Comparison of biparametric MRI to full multiparametric MRI for detection of clinically significant prostate cancer

• Published in: Prostate cancer and prostatic diseases 2019-05, Vol.22 (2), p.331-336
• Main Authors: Sherrer, Rachael L., Glaser, Zachary A., Gordetsky, Jennifer B., Nix, Jeffrey W., Porter, Kristin K., Rais-Bahrami, Soroush
• Format: Article
• Language: English
• Subjects: 692/308/53/2421; 692/53/2421; 692/699/67/589/466; Adult; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Biopsy; Cancer diagnosis; Cancer Research; Carcinoma; Care and treatment; Clinical significance; Diagnosis; Diagnostic imaging; Diagnostic systems; Diffusion Magnetic Resonance Imaging - methods; Diffusion rate; Field of view; Health risks; Humans; Image-Guided Biopsy; Lesions; Magnetic resonance imaging; Male; Medical imaging; Middle Aged; Multiparametric Magnetic Resonance Imaging - methods; NMR; Nuclear magnetic resonance; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retirement benefits; Ultrasonography; Ultrasound
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-018-0107-0

Background Multiparametric magnetic resonance imaging (MP-MRI) and MRI/ultrasound (US) fusion-guided biopsy are becoming more widely used techniques for prostate cancer (PCa) diagnosis and management. However, their widespread adoption and use, where available, are limited by cost and added time. These limitations could be minimized if a biparametric MRI (BP-MRI) focusing on T2-weighted and diffusion-weighted imaging is performed. Herein we report the cancer detection rate of BP-MRI compared with full MP-MRI. Methods Biopsy-naive and prior negative biopsy patients with clinical suspicion for PCa underwent MP-MRI with an imaging protocol incorporating narrow field-of-view T2-weighted, diffusion-weighted, and DCE pelvic MRI. Then patients underwent MRI/US fusion-guided biopsy of target lesions between November 2013 and October 2017. The pathology results were compared to the positivity of the DCE sequence compared to the BP-MRI findings alone. Results There were 648 targeted lesions biopsied in 344 patients. We defined biparametric screen filter positivity as both T2-weighted and diffusion-weighted imaging positivity for the same lesion. The majority of target lesions (552/648, 85%) were screen filter positive. For those that were screen filter negative, a minority (14/96, 15%) had DCE-positive findings. Of these, 2/3 (67%) cancer-positive cases were seen on T2-weighted imaging. For those 82 that were screen filter negative and DCE negative, the DCE phase would not have added imaging suspicion. Only 3/82 (3.7%) were cancer positive; 2 with low risk, grade group 1 cancer and 1 with intraductal carcinoma, all identified on targeted T2-weighted MRI positivity. Conclusions BP-MRI for the evaluation of PCa and for guiding MRI/US fusion-targeted biopsy has the advantages of reducing cost, time, and contrast exposure of MP-MRI by eliminating the DCE phase. These benefits are realized without forfeiting valuable diagnostic information, as shown by similar cancer detection rates of BP-MRI and MP-MRI in this study, particularly for clinically significant cases of PCa.