Abbreviated magnetic resonance imaging (aMRI) protocols have emerged as an alternative to multiparametric MRI (mpMRI) to reduce examination time and costs.
To compare multiple aMRI protocols for predicting pathological stage ≥T3 (≥pT3) prostate cancer (PCa).
One hundred and eight men undergoing staging mpMRI before radical prostatectomy (RP) were retrospectively evaluated. 3.0-T imaging was performed with a 32-channel surface coil and a protocol including diffusion-weighted imaging (DWI), transverse T2-weighted (tT2W) imaging, coronal T2W (cT2W) imaging, sagittal T2W (sT2) imaging, and dynamic contrast-enhanced (DCE) imaging. Two readers independently assessed whether any MRI observation showed stage ≥T3 on each sequence (reading order: DWI, cT2W, tT2W, sT2W, DCE). Final stage was assessed by matching readers' assignments to pathology, and combining them into eight protocols: DWI + tT2W, DWI + cT2W + tT2W, DWI + tT2W + sT2W, DWI + cT2W + tT2W + sT2W, DWI + tT2W + DCE, DWI + cT2W + tT2W + DCE, DWI + tT2W + sT2W + DCE, and mpMRI. Diagnostic accuracy and inter-reader agreement for aMRI protocols were calculated.
Prevalence of ≥pT3 PCa was 31.5%. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of aMRI protocols were comparable to mpMRI for R1. Sensitivity was 74.3% (95% confidence interval [CI] 64.8-72.0) to 77.1% (95% CI 67.9-84.4), and NPV 86.8% (95% CI 78.6-92.3) to 88.1% (95% CI 80.1-93.3). All accuracy measures of the various aMRI protocols were similar to mpMRI also for R2, albeit all slightly lower compared to R1. On a per-protocol basis, there was substantial inter-reader agreement in predicting stage ≥pT3 (k 0.63-0.67).
When comparing the diagnostic accuracy of multiple aMRI protocols against mpMRI for predicting stage ≥pT3 PCa, the protocol with the fewest sequences (DWI + tT2W) is apparently equivalent to standard mpMRI.
Acta radiologica (Stockholm, Sweden : 1987). 2020 Jul 27 [Epub ahead of print]
Gianluca Giannarini, Lorenzo Cereser, Giuseppe Como, Filippo Bonato, Stefano Pizzolitto, Claudio Valotto, Vincenzo Ficarra, Fabrizio Dal Moro, Chiara Zuiani, Rossano Girometti
Urology Unit, Academic Medical Centre "Santa Maria della Misericordia," Udine, Italy., Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia," Udine, Italy., Department of Medicine, University of Udine, Academic Medical Centre "Santa Maria della Misericordia," Udine, Italy., Pathology Unit, Academic Medical Centre "Santa Maria della Misericordia," Udine, Italy., Department of Human and Pediatric Pathology "Gaetano Barresi," Urologic Section, University of Messina, Messina, Italy., Urologic Clinic, University of Udine, Udine, Italy.