On-table monitoring of prostate MRI could enable tailored utilisation of gadolinium contrast

To compare the impact of on-table monitoring vs standard-of-care multiparametric MRI (mpMRI) for the utilisation of gadolinium contrast use in prostate MRI.

This retrospective observation study of prospectively acquired data was conducted at a single institution over an 18-month period. A cohort of patients undergoing MRI for suspected prostate cancer (PCa) underwent on-table monitoring where their T2 and DWI images were reviewed by a supervising radiologist during the scan to decide whether to acquire dynamic contrast-enhanced (DCE) sequences. MRI scans were reported using PI-RADS v2.1, patients were followed up with biopsy for at least 12 months. The rate of gadolinium administration, biopsy rates, and diagnostic accuracy were compared to that of a standard-of-care control group undergoing mpMRI during the same period using propensity score matching. Estimates of cost savings were also calculated.

1410 patients were identified and after propensity score matching 598 patients were analysed, with 178 undergoing on-table monitoring. Seventy-five and eight tenths (135/178) of patients did not receive gadolinium. Contrast was used mainly for indeterminate lesions (27/43) and significant artefacts on bpMRI (14/43). When comparing the monitored cohort to a non-monitored control group, there was a comparable number of biopsies performed (52.2% vs 49.5%, p = 0.54), PI-RADS 3/5 scoring rates (10.1% vs 7.4%, p = 0.27), sensitivity (98.3% vs 99.2%, p = 0.56), and specificity (63.9% vs 70.7%, p = 0.18) for detection of clinically-significant PCa. When acquired, DCE was deemed helpful in 67.4% (29/43) of cases and improved both PI-QUALv2 and reader confidence scores. There was an estimated saving of £56,677 over the 18-month study.

On-table monitoring significantly reduced the need for gadolinium contrast without compromising diagnostic accuracy and biopsy rates.

Question Default use of gadolinium contrast in prostate MRI is not always of clinical benefit and has associated side effects and healthcare costs. Findings On-table monitoring avoided the use of gadolinium in 75.8% of patients, reducing associated costs whilst maintaining clinically significant cancer detection, and diagnostic accuracy and improving reader confidence. Clinical relevance On-table monitoring offers personalised patient protocolling with a significant reduction in the use of gadolinium and its associated side effects and costs, potentially maximising the advantages of both multiparametric and biparametric prostate MRI.