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Multiparametric Magnetic Resonance Imaging in Evaluation of Clinically Significant Prostate Cancer
Aim In this prospective study, we evaluate the role of multiparametric magnetic resonance imaging (mp-MRI) in the assessment of clinically significant prostate cancer at 1.5 T without endorectal coil (ERC).
Materials and Methods Forty-five men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] level > 4 ng/mL, hard prostate on digital rectal examination, and suspicious area at transrectal ultrasound [TRUS]) were evaluated using the mp-MRI protocol over a period of 24 months. All cases were interpreted using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines and correlated with histopathology.
Statistical Analysis Used A chi-squared test was used for analysis of nominal/categorical variables and receiver operating characteristic (ROC) curve and one-way analysis of variance (ANOVA) test for continuous variables.
Results The mean age was 67 years and the mean PSA was 38.2 ng/mL. Eighty percent had prostate cancer and 20% were benign (11% benign prostatic hyperplasia [BPH] and 9% chronic prostatitis). Eighty-six percent of all malignancies were in the peripheral zone. The PI-RADS score for T2-weighted (T2W) imaging showed good sensitivity (81%) but low specificity (67%). The PI-RADS score for diffusion weighted imaging (DWI) with sensitivity of 92% and specificity of 78% had a better accuracy overall than T2W imaging alone. The mean apparent diffusion coefficient (ADC) value (×10–6 mm2/s) was 732 ± 160 in prostate cancer, 1,009 ± 161 in chronic prostatitis, 1,142 ± 82 in BPH, and 663 in a single case of granulomatous prostatitis. Low ADC values (<936) have shown good correlation (area under curve [AUC]: 0.87) with the presence of cancer foci. Inverse correlation was observed between Gleason scores and ADC values. Dynamic contrast-enhanced (DCE) imaging has shown 100% sensitivity/negative predictive value (NPV), but moderate specificity (67%) in predicting malignancy. The final PI-RADS score had 100% sensitivity and NPV with good overall positive predictive value (PPV) of 95%.
Conclusions T2W imaging and DWI remain the mainstays in diagnosis of prostate cancer with mp-MRI. DCE-MRI can be a problem-solving tool in case of equivocal findings. Because assessment with mp-MRI can be subjective, use of the newly developed PI-RADS version 2 scoring system is helpful in accurate interpretation.
KeywordsDCE-MRI - diffusion weighted Imaging - mp-MRI - multiparametric MRI - PI-RADS - prostate cancer
23 May 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Rawla P. Epidemiology of prostate cancer. World J Oncol 2019; 10 (02) 63-89
- 2 Popat PB, Maheshwari S, Sable NP, Thakur M, Katdare A. Multiparametric MRI approach to prostate cancer with a pictorial essay on PI-RADS. J Soc Gastrointest Abdom Radiol 2019; 2: 4-17
- 3 Stabile A, Giganti F, Rosenkrantz AB. et al. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020; 17 (01) 41-61
- 4 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127 (12) 2893-2917
- 5 Notani PN. Global variation in cancer incidence and mortality. Curr Sci 2001; 81 (05) 465-474
- 6 Jain S, Saxena S, Kumar A. Epidemiology of prostate cancer in India. Meta Gene 2014; 2: 596-605
- 7 American Cancer Society. Cancer Facts & Figures. Atlanta, GA: American Cancer Society 2016
- 8 Mettlin CJ, Black B, Lee F, Littrup PJ, DuPont A, Babaian R. Workgroup #2: screening and detection. Reference range/clinical issues of PSA. Cancer 1993; 71 (08) 2679-2680
- 9 Partin AW, Kattan MW, Subong EN. et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 1997; 277 (18) 1445-1451
- 10 Catalona WJ, Smith DS, Ratliff TL. et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991; 324 (17) 1156-1161
- 11 Cornud F, Hamida K, Flam T. et al. Endorectal color Doppler sonography and endorectal MR imaging features of nonpalpable prostate cancer: correlation with radical prostatectomy findings. AJR Am J Roentgenol 2000; 175 (04) 1161-1168
- 12 Smith Jr JA, Scardino PT, Resnick MI, Hernandez AD, Rose SC, Egger MJ. Transrectal ultrasound versus digital rectal examination for the staging of carcinoma of the prostate: results of a prospective, multi-institutional trial. J Urol 1997; 157 (03) 902-906
- 13 Brock M, von Bodman C, Sommerer F. et al. Comparison of real-time elastography with grey-scale ultrasonography for detection of organ-confined prostate cancer and extra capsular extension: a prospective analysis using whole mount sections after radical prostatectomy. BJU Int 2011; 108 (08/02) E217-E222
- 14 Wefer AE, Hricak H, Vigneron DB. et al. Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol 2000; 164 (02) 400-404
- 15 Salomon L, Colombel M, Patard JJ. et al. Value of ultrasound-guided systematic sextant biopsies in prostate tumor mapping. Eur Urol 1999; 35 (04) 289-293
- 16 Stamey TA, McNeal JE. Adenocarcinoma of the prostate. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, Jr, eds. Campbell’s Urology. 19th ed. Philadelphia, PA: WB Saunders 1992. 1181.
