Marloes van der Leest1, Bas Israël2, Erik Bastiaan Cornel3, Patrik Zámecnik4, Ivo G Schoots5, Hans van der Lelij6, Anwar R Padhani7, Maroeska Rovers8, Inge van Oort9, Michiel Sedelaar9, Christina Hulsbergen-van de Kaa10, Gerjon Hannink8, Jeroen Veltman11, Jelle Barentsz4. 1. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: marloes.vanderleest@radboudumc.nl. 2. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Department of Urology, Ziekenhuis Groep Twente, Almelo-Hengelo, The Netherlands. 4. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 6. Department of Radiology and Nuclear Medicine, Maasstad Hospital, Rotterdam, The Netherlands. 7. Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK. 8. Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. 10. Laboratory Pathology Oost-Nederland, Hengelo, The Netherlands. 11. Department of Radiology, Ziekenhuis Groep Twente, Almelo-Hengelo, The Netherlands.
Abstract
BACKGROUND: To make magnetic resonance imaging (MRI) more accessible to men at risk of high-grade prostate cancer (PCa), there is a need for quicker, simpler, and less costly MRI protocols. OBJECTIVE: To compare the diagnostic performance of monoplanar ("fast" biparametric MRI [bp-MRI]) and triplanar noncontrast bp-MRI with that of the current contrast-enhanced multiparametric MRI (mp-MRI) in the detection of high-grade PCa in biopsy-naïve men. DESIGN, SETTING, AND PARTICIPANTS: A prospective, multireader, head-to-head study included 626 biopsy-naïve men, between February 2015 and February 2018. INTERVENTION: Men underwent prebiopsy contrast-enhanced mp-MRI. Prior to biopsy, two blinded expert readers subsequently assessed "fast" bp-MRI, bp-MRI, and mp-MRI. Thereafter, systematic transrectal ultrasound-guided biopsies (SBs) were performed. Men with suspicious mp-MRI (Prostate Imaging Reporting and Data System 3-5 lesions) also underwent MR-in-bore biopsy (MRGB). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was the diagnostic performance of each protocol for the detection of high-grade PCa. Secondary outcomes included the difference in biopsy avoidance, detection of low-grade PCa, acquisition times, decision curve analyses, inter-reader agreement, and direct costs. Results from combined MRGB and SB were used as the reference standard. High-grade PCa was defined as grade ≥2. RESULTS AND LIMITATIONS: Sensitivity for high-grade PCa for all protocols was 95% (180/190; 95% confidence interval [CI]: 91-97%). Specificity was 65% (285/436; 95% CI: 61-70%) for "fast" bp-MRI and 69% (299/436; 95% CI: 64-73%) for bp-MRI and mp-MRI. With fast bp-MRI, 0.96% (6/626) more low-grade PCa was detected. Biopsy could be avoided in 47% for the fast bp-MRI and in 49% for the bp-MRI and mp-MRI protocols. Fast bp-MRI and bp-MRI can be performed in 8 and 13min, respectively, instead of 16min at lower direct costs. Inter-reader agreement was 90% for fast bp-MRI protocol and 93% for bp-MRI protocol. A main limitation is the generalizability of these results in less experienced centers. CONCLUSIONS: Short MRI protocols can improve prostate MRI accessibility at a lower direct cost. For fast bp-MRI, this is at the cost of ∼2% more biopsies and ∼1% more overdetection of low-grade PCa. In order to implement this technique in nonexpert, low-volume, lower-field-strength scanners, further prospective studies have to be performed. PATIENT SUMMARY: We compared the value of three different magnetic resonance imaging (MRI) protocols for the detection of prostate cancer in men with elevated prostate-specific antigen levels. Our results show that, when used in expert centers, shorter MRI protocols do not compromise the detection of harmful disease. This increases MRI capacity at lower direct costs.
BACKGROUND: To make magnetic resonance imaging (MRI) more accessible to men at risk of high-grade prostate cancer (PCa), there is a need for quicker, simpler, and less costly MRI protocols. OBJECTIVE: To compare the diagnostic performance of monoplanar ("fast" biparametric MRI [bp-MRI]) and triplanar noncontrast bp-MRI with that of the current contrast-enhanced multiparametric MRI (mp-MRI) in the detection of high-grade PCa in biopsy-naïve men. DESIGN, SETTING, AND PARTICIPANTS: A prospective, multireader, head-to-head study included 626 biopsy-naïve men, between February 2015 and February 2018. INTERVENTION: Men underwent prebiopsy contrast-enhanced mp-MRI. Prior to biopsy, two blinded expert readers subsequently assessed "fast" bp-MRI, bp-MRI, and mp-MRI. Thereafter, systematic transrectal ultrasound-guided biopsies (SBs) were performed. Men with suspicious mp-MRI (Prostate Imaging Reporting and Data System 3-5 lesions) also underwent MR-in-bore biopsy (MRGB). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was the diagnostic performance of each protocol for the detection of high-grade PCa. Secondary outcomes included the difference in biopsy avoidance, detection of low-grade PCa, acquisition times, decision curve analyses, inter-reader agreement, and direct costs. Results from combined MRGB and SB were used as the reference standard. High-grade PCa was defined as grade ≥2. RESULTS AND LIMITATIONS: Sensitivity for high-grade PCa for all protocols was 95% (180/190; 95% confidence interval [CI]: 91-97%). Specificity was 65% (285/436; 95% CI: 61-70%) for "fast" bp-MRI and 69% (299/436; 95% CI: 64-73%) for bp-MRI and mp-MRI. With fast bp-MRI, 0.96% (6/626) more low-grade PCa was detected. Biopsy could be avoided in 47% for the fast bp-MRI and in 49% for the bp-MRI and mp-MRI protocols. Fast bp-MRI and bp-MRI can be performed in 8 and 13min, respectively, instead of 16min at lower direct costs. Inter-reader agreement was 90% for fast bp-MRI protocol and 93% for bp-MRI protocol. A main limitation is the generalizability of these results in less experienced centers. CONCLUSIONS: Short MRI protocols can improve prostate MRI accessibility at a lower direct cost. For fast bp-MRI, this is at the cost of ∼2% more biopsies and ∼1% more overdetection of low-grade PCa. In order to implement this technique in nonexpert, low-volume, lower-field-strength scanners, further prospective studies have to be performed. PATIENT SUMMARY: We compared the value of three different magnetic resonance imaging (MRI) protocols for the detection of prostate cancer in men with elevated prostate-specific antigen levels. Our results show that, when used in expert centers, shorter MRI protocols do not compromise the detection of harmful disease. This increases MRI capacity at lower direct costs.
Keywords:
Abbreviated prostate magnetic resonance imaging protocols; Biparametric magnetic resonance imaging; Diagnostic imaging; Dynamic contrast-enhanced imaging; Prostate Imaging Reporting and Data System; Prostate cancer
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