Decreased prostate MRI cancer detection rate due to moderate to severe susceptibility artifacts from hip prosthesis
Hirotsugu Nakai1, Hiroaki Takahashi1, Daniel A Adamo1
1Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Objectives:
To evaluate the impact of susceptibility artifacts from hip prosthesis on cancer detection rate (CDR) in prostate MRI.
Materials And Methods:
This three-center retrospective study included prostate MRI studies for patients without known prostate cancer between 2017 and 2021. Exams with hip prosthesis were searched on MRI reports. The degree of susceptibility artifact on diffusion-weighted images was retrospectively categorized into mild, moderate, and severe (> 66%, 33-66%, and < 33% of the prostate volume are evaluable) by blind reviewers. CDR was defined as the number of exams with Gleason score ≥7 detected by MRI (PI-RADS ≥3) divided by the total number of exams. For each artifact grade, control exams without hip prosthesis were matched (1:6 match), and CDR was compared. The degree of CDR reduction was evaluated with ratio, and influential factors were evaluated by expanding the equation.
Results:
Hip arthroplasty was present in 548 (4.8%) of the 11,319 MRI exams. CDR of the cases and matched control exams for each artifact grade were as follows: mild (n = 238), 0.27 vs 0.25, CDR ratio = 1.09 [95% CI: 0.87-1.37]; moderate (n = 143), 0.18 vs 0.27, CDR ratio = 0.67 [95% CI: 0.46-0.96]; severe (n = 167), 0.22 vs 0.28, CDR ratio = 0.80 [95% CI: 0.59-1.08]. When moderate and severe artifact grades were combined, CDR ratio was 0.74 [95% CI: 0.58-0.93]. CDR reduction was mostly attributed to the increased frequency of PI-RADS 1-2.
Conclusion:
With moderate to severe susceptibility artifacts from hip prosthesis, CDR was decreased to 74% compared to the matched control.
Clinical Relevance Statement:
Moderate to severe susceptibility artifacts from hip prosthesis may cause a non-negligible CDR reduction in prostate MRI. Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1-2 was assigned.
Key Points:
• We proposed cancer detection rate as a diagnostic performance metric in prostate MRI. • With moderate to severe susceptibility artifacts secondary to hip arthroplasty, cancer detection rate decreased to 74% compared to the matched control. • Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1-2 is assigned.
Insights
Hip prosthesis artifacts in prostate MRI reduce cancer detection rate (CDR) by up to 26% in moderate to severe cases. This highlights the need to consider systematic prostate biopsy for PI-RADS 1-2 findings when artifacts are present.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate MRI is crucial for cancer detection.
- Hip prostheses can cause susceptibility artifacts, potentially impacting image quality.
- The effect of these artifacts on cancer detection rate (CDR) in prostate MRI is not well-defined.
Purpose of the Study:
- To evaluate the impact of susceptibility artifacts from hip prostheses on the cancer detection rate (CDR) in prostate MRI.
- To quantify the reduction in CDR associated with varying degrees of artifact severity.
Main Methods:
- Retrospective analysis of 11,319 prostate MRI exams (2017-2021) across three centers.
- Categorization of susceptibility artifact severity (mild, moderate, severe) in patients with hip prostheses.
- Matched comparison of CDR between patients with and without hip prosthesis artifacts, with analysis of PI-RADS scores.
Main Results:
- Hip arthroplasty was present in 4.8% of exams.
- Moderate to severe artifacts led to a combined CDR ratio of 0.74 (95% CI: 0.58-0.93), indicating a 26% reduction in CDR.
- CDR reduction was primarily linked to an increased frequency of PI-RADS 1-2 findings.
Conclusions:
- Moderate to severe susceptibility artifacts from hip prostheses significantly decrease the cancer detection rate in prostate MRI.
- A CDR reduction to 74% of the control group was observed with moderate to severe artifacts.
- Consideration of expanding indications for systematic prostate biopsy for PI-RADS 1-2 findings may be warranted in the presence of these artifacts.
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