Ahmed El-Shater Bosaily1, Elena Frangou2, Hashim U Ahmed3, Mark Emberton4, Shonit Punwani4, Richard Kaplan2, Louise C Brown2, Alex Freeman5, Charles Jameson5, Richard Hindley6, Delia Peppercorn6, Andrew Thrower6, Mathias Winkler7, Tara Barwick8, Victoria Stewart8, Nick Burns-Cox9, Paul Burn9, Maneesh Ghei10, Jeevan Kumaradevan10, Raj Prasad11, Janice Ash-Miles11, Iqbal Shergill12, Sanjay Agarwal12, Derek Rosario13, Ferekh Salim13, Simon Bott14, Hywel Evans14, Alastair Henderson15, Sukanya Ghosh15, Tim Dudderidge16, J Smart16, Ken Tung16, Alexander Kirkham5. 1. Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK. Electronic address: ashater@nhs.net. 2. The Medical Research Council, London, UK. 3. Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK. 4. Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK. 5. University College Hospital NHS Foundation Trust, London, UK. 6. Hampshire Hospitals NHS Foundation Trust, Hampshire, UK. 7. Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK. 8. Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK. 9. Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK. 10. Whittington Health NHS Trust, London, UK. 11. North Bristol NHS Trust, Bristol, UK. 12. Wrexham Maelor Hospital, Wrexham, UK. 13. Royal Hallamshire Hospital, Sheffield, UK. 14. Frimley Health NHS Foundation Trust, Camberley, UK. 15. Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK. 16. University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Abstract
BACKGROUND: Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE: To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS: PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS: Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS: Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY: An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
BACKGROUND: Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE: To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS: PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS: Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS: Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY: An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
Authors: Alexander P Cole; Bjoern J Langbein; Francesco Giganti; Fiona M Fennessy; Clare M Tempany; Mark Emberton Journal: Br J Radiol Date: 2021-12-16 Impact factor: 3.039
Authors: Naomi Morka; Benjamin S Simpson; Rhys Ball; Alex Freeman; Alex Kirkham; Daniel Kelly; Hayley C Whitaker; Mark Emberton; Joseph M Norris Journal: BMJ Open Date: 2021-05-05 Impact factor: 2.692
Authors: Giorgio Brembilla; Francesco Giganti; Harbir Sidhu; Massimo Imbriaco; Sue Mallett; Armando Stabile; Alex Freeman; Hashim U Ahmed; Caroline Moore; Mark Emberton; Shonit Punwani Journal: Diagnostics (Basel) Date: 2022-01-18