National guidelines recommend prostate multiparametric (mp) MRI in men with suspected prostate cancer before biopsy. In this study, we explore prostate mpMRI protocols across 14 London hospitals and determine whether standardisation improves diagnostic quality.
An MRI physicist facilitated mpMRI set-up across several regional hospitals, working together with experienced uroradiologists who judged diagnostic quality. Radiologists from the 14 hospitals participated in the assessment and optimisation of prostate mpMRI image quality, assessed according to both PiRADSv2 recommendations and on the ability to "rule in" and/or "rule out" prostate cancer. Image quality and sequence parameters of representative mpMRI scans were evaluated across 23 MR scanners. Optimisation visits were performed to improve image quality, and 2 radiologists scored the image quality pre- and post-optimisation.
20/23 mpMRI protocols, consisting of 111 sequences, were optimised by modifying their sequence parameters. Pre-optimisation, only 15% of T2W images were non-diagnostic, whereas 40% of ADC maps, 50% of high b-value DWI and 41% of DCE-MRI were considered non-diagnostic. Post-optimisation, the scores were increased with 80% of ADC maps, 74% of high b-value DWI and 88% of DCE-MRI to be partially or fully diagnostic. T2W sequences were not optimised, due to their higher baseline quality scores.
Targeted intervention at a regional level can improve the diagnostic quality of prostate mpMRI protocols, with implications for improving prostate cancer detection rates and targeted biopsies.
Insights into imaging. 2021 Apr 20*** epublish ***
Marianthi-Vasiliki Papoutsaki, Clare Allen, Francesco Giganti, David Atkinson, Louise Dickinson, Jacob Goodman, Helen Saunders, Tristan Barrett, Shonit Punwani
Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Department of Radiology, University College London Hospital NHS Foundation Trust, Euston Road, London, WC1H 8NJ, UK., North East London Cancer Alliance, Tower Hamlets CCG, London, E1 4DG, UK., North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK., Department of Radiology, School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, UK., Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK. .