- 17 Fowler Jr JE, Condon MA, Terrell FL. Cancer diagnosis with prostate specific antigen greater than 10 ng./ml. and negative peripheral zone prostate biopsy. J Urol 1996; 156 (04) 1370-1374
- 18 Obek C, Louis P, Civantos F, Soloway MS. Comparison of digital rectal examination and biopsy results with the radical prostatectomy specimen. J Urol 1999; 161 (02) 494-498, discussion 498–499
- 19 Peller PA, Young DC, Marmaduke DP, Marsh WL, Badalament RA. Sextant prostate biopsies. A histopathologic correlation with radical prostatectomy specimens. Cancer 1995; 75 (02) 530-538
- 20 Hricak H, Williams RD, Spring DB. et al. Anatomy and pathology of the male pelvis by magnetic resonance imaging. AJR Am J Roentgenol 1983; 141 (06) 1101-1110
- 21 Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics 2011; 31 (03) 677-703
- 22 Ravizzini G, Turkbey B, Kurdziel K, Choyke PL. New horizons in prostate cancer imaging. Eur J Radiol 2009; 70 (02) 212-226
- 23 Cruz M, Tsuda K, Narumi Y. et al. Characterization of low-intensity lesions in the peripheral zone of prostate on pre-biopsy endorectal coil MR imaging. Eur Radiol 2002; 12 (02) 357-365
- 24 Kim B, Kawashima A, Ryu JA. Takahashi N, Hartman RP, King BF Jr. Imaging of the seminal vesicle and vas deferens. Radiographics 2009; 29 (04) 1105-1121
- 25 Taha Ali TF, ElHariri MA, Riad MM. Diffusion-weighted MRI in prostatic lesions: diagnostic performance of normalized ADC using normal peripheral prostatic zone as a reference. Egypt J Radiol Nucl Med 2018; 49: 239-244
- 26 Yamamura J, Salomon G, Buchert R. et al. Magnetic resonance imaging of prostate cancer: diffusion-weighted imaging in comparison with sextant biopsy. J Comput Assist Tomogr 2011; 35 (02) 223-228
- 27 Anwar SS, Anwar Khan Z, Shoaib Hamid R. et al. Assessment of apparent diffusion coefficient values as predictor of aggressiveness in peripheral zone prostate cancer: comparison with Gleason score. ISRN Radiol 2014; 2014: 263417
- 28 Kim JK, Hong SS, Choi YJ. et al. Wash-in rate on the basis of dynamic contrast-enhanced MRI: usefulness for prostate cancer detection and localization. J Magn Reson Imaging 2005; 22 (05) 639-646
- 29 Ghai S, Haider MA. Multiparametric-MRI in diagnosis of prostate cancer. Indian J Urol 2015; 31 (03) 194-201
- 30 van Dorsten FA, van der Graaf M, Engelbrecht MRW. et al. Combined quantitative dynamic contrast-enhanced MR imaging and (1)H MR spectroscopic imaging of human prostate cancer. J Magn Reson Imaging 2004; 20 (02) 279-287
- 31 Barentsz JO, Richenberg J, Clements R. et al. European Society of Urogenital Radiology. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22 (04) 746-757
- 32 de Rooij M, Hamoen EHJ, Fütterer JJ, Barentsz JO, Rovers MM. Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis. AJR Am J Roentgenol 2014; 202 (02) 343-351
- 33 Abd-Alazeez M, Ahmed HU, Arya M. et al. The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level: can it rule out clinically significant prostate cancer?. Urol Oncol 2014; 32 (01) 45.e17-45.e22
