Purpose To evaluate the use of an automated hybrid multidimensional MRI (HM-MRI)-based tool to prospectively identify prostate cancer targets before MRI/US fusion biopsy in comparison with Prostate Imaging and Reporting Data System (PI-RADS)-based multiparametric MRI (mpMRI) evaluation by expert radiologists. Materials and Methods In this prospective clinical trial (ClinicalTrials.gov registration no. NCT03585660), 91 male participants (mean age, 65 years ± 8 [SD]) with known or suspected prostate cancer underwent 3-T MRI with a conventional mpMRI protocol and HM-MRI followed by subsequent biopsy between August 2018 and March 2023. Using the HM-MRI tool, tissue composition was calculated using a three-compartment model, and suspected prostate cancer regions with elevated epithelium (>40%) and reduced lumen (<20%) meeting the minimum size requirement of 25 mm2 were identified. Up to two additional biopsy targets per participant were automatically selected with the HM-MRI tool in addition to the biopsy targets selected based on an expert radiologist's mpMRI interpretation (≥PI-RADS 3) using an MRI/US fusion biopsy device. Additional 12-core transrectal US-guided sextant random biopsy cores were also obtained. Detection of clinically significant prostate cancer (≥Gleason 3+4) was compared between HM-MRI and mpMRI by calculating area under the receiver operating characteristic curve and diagnostic accuracy metrics. Results The diagnostic performance of HM-MRI was either higher than mpMRI or showed no evidence of a difference when compared with mpMRI. On a per-participant basis, HM-MRI had significantly higher accuracy (55% vs 44%; P = .02) and specificity (36% vs 14%: P = .002) than mpMRI. On a per-lesion basis, HM-MRI had significantly higher accuracy (58% vs 39%; P < .001) and positive predictive value (31% vs 22%; P = .004) compared with mpMRI. Only one lesion was missed when using the combination of mpMRI and HM-MRI. On a per-sextant basis, HM-MRI showed significantly better performance than mpMRI for all metrics, including primary end points of the area under the receiver operating characteristic curve (0.76 vs 0.65; P < .001) and accuracy (83.9% vs 79.0%; P = .006). Conclusion This study demonstrates that HM-MRI has the potential to improve MRI/US fusion biopsy results for prostate cancer detection by providing complementary information to PI-RADS-based evaluation by expert radiologists. Keywords: Prostate Cancer, Hybrid Multidimensional MRI, Multiparametric MRI, PI-RADS Clinical trial registration no. NCT03585660 ©RSNA, 2025.
Radiology. Imaging cancer. 2025 Jan [Epub]
Aritrick Chatterjee, Ambereen N Yousuf, Roger Engelmann, Carla Harmath, Grace Lee, Milica Medved, Ernest B Jamison, Abel Lorente Campos, Batuhan Gundogdu, Glenn Gerber, Luke F Reynolds, Parth K Modi, Tatjana Antic, Mihai Giurcanu, Scott Eggener, Gregory S Karczmar, Aytekin Oto
From the Department of Radiology (A.C., A.N.Y., R.E., C.H., G.L., M.M., E.B.J., A.L.C., B.G., G.S.K., A.O.), Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy (A.C., A.N.Y., M.M., A.L.C., B.G.), Department of Surgery, Section of Urology (G.G., L.F.R., P.K.M., S.E.), Department of Pathology (T.A.), and Department of Public Health Sciences (M.G.), University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637.