TY - JOUR
T1 - Population net benefit of prostate MRI with high spatiotemporal resolution contrast-enhanced imaging
T2 - A decision curve analysis
AU - Prabhu, Vinay
AU - Rosenkrantz, Andrew B.
AU - Otazo, Ricardo
AU - Sodickson, Daniel K.
AU - Kang, Stella K.
N1 - Funding Information:
Dr. Kang is supported by Award Number K07CA197134 from the National Cancer Institute (P.I. Stella Kang, MD, MSc). Andrew B. Rosenkrantz received royalties from Thieme Medical Publishers. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
Publisher Copyright:
© 2019 International Society for Magnetic Resonance in Medicine
PY - 2019/5
Y1 - 2019/5
N2 - Background: The value of dynamic contrast-enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial. Purpose: To evaluate the population net benefit of risk stratification using DCE-MRI for detection of high-grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging. Study Type: Decision curve analysis. Population: Previously published patient studies on MRI for HGPCA detection, one using DCE with golden-angle radial sparse parallel (GRASP) images and the other using standard DCE-MRI. Field Strength/Sequence: GRASP or standard DCE-MRI at 3 T. Assessment: Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) category (1–5), before and after reclassification of peripheral zone lesions from PI-RADS 3–4 based on contrast-enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI-RADS ≥3 (using NC-MRI), and PI-RADS ≥4 on DCE. Statistical Tests: Decision curve analysis was performed for both GRASP and standard DCE-MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies. Results: For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE-MRI with biopsy of PI-RADS ≥4 lesions provided the highest net benefit, while biopsy of PI-RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2–11%). In the same range of risk thresholds using standard DCE-MRI, the optimal strategy was biopsy for all lesions (0–15% risk threshold) or PI-RADS ≥3 on NC-MRI (16–33% risk threshold). Data Conclusion: GRASP DCE-MRI may potentially enable biopsy of PI-RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI-RADS ≥3 lesions. J. Magn. Reson. Imaging 2019;49:1400–1408.
AB - Background: The value of dynamic contrast-enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial. Purpose: To evaluate the population net benefit of risk stratification using DCE-MRI for detection of high-grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging. Study Type: Decision curve analysis. Population: Previously published patient studies on MRI for HGPCA detection, one using DCE with golden-angle radial sparse parallel (GRASP) images and the other using standard DCE-MRI. Field Strength/Sequence: GRASP or standard DCE-MRI at 3 T. Assessment: Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) category (1–5), before and after reclassification of peripheral zone lesions from PI-RADS 3–4 based on contrast-enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI-RADS ≥3 (using NC-MRI), and PI-RADS ≥4 on DCE. Statistical Tests: Decision curve analysis was performed for both GRASP and standard DCE-MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies. Results: For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE-MRI with biopsy of PI-RADS ≥4 lesions provided the highest net benefit, while biopsy of PI-RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2–11%). In the same range of risk thresholds using standard DCE-MRI, the optimal strategy was biopsy for all lesions (0–15% risk threshold) or PI-RADS ≥3 on NC-MRI (16–33% risk threshold). Data Conclusion: GRASP DCE-MRI may potentially enable biopsy of PI-RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI-RADS ≥3 lesions. J. Magn. Reson. Imaging 2019;49:1400–1408.
KW - contrast media
KW - decision support techniques
KW - magnetic resonance imaging
KW - prostatic neoplasms
KW - risk assessment
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U2 - 10.1002/jmri.26318
DO - 10.1002/jmri.26318
M3 - Article
C2 - 30629317
AN - SCOPUS:85059829876
SN - 1053-1807
VL - 49
SP - 1400
EP - 1408
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 5
ER -