Department of Radiology, NYU School of Medicine, New York, New York, USA.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.
J Magn Reson Imaging. 2019 May;49(5):1400-1408. doi: 10.1002/jmri.26318. Epub 2019 Jan 10.
The value of dynamic contrast-enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial.
To evaluate the population net benefit of risk stratification using DCE-MRI for detection of high-grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging.
Decision curve analysis.
Previously published patient studies on MRI for HGPCA detection, one using DCE with golden-angle radial sparse parallel (GRASP) images and the other using standard DCE-MRI.
FIELD STRENGTH/SEQUENCE: GRASP or standard DCE-MRI at 3 T.
Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) category (1-5), before and after reclassification of peripheral zone lesions from PI-RADS 3-4 based on contrast-enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI-RADS ≥3 (using NC-MRI), and PI-RADS ≥4 on DCE.
Decision curve analysis was performed for both GRASP and standard DCE-MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies.
For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE-MRI with biopsy of PI-RADS ≥4 lesions provided the highest net benefit, while biopsy of PI-RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2-11%). In the same range of risk thresholds using standard DCE-MRI, the optimal strategy was biopsy for all lesions (0-15% risk threshold) or PI-RADS ≥3 on NC-MRI (16-33% risk threshold).
GRASP DCE-MRI may potentially enable biopsy of PI-RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI-RADS ≥3 lesions. J. Magn. Reson. Imaging 2019;49:1400-1408.
与非对比 MRI 相比，动态对比增强（DCE）序列在前列腺 MRI 中的价值存在争议。
评估使用 DCE-MRI 进行高危前列腺癌（HGPCA）检测的风险分层的人群净获益，同时评估高时空分辨率 DCE 成像的作用。
决策曲线分析。
之前发表的关于 MRI 检测 HGPCA 的患者研究，一项使用带有 Golden-angle radial sparse parallel（GRASP）图像的 DCE，另一项使用标准 DCE-MRI。
场强/序列：GRASP 或标准 DCE-MRI，场强 3 T。
每个研究报告了每个前列腺影像报告和数据系统版本 2（PI-RADS v2）类别（1-5）中具有 HGPCA 的病变比例，基于对比增强图像对 PI-RADS 3-4 外周区病变进行重新分类前后。当假设对：所有病变、无病变、PI-RADS≥3（使用 NC-MRI）和 DCE 上的 PI-RADS≥4 进行活检时，将这种额外的风险分层信息转化为人群净获益。
对 GRASP 和标准 DCE-MRI 数据进行决策曲线分析，将避免不必要的活检和检测 HGPCA 的情况转化为人群净获益。我们对 HGPCA 患病率进行了标准化净获益值，并以图形方式总结了活检策略的比较净获益。
在 HGPCA（>11%）风险阈值的临床相关范围内，使用 GRASP DCE-MRI 对 PI-RADS≥4 病变进行活检提供了最高的净获益，而在低个人风险阈值（2-11%）时，对 PI-RADS≥3 病变进行活检提供了最高的净获益。在使用标准 DCE-MRI 的相同风险阈值范围内，最佳策略是对所有病变（0-15%风险阈值）或 NC-MRI 上的 PI-RADS≥3（16-33%风险阈值）进行活检。
GRASP DCE-MRI 可能能够对 PI-RADS≥4 病变进行活检，与对所有 PI-RADS≥3 病变进行活检相比，相对保留 HGPCA 的检测并避免不必要的活检。J. Magn. Reson. Imaging 2019;49:1400-1408。
