Synthetic MRI as a T2WI alternative in bp-MRI: comparable image quality and improved PI-RADS performance

Prostate cancer significantly impacts men's health, highlighting the necessity for precise diagnosis. This study evaluates combining Magnetic Resonance Image Compilation (MAGiC) parameters with Prostate Imaging Reporting and Data System (PI-RADS) scores to enhance diagnostic accuracy among radiologists with varied experience.

In this retrospective study, 174 patients with suspected prostate cancer were recruited from February 2023 to May 2024. Synthetic MRI-derived T1, T2, and proton density (PD) maps were generated, and synthetic T2-weighted imaging (T2WI) was reconstructed. Two radiologists of varying experience independently assessed lesions using PI-RADS based on both synthetic and conventional T2WI. Image quality was evaluated using the prostate imaging quality (PI-QUAL) scoring v2 system, and diagnostic performance was analyzed using receiver operating characteristic (ROC) curve analysis.

Synthetic T2WI exhibited comparable image quality to conventional T2WI (P = 0.065). After excluding low-quality images, 99 lesions were analyzed. In the peripheral zone, higher T1 values were significantly linked to non-cancerous lesions (R1: OR = 0.989, P = 0.009; R2: OR = 0.990, P = 0.004). The integration of T1 values with PI-RADS scores improved diagnostic performance, achieving area under the curve (AUC) values of 0.960 for R1 and 0.944 for R2.

The integration of MAGiC parameters, particularly T1 values, with PI-RADS scores significantly enhances diagnostic accuracy for clinically significant prostate cancer, especially benefitting less experienced radiologists. Additionally, synthetic T2WI demonstrates comparable image quality to conventional T2WI, supporting the clinical implementation of MAGiC parameters in prostate MRI assessments.