Papoutsaki Marianthi-Vasiliki, Allen Clare, Giganti Francesco, Atkinson David, Dickinson Louise, Goodman Jacob, Saunders Helen, Barrett Tristan, Punwani Shonit
Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
Department of Radiology, University College London Hospital NHS Foundation Trust, Euston Road, London, WC1H 8NJ, UK.
Insights Imaging. 2021 Apr 20;12(1):52. doi: 10.1186/s13244-021-00990-y.
National guidelines recommend prostate multiparametric (mp) MRI in men with suspected prostate cancer before biopsy. In this study, we explore prostate mpMRI protocols across 14 London hospitals and determine whether standardisation improves diagnostic quality.
An MRI physicist facilitated mpMRI set-up across several regional hospitals, working together with experienced uroradiologists who judged diagnostic quality. Radiologists from the 14 hospitals participated in the assessment and optimisation of prostate mpMRI image quality, assessed according to both PiRADSv2 recommendations and on the ability to "rule in" and/or "rule out" prostate cancer. Image quality and sequence parameters of representative mpMRI scans were evaluated across 23 MR scanners. Optimisation visits were performed to improve image quality, and 2 radiologists scored the image quality pre- and post-optimisation.
20/23 mpMRI protocols, consisting of 111 sequences, were optimised by modifying their sequence parameters. Pre-optimisation, only 15% of T2W images were non-diagnostic, whereas 40% of ADC maps, 50% of high b-value DWI and 41% of DCE-MRI were considered non-diagnostic. Post-optimisation, the scores were increased with 80% of ADC maps, 74% of high b-value DWI and 88% of DCE-MRI to be partially or fully diagnostic. T2W sequences were not optimised, due to their higher baseline quality scores.
Targeted intervention at a regional level can improve the diagnostic quality of prostate mpMRI protocols, with implications for improving prostate cancer detection rates and targeted biopsies.
国家指南建议对疑似前列腺癌的男性在活检前进行前列腺多参数（mp）MRI检查。在本研究中，我们探索了伦敦14家医院的前列腺mpMRI方案，并确定标准化是否能提高诊断质量。
一名MRI物理学家在几家地区医院协助进行mpMRI设置，与判断诊断质量的经验丰富的泌尿放射科医生合作。来自14家医院的放射科医生参与了前列腺mpMRI图像质量的评估和优化，根据PiRADSv2建议以及“确诊”和/或“排除”前列腺癌的能力进行评估。在23台MR扫描仪上评估了代表性mpMRI扫描的图像质量和序列参数。进行了优化访问以提高图像质量，两名放射科医生对优化前后的图像质量进行评分。
通过修改序列参数，对由111个序列组成的20/23个mpMRI方案进行了优化。优化前，只有15%的T2W图像无法诊断，而40%的ADC图、50%的高b值DWI和41%的DCE-MRI被认为无法诊断。优化后，评分有所提高，80%的ADC图、74%的高b值DWI和88%的DCE-MRI部分或完全可诊断。由于T2W序列的基线质量评分较高，因此未对其进行优化。
区域层面的针对性干预可以提高前列腺mpMRI方案的诊断质量，这对提高前列腺癌的检出率和靶向活检具有重要意义。
