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Investigating the Role of DCE-MRI, over T2 and DWI, in accurate PI-RADS v2 Assessment of Clinically Significant Peripheral Zone Prostate Lesions as Defined at Radical Prostatectomy

Institution:
1Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
2Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Publisher:
Springer
Publication Date:
Oct-2018
Journal:
Abdom Radiol (NY)
Citation:
Abdom Radiol (NY). 2018 Oct 25.
PubMed ID:
30361870
Keywords:
DCE-MRI, DWI, PI-RADS v2, Prostate
Appears in Collections:
NCIGT, SPL
Sponsors:
U01 CA151261/National Institutes of Health/
P41 EB015898/National Institutes of Health/
R25 CA89017/National Institutes of Health/
DPH403516/Massachusetts Department of Public Health/
Generated Citation:
Taghipour M., Ziaei A., Alessandrino F., Hassanzadeh E., Harisinghani M., Vangel M., Tempany C.M., Fennessy F.M. Investigating the Role of DCE-MRI, over T2 and DWI, in accurate PI-RADS v2 Assessment of Clinically Significant Peripheral Zone Prostate Lesions as Defined at Radical Prostatectomy. Abdom Radiol (NY). 2018 Oct 25. PMID: 30361870.
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PURPOSE: PI-RADS v2 dictates that dynamic contrast-enhanced (DCE) imaging be used to further classify peripheral zone (PZ) cases that receive a diffusion-weighted imaging equivocal score of three (DWI3), a positive DCE resulting in an increase in overall assessment score to a four, indicative of clinically significant prostate cancer (csPCa). However, the accuracy of DCE in predicting csPCa in DWI3 PZ cases is unknown. This study sought to determine the frequency with which DCE changes the PI-RADS v2 DWI3 assessment category, and to determine the overall accuracy of DCE-MRI in equivocal PZ DWI3 lesions. MATERIALS AND METHODS: This is a retrospective study of patients with pathologically proven PCa who underwent prostate mpMRI at 3T and subsequent radical prostatectomy. PI-RADS v2 assessment categories were determined by a radiologist, aware of a diagnosis of PCa, but blinded to final pathology. csPCa was defined as a Gleason score ≥ 7 or extra prostatic extension at pathology review. Performance characteristics and diagnostic accuracy of DCE in assigning a csPCa assessment in PZ lesions were calculated. RESULTS: A total of 271 men with mean age of 59 ± 6 years mean PSA 6.7 ng/mL were included. csPCa was found in 212/271 (78.2%) cases at pathology, 209 of which were localized in the PZ. DCE was necessary to further classify (45/209) of patients who received a score of DWI3. DCE was positive in 29/45 cases, increasing the final PI-RADS v2 assessment category to a category 4, with 16/45 having a negative DCE. When compared with final pathology, DCE was correct in increasing the assessment category in 68.9% ± 7% (31/45) of DWI3 cases. CONCLUSION: DCE increases the accuracy of detection of csPCa in the majority of PZ lesions that receive an equivocal PI-RADS v2 assessment category using DWI.