Abstract
Aim
To evaluate the accuracy of a T2-weighted (T2w) – and a parallel transmit zoomed b = 2000 s/mm2 (b2000) – diffusion-weighted imaging sequence among three readers with different degrees of experience for prostate cancer (Pca) detection.
Methods
Ninety-three patients with suspected Pca were enrolled. For b2000 a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory was applied, and the field of view (FOV) was reduced to one-third. All three readers (Reader A: 7, B 4 and C <1 years of experience in prostate MRI) independently evaluated b2000 with regard to the presence of suspicious lesions that displayed increased signal. The results were compared to histopathology obtained by real-time MR/ultrasound fusion and systematic biopsy.
Results
In 62 patients Pca was confirmed. One significant Pca (Gleason score (GS) 7b) was missed by Reader C. Overall, sensitivity/specificity/positive predictive value/negative predictive value were 90/71/86/79% for Reader A, 87/84/92/76% for Reader B and 85/74/87/72% for Reader C, respectively. Detection rates for significant Pca (GS >7a) were 100/100/94% for Readers A/B/C, respectively. Inter-reader agreement was generally good (Kappa A/B: 0.8; A/C: 0.82; B/C: 0.74).
Conclusion
B2000 in combination with a T2w could be useful to detect clinically significant Pca.
Key Points
• Significant prostate cancer using zoomed ultra-high b-value DWI was detected.
• Diagnostic performance among readers with different degrees of experience was good.
• mp- MRI of the prostate using a comprehensive non-contrast protocol is clinically feasible.
Similar content being viewed by others
Abbreviations
- ADC:
-
Apparent diffusion coefficient
- DWI:
-
Diffusion-weighted imaging
- DCE:
-
Dynamic contrast-enhanced imaging
- ET:
-
Echo time
- FOV:
-
Field of view
- GS:
-
Gleason score
- HIFU:
-
High intensity focused ultrasound
- mp:
-
Multiparametric
- NPV:
-
Negative predictive value
- b2000:
-
Parallel transmit zoomed b = 2000 s/mm2 -sequence
- PPV:
-
Positive predictive value
- Pca:
-
Prostate cancer
- PI-RADS:
-
v2 Prostate imaging reporting and data system version 2
- PSA:
-
Prostate specific antigen (PSA)
- SS:
-
Sensitivity
- SI:
-
Signal-intensity
- SNR:
-
Signal-to-noise ratio
- SP:
-
Specificity
- T2w:
-
T2-weighted
- TRUS:
-
Transrectal ultrasound
- US:
-
Ultrasound
References
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T et al (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137
Cerantola Y, Dragomir A, Tanguay S, Bladou F, Aprikian A, Kassouf W (2016) Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. Urol Oncol 34:119 e1–9
Rosenkrantz AB, Lim RP, Haghighi M, Somberg MB, Babb JS, Taneja SS (2013) Comparison of interreader reproducibility of the prostate imaging reporting and data system and likert scales for evaluation of multiparametric prostate MRI. AJR Am J Roentgenol 201:W612–W618
Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757
Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F et al (2016) Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. Eur Urol 69:41–49
Vargas HA, Hotker AM, Goldman DA, Moskowitz CS, Gondo T, Matsumoto K, Ehdaie B, Woo S, Fine SW, Reuter VE, Sala E, Hricak H (2016) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 26(6):1606–1612
Weberling LD, Kieslich PJ, Kickingereder P, Wick W, Bendszus M, Schlemmer HP et al (2015) Increased signal intensity in the dentate nucleus on unenhanced T1-weighted images after gadobenate dimeglumine administration. Investig Radiol 50:743–748
Radbruch A, Weberling LD, Kieslich PJ, Hepp J, Kickingereder P, Wick W et al (2015) High-signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evaluation of the macrocyclic gadolinium-based contrast agent gadobutrol. Investig Radiol 50:805–810
Radbruch A, Weberling LD, Kieslich PJ, Eidel O, Burth S, Kickingereder P et al (2015) Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology 275:783–791
Wetter A, Nensa F, Lipponer C, Guberina N, Olbricht T, Schenck M et al (2015) High and ultra-high b-value diffusion-weighted imaging in prostate cancer: a quantitative analysis. Acta Radiol 56:1009–1015
Katahira K, Takahara T, Kwee TC, Oda S, Suzuki Y, Morishita S et al (2011) Ultra-high-b-value diffusion-weighted MR imaging for the detection of prostate cancer: evaluation in 201 cases with histopathological correlation. Eur Radiol 21:188–196
Bittencourt LK, Attenberger UI, Lima D, Strecker R, de Oliveira A, Schoenberg SO et al (2014) Feasibility study of computed vs measured high b-value (1400 s/mm(2)) diffusion-weighted MR images of the prostate. World J Radiol 6:374–380
Riffel P, Michaely HJ, Morelli JN, Pfeuffer J, Attenberger UI, Schoenberg SO et al (2014) Zoomed EPI-DWI of the pancreas using two-dimensional spatially-selective radiofrequency excitation pulses. PLoS One 9, e89468
Riffel P, Michaely HJ, Morelli JN, Pfeuffer J, Attenberger UI, Schoenberg SO et al (2014) Zoomed EPI-DWI of the head and neck with two-dimensional, spatially-selective radiofrequency excitation pulses. Eur Radiol 24:2507–2512
