from the peripheral zone and 10/63 lesions (15.9%) originated from the transition zone. The AUC values for fpMRI were 0.878 for reader 1, 0.937 for reader 2, and 0.855 for reader 3. For mpMRI, the AUC values were 0.893 for reader 1, 0.94 for reader 2, and 0.862 for reader 3. Inter and intrareader agreements were moderate to substantial (κ range, 0.5-0.79). The total cost per examination was calculated as €12.39 and €30.10 for fpMRI and mpMRI, respectively.
Data Conclusions:
Fast MRI protocol has similar diagnostic performance with mpMRI in detecting csPCA, and fpMRI can be considered an alternative protocol that could create a lower financial burden on health-care systems.
Level Of Evidence:
4 TECHNICAL EFFICACY STAGE: 6.
Insights
Fast prostate MRI (fpMRI) shows diagnostic performance comparable to multiparametric MRI (mpMRI) for detecting clinically significant prostate cancer (csPCA). fpMRI offers a cost-effective alternative, reducing financial burden on healthcare systems.
Area of Science:
- Radiology and Imaging
- Oncology
- Medical Economics
Background:
- Multiparametric MRI (mpMRI) for prostate cancer detection is effective but costly and time-consuming.
- Fast prostate MRI (fpMRI) protocols have emerged as potential alternatives.
- Limited data exists on the diagnostic performance and cost-effectiveness of fpMRI.
Purpose of the Study:
- To compare the diagnostic performance of fpMRI and mpMRI in identifying clinically significant prostate cancer (csPCA).
- To conduct a cost analysis comparing fpMRI and mpMRI protocols.
Main Methods:
- Retrospective analysis of 103 patients (63 with csPCA) using 1.5-T MRI (T1WI, T2WI, DWI, DCE-T1W).
- Three independent readers evaluated fpMRI and mpMRI images, blinded to patient data.
- Diagnostic performance was assessed using ROC analysis (AUC), and inter/intrareader agreement was evaluated with Kappa (κ) coefficients. Cost analysis was performed.
Main Results:
- Area Under the Curve (AUC) values for fpMRI ranged from 0.855 to 0.937, and for mpMRI from 0.862 to 0.940, indicating similar diagnostic performance.
- Inter- and intrareader agreement was moderate to substantial (κ range, 0.5–0.79).
- Total examination costs were €12.39 for fpMRI versus €30.10 for mpMRI.
Conclusions:
- fpMRI demonstrates comparable diagnostic efficacy to mpMRI in detecting csPCA.
- fpMRI presents a viable, lower-cost alternative to mpMRI, potentially reducing healthcare expenditure.
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