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The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial.
BJU Int 2019BI

Abstract

OBJECTIVE

To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging in men requiring a repeat biopsy within the PICTURE study.

PATIENTS AND METHODS

PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification following a previous non-MRI guided TRUS biopsy underwent a 3-Tesla mpMRI consisting of T2W, DWI and DCE followed by transperineal template prostate mapping (TPM) biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver operating characteristic (AUROC) fanalysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set as a LIKERT score >/=3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed Definition 1 (primary definition), UCL/Ahmed Definition 2, any Gleason >/=3+4 and any Gleason >/=4+3.

RESULTS

Of 249, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W at AUROC 0.74 (95% CI 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82) and T2W+DWI+DCE at 0.77 (95% CI 0.71-0.82) (p=0.55). The AUROCs remained comparable using other definitions of clinically significant disease including UCL/Ahmed 2 (p=0.79), Gleason >/=3+4 (p=0.53) and Gleason >/=4+3 (p=0.53).

CONCLUSIONS

Using a 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy. However, such a strategy can lead to a higher rate of equivocal lesions.

Authors+Show Affiliations

Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. Department of Urology, Imperial College Healthcare NHS Trust, London, UK.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom. Department of Urology, UCLH NHS Foundation Trust, London, UK.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom. Department of Urology, UCLH NHS Foundation Trust, London, UK.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom. Department of Urology, UCLH NHS Foundation Trust, London, UK.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom.Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. Department of Urology, Imperial College Healthcare NHS Trust, London, UK. Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom.Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. Department of Urology, Imperial College Healthcare NHS Trust, London, UK. Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom.Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.Department of Pathology, UCLH NHS Foundation Trust London, United Kingdom.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom. Department of Urology, UCLH NHS Foundation Trust, London, UK.Department of Radiology, UCLH NHS Foundation Trust, London, United Kingdom. Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom.Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom. Department of Urology, UCLH NHS Foundation Trust, London, UK.Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. Department of Urology, Imperial College Healthcare NHS Trust, London, UK. Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31733173

Citation

Eldred-Evans, David, et al. "The Added Value of Diffusion-weighted Images and Dynamic Contrast-enhancement in Multi-parametric MRI for the Detection of Clinically Significant Prostate Cancer in the PICTURE Trial." BJU International, 2019.
Eldred-Evans D, Neves JB, Simmons LAM, et al. The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial. BJU Int. 2019.
Eldred-Evans, D., Neves, J. B., Simmons, L. A. M., Kanthabalan, A., McCartan, N., Shah, T. T., ... Ahmed, H. U. (2019). The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial. BJU International, doi:10.1111/bju.14953.
Eldred-Evans D, et al. The Added Value of Diffusion-weighted Images and Dynamic Contrast-enhancement in Multi-parametric MRI for the Detection of Clinically Significant Prostate Cancer in the PICTURE Trial. BJU Int. 2019 Nov 16; PubMed PMID: 31733173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial. AU - Eldred-Evans,David, AU - Neves,Joana B, AU - Simmons,Lucy A M, AU - Kanthabalan,Abi, AU - McCartan,Neil, AU - Shah,Taimur T, AU - Arya,Manit, AU - Charman,Susan C, AU - Freeman,Alex, AU - Moore,Caroline M, AU - Punwani,Shonit, AU - Emberton,Mark, AU - Ahmed,Hashim U, Y1 - 2019/11/16/ PY - 2019/11/17/entrez PY - 2019/11/17/pubmed PY - 2019/11/17/medline JF - BJU international JO - BJU Int. N2 - OBJECTIVE: To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging in men requiring a repeat biopsy within the PICTURE study. PATIENTS AND METHODS: PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification following a previous non-MRI guided TRUS biopsy underwent a 3-Tesla mpMRI consisting of T2W, DWI and DCE followed by transperineal template prostate mapping (TPM) biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver operating characteristic (AUROC) fanalysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set as a LIKERT score >/=3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed Definition 1 (primary definition), UCL/Ahmed Definition 2, any Gleason >/=3+4 and any Gleason >/=4+3. RESULTS: Of 249, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W at AUROC 0.74 (95% CI 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82) and T2W+DWI+DCE at 0.77 (95% CI 0.71-0.82) (p=0.55). The AUROCs remained comparable using other definitions of clinically significant disease including UCL/Ahmed 2 (p=0.79), Gleason >/=3+4 (p=0.53) and Gleason >/=4+3 (p=0.53). CONCLUSIONS: Using a 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy. However, such a strategy can lead to a higher rate of equivocal lesions. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/31733173/The_added_value_of_diffusion-weighted_images_and_dynamic_contrast-enhancement_in_multi-parametric_MRI_for_the_detection_of_clinically_significant_prostate_cancer_in_the_PICTURE_trial L2 - https://doi.org/10.1111/bju.14953 DB - PRIME DP - Unbound Medicine ER -