Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.
Eur Radiol. 2020 Jul;30(7):4039-4049. doi: 10.1007/s00330-020-06782-0. Epub 2020 Mar 12.
To assess the added value of dynamic contrast-enhanced (DCE) in prostate MR in clinical practice.
Two hundred sixty-four patients underwent prostate MRI, with T2 and DWI sequences initially interpreted, prior to full multiparametric magnetic resonance imaging (mpMRI) interpretation using a Likert 1-5 scale. A prospective opinion was given on likely benefit of contrast prior to review of the DCE sequence, and retrospectively following full mpMRI review. The final histology result following targeted and/or systematic biopsy of the prostate was used for outcome purposes.
Biparametric magnetic resonance imaging (bpMRI) and mpMRI were assigned the same score in 86% of cases; when dichotomising to a negative or positive MRI (Likert score ≥ 3), concordance increased to 92.8%. At Likert score ≥ 3 bpMRI detected 89.9% of all cancers and 93.5% clinically significant prostate cancers (csPCa) and mpMRI 90.7% and 94.6%, respectively. mpMRI had fewer false positives than bpMRI (11.4% vs 18.9%) and a lower Likert 3 rate (8.3% vs 17%), conferring higher specificity (74% vs 67%), but similar sensitivity (95% versus 94%) and ROC-AUC (90% vs 89%). At a positive MRI threshold of Likert ≥ 4, mpMRI had a higher sensitivity than bpMRI (89% versus 80%) and detected more csPCa (89.2% versus 79.6%). DCE was prospectively considered of potential benefit in 27.3%, but readers would only recall 11% of patients for DCE sequences, mainly to assess score 3 peripheral zone lesions. Following full mpMRI review, DCE was considered helpful in 28.4% of cases; in 23/75 (30.6%) of these cases this only became apparent after reviewing the sequence, reasons included increased confidence, presence of "safety-net" lesions or inflammatory lesions.
BpMRI has equivalent cancer detection rates to mpMRI; however, mpMRI had fewer Likert 3 call rates and increased specificity and was subjectively considered of benefit by readers in 28.4% of cases.
• bpMRI has similar cancer detection rates to the full mpMRI protocol at a positive MRI threshold of Likert 3. • mpMRI had fewer intermediate category 3 calls (8.3%) than bpMRI (17%) and fewer false positives than bpMRI (11.4% vs 18.9%), conferring higher specificity (74% vs 67%). • Readers considered DCE beneficial in 28.4% of cases, but in a relatively high number (30.6%) this only became apparent after reviewing the sequence.
评估前列腺磁共振成像（MRI）中动态对比增强（DCE）的临床应用价值。
264 例患者接受了前列腺 MRI 检查，初始进行 T2 和 DWI 序列解读，之后采用 Likert 1-5 评分进行全参数 MRI（mpMRI）解读。在回顾 DCE 序列之前，前瞻性地评估对比剂的可能获益，并在完成全参数 MRI 解读后进行回顾性评估。以靶向和/或系统前列腺活检的最终组织学结果作为评估结果。
在 86%的病例中，双参数 MRI（bpMRI）和 mpMRI 的评分相同；当将评分分为阴性或阳性（Likert 评分≥3）时，一致性增加至 92.8%。在 Likert 评分≥3 时，bpMRI 检测到 89.9%的所有癌症和 93.5%的临床显著前列腺癌（csPCa），mpMRI 分别检测到 90.7%和 94.6%。mpMRI 的假阳性率（11.4%）低于 bpMRI（18.9%），Likert 3 评分率（8.3%）也低于 bpMRI（17%），因此特异性（74% vs 67%）更高，但敏感性（95% vs 94%）和 ROC-AUC（90% vs 89%）相似。在阳性 MRI 阈值 Likert≥4 时，mpMRI 的敏感性（89%）高于 bpMRI（80%），且检测到更多的 csPCa（89.2% vs 79.6%）。DCE 在前瞻性评估中被认为具有潜在获益的比例为 27.3%，但读者仅会回忆起 11%的患者进行 DCE 序列检查，主要是为了评估评分 3 的外周区病变。在完成全参数 MRI 检查后，28.4%的病例认为 DCE 是有帮助的；在这 23/75（30.6%）例中，仅在回顾序列后才发现这一点，原因包括增加了信心、存在“安全网”病变或炎症性病变。
bpMRI 与 mpMRI 相比，具有相同的癌症检出率；然而，mpMRI 的 Likert 3 评分较低，特异性较高，且在 28.4%的病例中，读者主观上认为其具有获益。
bpMRI 与全参数 mpMRI 协议在 Likert 3 阳性 MRI 阈值下具有相似的癌症检出率。
mpMRI 的中等类别 3 评分（8.3%）低于 bpMRI（17%），假阳性率（11.4%）低于 bpMRI（18.9%），因此特异性（74% vs 67%）更高。
读者认为 DCE 在 28.4%的病例中有获益，但在相当多的病例（30.6%）中，只有在回顾序列后才发现这一点。
