Giulia Cristel1, Antonio Esposito2, Anna Damascelli3, Alberto Briganti4, Alessandro Ambrosi5, Giorgio Brembilla2, Lisa Brunetti2, Sofia Antunes3, Massimo Freschi6, Francesco Montorsi4, Alessandro Del Maschio2, Francesco De Cobelli2. 1. Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy. Electronic address: cristel.giulia@hsr.it. 2. Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy. 3. Department of Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy. 4. Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Urology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy. 5. Vita Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy. 6. Department of Pathology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Abstract
PURPOSE: To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization. METHOD: Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive. RESULTS: GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10-3/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified. CONCLUSIONS: Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.
PURPOSE: To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization. METHOD: Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive. RESULTS:GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10-3/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified. CONCLUSIONS: Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.