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Prospective comparison of a fast 1.5‐T biparametric with the 3.0‐T multiparametric ESUR magnetic resonance imaging protocol as a triage test for men at risk of prostate cancer
Author(s) -
Van Nieuwenhove Sandy,
Saussez Thibaud Pierre,
Thiry Sarah,
Trefois Pierre,
Annet Laurence,
Michoux Nicolas,
Lecouvet Frédéric,
Tombal Bertrand
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14538
Subject(s) - medicine , magnetic resonance imaging , prostate cancer , receiver operating characteristic , prostate , nuclear medicine , radiology , biopsy , gold standard (test) , area under the curve , prostate biopsy , diffusion mri , cancer
Objective To compare prospectively the diagnostic performance of a biparametric (T2‐weighted imaging [T2WI] and diffusion‐weighted imaging [ DWI ]) 1.5‐T fast magnetic resonance imaging ( fMRI ) protocol with the standard 3.0‐T multiparametric MRI (mp MRI ) protocol of the European Society of Urological Imaging ( ESUR ) in men referred for a prostate biopsy. Patients and Methods Ninety patients with a prostate cancer ( PC a) risk of ≥10% according to the SWOP calculator 4 underwent first fMRI and then the reference mp MRI . Patients with Prostate Imaging Reporting and Data System ( PI ‐ RADS ) v.2 lesions ≥3/5 on the mp MRI were scheduled for MRI /ultrasonography ( US ) fusion‐guided prostate biopsy. Performance of fMRI was assessed using receiver‐operating characteristic curve analysis and mp MRI as reference. Calculation of inter‐technique agreement on PI‐RADS v.2 score by Cohen's κ. Results The diagnostic accuracy of fMRI shown by the lesion‐based analysis was excellent: area under the curve ( AUC ) 0.961 ( P < 0.001), sensitivity 95%, specificity 97%, positive predictive value (PPV) 99%, negative predictive value (NPV) 89%. The patient‐based analysis showed an AUC for fMRI of 0.975 ( P < 0.001), a sensitivity of 98%, a specificity of 97%, a PPV of 98% and an NPV of 97%. Agreement on the PI ‐ RADS score between both protocols was found to be good (κ = 0.78 [0.57; 0.99]); f MRI missing PI ‐ RADS 4 lesions in three patients. Biopsy results showed no cancer in two patients (two cores per nodule) and Gleason 6 cancer in one patient. There was only one false‐positive fMRI , with a PI ‐ RADS score of 4, whose biopsy was negative. Conclusion In the triage of men with a high risk of PCa for prostate biopsy, an f MRI protocol (1.5‐T magnet, T2WI + DWI , <15 min) may safely replace the traditional ESUR 3.0‐T mp MRI protocol, saving time and contrast injection.