Arumainayagam, N; (2015) Multi-parametric magnetic resonance imaging in the diagnosis of prostate cancer. Doctoral thesis , UCL (University College London).

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Abstract

Introduction Multi-parametric magnetic resonance imaging (mp-MRI) has shown promise in the detection of prostate cancer. The purpose of this thesis was to evaluate the diagnostic performance of mp-MRI for prostate cancer detection by using transperineal prostate mapping (TPM) biopsies as the reference standard in men who had previous external beam radiotherapy and men who had not had any previous treatment. Methods Mp-MRI was performed on 13 men with previous external beam radiotherapy treatment for localised prostate cancer and 64 men who had not had any previous treatment. Mp-MRI included T2-weighted, dynamic contrast enhanced and diffusion weighted imaging sequences, using a 1.5T magnet and a pelvic phased-array coil. All men in these studies then underwent TPM biopsies. Two radiologists reported on the 13 mp-MRI scans in the previous radiotherapy treated population, using 4 sectors (quadrant) analysis, and an additional radiologist (total of three) reported on the 64 mp-MRI scans in the previously untreated group. Mp-MRI reports used a Likert scoring system to quantify the degree of suspicion of cancer being present in a given quadrant. The diagnostic accuracy of mp-MRI was evaluated at varying thresholds of cancer for both groups. Results In the post-radiotherapy group overall accuracy was 0.77 – 0.89 for all cancer and 0.86 – 0.93 when only cancer with ≥ 3mm biopsy core length was considered significant. In the treatment naïve group for the primary endpoint definition of clinically significant cancer (Gleason ≥ 3+4 and / or any cancer core length ≥ 4mm) accuracy values were 58-73% (sensitivity), 71-84% (specificity), 49-63% (positive predictive value), 84-89% (negative predictive value), 2.0 - 3.44 (positive likelihood ratio) and 0.3 - 0.5 (negative likelihood ratio). Overall accuracy values (area under receiver operator characteristic curves) were 0.73 – 0.84. Conclusions Mp-MRI can help identify and rule out clinically significant prostate cancer both in treatment naïve and post-radiotherapy prostate glands.

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