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The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial

Eldred-Evans, D; Neves, JB; Simmons, LAM; Kanthabalan, A; McCartan, N; Shah, TT; Arya, M; ... Ahmed, HU; + view all (2020) The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial. BJU International , 125 (3) pp. 391-398. 10.1111/bju.14953.

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Abstract

Objective: To determine the additional diagnostic value of diffusion‐weighted imaging (DWI) and dynamic contrast‐enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. Patients and Methods: PICTURE was a paired‐cohort confirmatory study in which 249 men who required further risk stratification after a previous non‐magnetic resonance imaging (MRI)‐guided transrectal ultrasonography‐guided biopsy underwent a 3‐Tesla (3T) multiparametic (mp)MRI consisting of T2‐weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver‐operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. Results: Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68–0.80), T2W+DWI at 0.76 (95% CI 0.71–0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71–0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). Conclusions: Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions.

Type: Article
Title: The added value of diffusion-weighted images and dynamic contrast-enhancement in multi-parametric MRI for the detection of clinically significant prostate cancer in the PICTURE trial
DOI: 10.1111/bju.14953
Publisher version: https://doi.org/10.1111/bju.14953
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: transperineal template prostate mapping, biopsy biparametric, MRI prostate cancer, diffusion‐weighted imaging, dynamic contrast enhancement #PCSM, #ProstateCancer
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Metabolism and Experi Therapeutics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10086206
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