The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study


Autoři: Ilinca Cosma aff001;  Cornelia Tennstedt-Schenk aff003;  Sven Winzler aff002;  Marios Nikos Psychogios aff004;  Alexander Pfeil aff005;  Ulf Teichgraeber aff001;  Ansgar Malich aff002;  Ismini Papageorgiou aff001
Působiště autorů: Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany aff001;  Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany aff002;  Institute for Pathology, Muehlhausen, Germany aff003;  Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland aff004;  Department of Internal Medicine, University Hospital Jena, Jena, Germany aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227031

Souhrn

Objective

Prostate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).

Materials and methods

The study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.

Results

Significant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.

Conclusion

DCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

Klíčová slova:

Biopsy – Cancer detection and diagnosis – Diffusion weighted imaging – Chi square tests – Lesions – Magnetic resonance imaging – Prostate cancer – Prostate gland


Zdroje

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