Added value of diffusion-weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial
| Autor: | David Eldred-Evans, Alex Freeman, Lucy A.M. Simmons, Joana B. Neves, Caroline M. Moore, Manit Arya, Susan C. Charman, Abi Kanthabalan, Hashim U. Ahmed, Shonit Punwani, Mark Emberton, Neil McCartan, Taimur T. Shah |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.diagnostic_test
business.industry Urology 030232 urology & nephrology Diagnostic accuracy medicine.disease Confidence interval 03 medical and health sciences Prostate cancer Dynamic contrast 0302 clinical medicine medicine.anatomical_structure Prostate 030220 oncology & carcinogenesis Biopsy medicine Nuclear medicine business Multiparametric Magnetic Resonance Imaging Diffusion MRI |
| Zdroj: | BJU International. 125:391-398 |
| ISSN: | 1464-4096 |
| DOI: | 10.1111/bju.14953 |
| Popis: | Objective To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. Patients and methods PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification after a previous non-magnetic resonance imaging (MRI)-guided transrectal ultrasonography-guided biopsy underwent a 3-Tesla (3T) multiparametic (mp)MRI consisting of T2-weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver-operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. Results Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71-0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). Conclusions Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|