- 34 Itatani R, Namimoto T, Atsuji S. et al. Negative predictive value of multiparametric MRI for prostate cancer detection: outcome of 5-year follow-up in men with negative findings on initial MRI studies. Eur J Radiol 2014; 83 (10) 1740-1745
- 35 Hamoen EHJ, de M Rooij, Witjes JA, Barentsz JO, Rovers MM. Use of the prostate imaging reporting and data system (Pi-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol 2015; 67 (06) 1112-1121
- 36 American College of Radiology. PI-RADS TM Prostate Imaging: Reporting and Data System. 2015. Available at: https://www.acr.org/-/media/ACR/Files/RADS/ PI-RADS/PIRADS-V2.pdf. Accessed December 28, 2020
- 37 Engels RR, Israël B, Padhani AR, Barentsz JO. Multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer: What urologists need to know. Part 1: acquisition. Eur Urol 2020; 77 (04) 457-468
- 38 Weinreb JC, Barentsz JO, Choyke PL. et al. PI-RADS Prostate Imaging-Reporting and Data System: 2015, Version 2. Eur Urol 2016; 69 (01) 16-40
- 39 Fusco R, Sansone M, Granata V, Setola SV, Petrillo A. A systematic review on multiparametric MR imaging in prostate cancer detection. Infect Agent Cancer 2017; 12: 57
- 41 Fütterer JJ, Barentsz JO, Heijmink SWTPJ. Value of 3-T magnetic resonance imaging in local staging of prostate cancer. Top Magn Reson Imaging 2008; 19 (06) 285-289
- 42 Bour L, Schull A, Delongchamps NB. et al. Multiparametric MRI features of granulomatous prostatitis and tubercular prostate abscess. Diagn Interv Imaging 2013; 94 (01) 84-90
- 43 Zelhof B, Pickles M, Liney G. et al. Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer. BJU Int 2009; 103 (07) 883-888
- 44 Pickles MD, Gibbs P, Sreenivas M, Turnbull LW. Diffusion-weighted imaging of normal and malignant prostate tissue at 3.0T. J Magn Reson Imaging 2006; 23 (02) 130-134
- 45 Itou Y, Nakanishi K, Narumi Y, Nishizawa Y, Tsukuma H. Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer?. J Magn Reson Imaging 2011; 33 (01) 167-172
- 46 Turkbey B, Shah VP, Pang Y. et al. Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images?. Radiology 2011; 258 (02) 488-495
- 47 McNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 1988; 12 (12) 897-906
- 48 Gibbs P, Pickles MD, Turnbull LW. Diffusion imaging of the prostate at 3.0 tesla. Invest Radiol 2006; 41 (02) 185-188
- 49 Kim JH, Kim JK, Park BW, Kim N, Cho KS. Apparent diffusion coefficient: prostate cancer versus noncancerous tissue according to anatomical region. J Magn Reson Imaging 2008; 28 (05) 1173-1179
- 50 Verma S, Turkbey B, Muradyan N. et al. Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol 2012; 198 (06) 1277-1288
- 51 Cirillo S, Petracchini M, Della Monica P. et al. Value of endorectal MRI and MRS in patients with elevated prostate-specific antigen levels and previous negative biopsies to localize peripheral zone tumours. Clin Radiol 2008; 63 (08) 871-879