Attenberger UI, Rathmann N, Sertdemir M, Riffel P, Weidner A, Kannengiesser S, Morelli JN, Schoenberg SO, Hausmann D (2016) Small field-of-view single-shot EPI-DWI of the prostate: Evaluation of spatially-tailored two-dimensional radiofrequency excitation pulses. Z Med Phys 26(2):168–176
Thierfelder KM, Scherr MK, Notohamiprodjo M, Weiss J, Dietrich O, Mueller-Lisse UG et al (2014) Diffusion-weighted MRI of the prostate: advantages of Zoomed EPI with parallel-transmit-accelerated 2D-selective excitation imaging. Eur Radiol 24:3233–3241
Jambor I, Kahkonen E, Taimen P, Merisaari H, Saunavaara J, Alanen K et al (2015) Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy. J Magn Reson Imaging: JMRI 41:1394–1404
Ghai S, Louis AS, Van Vliet M, Lindner U, Haider MA, Hlasny E et al (2015) Real-time MRI-guided focused ultrasound for focal therapy of locally confined low-risk prostate cancer: feasibility and preliminary outcomes. AJR Am J Roentgenol 205:W177–W184
Moore CM, Kasivisvanathan V, Eggener S, Emberton M, Futterer JJ, Gill IS et al (2013) Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 64:544–552
Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822
Stark JR, Perner S, Stampfer MJ, Sinnott JA, Finn S, Eisenstein AS et al (2009) Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol 27:3459–3464
Cash H, Gunzel K, Maxeiner A, Stephan C, Fischer T, Durmus T, Miller K, Asbach P, Haas M, Kempkensteffen C (2016) Prostate cancer detection on transrectal ultrasonography-guided random biopsy despite negative real-time magnetic resonance imaging/ultrasonography fusion-guided targeted biopsy: reasons for targeted biopsy failure. BJU Int 118(1):35–43
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA et al (2016) The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol 40:244–252
Futterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A et al (2015) Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. Eur Urol 68:1045–1053
Hoeks CM, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SW et al (2011) Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 261:46–66
Scheenen TW, Rosenkrantz AB, Haider MA, Futterer JJ (2015) Multiparametric magnetic resonance imaging in prostate cancer management: current status and future perspectives. Investig Radiol 50:594–600
Schouten MG, Hoeks CM, Bomers JG (2015) Hulsbergen-van de Kaa CA, Witjes JA, Thompson LC, et al. Location of prostate cancers determined by multiparametric and MRI-guided biopsy in patients with elevated prostate-specific antigen level and at least one negative transrectal ultrasound-guided biopsy. AJR Am J Roentgenol 205:57–63
Turkbey B, Pinto PA, Mani H, Bernardo M, Pang Y, McKinney YL et al (2010) Prostate cancer: value of multiparametric MR imaging at 3 T for detection – histopathologic correlation. Radiology 255:89–99
Woodfield CA, Tung GA, Grand DJ, Pezzullo JA, Machan JT, 2nd Renzulli JF (2010) Diffusion-weighted MRI of peripheral zone prostate cancer: comparison of tumor apparent diffusion coefficient with Gleason score and percentage of tumor on core biopsy. AJR Am J Roentgenol 194:W316–W322
Turkbey B, Shah VP, Pang Y, Bernardo M, Xu S, Kruecker J et al (2011) Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? Radiology 258:488–495
Itou Y, Nakanishi K, Narumi Y, Nishizawa Y, Tsukuma H (2011) Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer? J Magn Reson Imaging: JMRI 33:167–172
Hoeks CM, Futterer JJ, Somford DM, van Oort IM, Huisman H, Barentsz JO (2009) Multiparametric MRI for prostate cancer screening. Ned Tijdschr Geneeskd 153:B487
Agarwal HK, Mertan FV, Sankineni S, Bernardo M, Senegas J, Keupp J et al (2017) Optimal high b-value for diffusion weighted MRI in diagnosing high risk prostate cancers in the peripheral zone. J Magn Reson Imaging 45:125–131
Maas MC, Futterer JJ, Scheenen TW (2013) Quantitative evaluation of computed high B value diffusion-weighted magnetic resonance imaging of the prostate. Invest Radiol 48:779–786
Bloch BN, Furman-Haran E, Helbich TH, Lenkinski RE, Degani H, Kratzik C et al (2007) Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging – initial results. Radiology 245:176–185
Futterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P et al (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241:449–458
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Prof. Dr. med. Stefan Schönberg.
Conflict of interest
The authors of this manuscript declare research agreements with Siemens Healthcare.
Funding
The authors state that this work has not received any funding.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was waived by the Institutional Review Board.
Ethical approval
Institutional Review Board approval was obtained.
Methodology
• retrospective
• diagnostic or prognostic study
• performed at one institution
Rights and permissions
About this article
Cite this article
Hausmann, D., Aksöz, N., von Hardenberg, J. et al. Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer?. Eur Radiol 28, 869–876 (2018). https://doi.org/10.1007/s00330-017-5004-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-017-5004-8