Verena C Obmann1, Shivani Pahwa1, William Tabayayong2, Yun Jiang3, Gregory O'Connor4, Sara Dastmalchian1, John Lu4, Soham Shah3, Karin A Herrmann1, Raj Paspulati1, Gregory MacLennan5, Lee Ponsky6, Robert Abouassaly2, Vikas Gulani7. 1. Department of Radiology, Case Western Reserve University, Cleveland, OH; Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH. 2. Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH. 3. Department of Radiology, Case Western Reserve University, Cleveland, OH. 4. School of Medicine, Case Western Reserve University, Cleveland, OH. 5. Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Pathology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH. 6. Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH. 7. Department of Radiology, Case Western Reserve University, Cleveland, OH; Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH. Electronic address: vxg46@case.edu.
Abstract
OBJECTIVE: To evaluate the performance of a rapid, low cost, noncontrast MRI examination as a secondary screening tool in detection of clinically significant prostate cancer. METHODS: In this prospective single institution study, 129 patients with elevated prostate-specific antigen levels or abnormal digital rectal examination findings underwent MRI with an abbreviated biparamatric MRI protocol consisting of high-resolution axial T2- and diffusion-weighted images. Index lesions were classified according to modified Prostate Imaging - Reporting and Data System (mPI-RADS) version 2.0. All patients underwent standard transrectal ultrasound-guided biopsy after MRI with the urologist being blinded to MRI results. Subsequently, all patients with suspicious lesions (mPI-RADS 3, 4, or 5) underwent cognitively guided targeted biopsy after discussion of MRI results with the urologist. Sensitivity and negative predictive value for identification of clinically significant prostate cancer (Gleason score 3+4 and above) were determined. RESULTS: Rapid biparametric MRI discovered 176 lesions identified in 129 patients. Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%. CONCLUSION: We found that a bp-MRI examination can detect clinically significant lesions and changed patient management in 10.8% of the patients. A rapid MRI protocol can be used as a useful secondary screening tool in men presenting with suspicion of prostate cancer.
OBJECTIVE: To evaluate the performance of a rapid, low cost, noncontrast MRI examination as a secondary screening tool in detection of clinically significant prostate cancer. METHODS: In this prospective single institution study, 129 patients with elevated prostate-specific antigen levels or abnormal digital rectal examination findings underwent MRI with an abbreviated biparamatric MRI protocol consisting of high-resolution axial T2- and diffusion-weighted images. Index lesions were classified according to modified Prostate Imaging - Reporting and Data System (mPI-RADS) version 2.0. All patients underwent standard transrectal ultrasound-guided biopsy after MRI with the urologist being blinded to MRI results. Subsequently, all patients with suspicious lesions (mPI-RADS 3, 4, or 5) underwent cognitively guided targeted biopsy after discussion of MRI results with the urologist. Sensitivity and negative predictive value for identification of clinically significant prostate cancer (Gleason score 3+4 and above) were determined. RESULTS: Rapid biparametric MRI discovered 176 lesions identified in 129 patients. Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%. CONCLUSION: We found that a bp-MRI examination can detect clinically significant lesions and changed patient management in 10.8% of the patients. A rapid MRI protocol can be used as a useful secondary screening tool in men presenting with suspicion of prostate cancer.
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