Abstract
Purpose
PIRADS v2 stipulates that dynamic contrast-enhanced (DCE) imaging be used to categorize diffusion-weighted-imaging (DWI) score 3 (DWI 3) peripheral zone (PZ) lesions as PIRADS score 3 (PIRADS 3; DCE −) or PIRADS 4 (DCE +). It’s controversial for the value of DCE in improving clinically significant prostate cancer (csPCa) detection. We aimed to figure out whether DCE improves csPCa detection and explore new available measures to improve csPCa detection.
Patients and methods
We retrospectively enrolled 375 patients who underwent mp MRI before MRI/ultrasound (US) fusion-targeted biopsy (TB) with transperineal systematic biopsy (SB). All lesions were classified as DWI 3/DCE −, DWI 3/DCE +, DWI 4/PIRADS 4 lesions. Detection rates of csPCa for each lesion group were analyzed. The diagnostic performance of each approach was analyzed by receiver operating characteristics (ROC) analysis and decision curve analysis.
Results
Totally, 109 DWI 3 or DWI 4 single lesions in PZ were analyzed (n = 109). The rates of csPCa detection for Group A, Group B, Group C is 10.3%, 13.9%, 55.9%, respectively (A vs. B, p = 0.625; B vs. C, p < 0.001). ROC analysis and decision curve analysis showed the method of combining Age, PSA Density (PSAD) and the mean apparent diffusion coefficient value (ADCmean) outperforms individual approaches for csPCa detection.
Conclusion
For DWI 3 lesions in PZ, DCE sequence has not additional value for improving detection of csPCa. The integration of clinical characteristics and bpMRI parameter improves the detection of csPCa.
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Funding
This research was supported by the National Natural Science Foundation of China (ID: 81772710 and 81572519) and the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014)and National Natural Science Foundation of China (81802535), China postdoctoral fund(223427), Nanjing Medical Science and technique Development Foundation (YKK 18064).
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The institutional review board (IRB) approval was obtained and all patients were informed and signed consent. The study protocol was approved by the Ethics Committee of the Drum Tower Hospital (2017-147-01).
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Wang, B., Gao, J., Zhang, Q. et al. Investigating the equivalent performance of biparametric compared to multiparametric MRI in detection of clinically significant prostate cancer. Abdom Radiol 45, 547–555 (2020). https://doi.org/10.1007/s00261-019-02281-z
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DOI: https://doi.org/10.1007/s00261-019-02281-z