Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden.
Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Radiol. 2021 Nov;31(11):8692-8702. doi: 10.1007/s00330-021-07907-9. Epub 2021 Apr 23.
The PIRADS Steering Committee has called for "higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up," however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa).
Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3-5 with bpMRI and/or mpMRI.
Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4-18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3-18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84-0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01-1.10.
In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives.
• In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room.
前列腺影像报告和数据系统（PI-RADS）指导委员会呼吁“在没有对比增强的 MRI 作为初始诊断工作的循证建议之前，需要更高质量的数据”，然而，在筛查等低风险环境中，双参数（bp）MRI 被认为是一种合理的选择。通过 bpMRI，更多的男性可以以更低的成本进行 MRI 检查，并且可以避免静脉内进入的侵袭性。本研究旨在评估 bpMRI 与 mpMRI 在前列腺癌（PCa）序贯筛查中的癌症检出率。
在正在进行的哥德堡前列腺癌筛查 2 试验中，我们评估了 551 例连续接受前列腺 MRI 检查的患者的癌症检出率。在同一检查中，读者首先评估 bpMRI，然后评估 mpMRI。对于 bpMRI 和/或 mpMRI 评分 PIRADS 3-5 的病变，进行了 4 次靶向活检。
mpMRI 检出 84/551 例（15.2%；95%CI：12.4-18.4），bpMRI 检出 83/551 例（15.1%；95%CI：12.3-18.2%）。bpMRI 与 mpMRI 相比，癌症检出的相对风险（RR）为 0.99（95%单侧置信区间：>94.8%）；bpMRI 不劣于 mpMRI（10%不劣效性边界）。bpMRI 导致的假阳性更少，为 45/128（35.2%），而 mpMRI 为 52/136（38.2%），RR=0.92；95%CI：0.84-0.98。在仅用 mpMRI 评分阳性的 8 个病变中，有 7 个是假阳性。bpMRI 的 MRI 和靶向活检的阳性预测值（PPV）为 128/83（64.8%），mpMRI 的 PPV 为 136/84（61.8%），RR=1.05，95%CI：1.01-1.10。
在 PSA 筛查人群中，bpMRI 与 mpMRI 相比，在癌症检出率方面不劣于后者，且假阳性率更低。
在 PSA 筛查后行 MRI 检查的前列腺癌筛查中，与多参数 MRI 相比，双参数 MRI 可使放射科医生检测到几乎相同数量的前列腺癌，并检出更少的假阳性病变。
在筛查项目中，应权衡高灵敏度与健康男性的成本和风险；通过采用双参数 MRI，可以使更多的男性免受钆造影剂的暴露，同时允许 MRI 室的周转率更高。
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