PURPOSE: To prospectively assess the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of significant prostate cancer (PCa).
MATERIALS AND METHODS: Prospective study of 111 consecutive men with prostate and/or bladder cancer undergoing 3T DW-MRI of the pelvis without endorectal coil prior to radical prostatectomy (n=78) or cystoprostatectomy (n=33). Three independent readers blinded to clinical and pathological data assigned PCa suspicion grade based on a qualitative DW-MRI analysis. Final pathology of prostates with and without cancer was the reference standard. Primary outcomes were sensitivity and specificity of DW-MRI for detection of significant PCa, defined as largest diameter of the "index lesion" ≥1 cm or extraprostatic extension or Gleason score ≥7 at final pathology. Secondary outcomes were inter-reader agreement assessed with Fleiss' kappa coefficient, and DW-MRI reading time.
RESULTS: Of the 111 patients, 93 had PCa (80 significant and 13 insignificant disease) and 18 had no PCa at final pathology. Sensitivity and specificity of DW-MRI for detection of significant PCa ranged from 89% to 91% and 77% to 81%, respectively, for the three readers. Inter-reader agreement was good, with Fleiss' kappa coefficient ranging from 0.65 to 0.74. Median reading time ranged between 13 min and 18 min.
CONCLUSIONS: 3T DW-MRI is a noninvasive technique that allows for detection of significant PCa with a high probability without contrast medium or endorectal coil, with good inter-reader agreement and in a short reading time. This technique should be further evaluated as a tool to stratify PCa patients for individualized treatment options.
Written by:
Bains LJ, Studer UE, Froehlich JM, Giannarini G, Triantafyllou M, Fleischmann A, Thoeny HC. Are you the author?
Department of Radiology, Neuroradiology and Nuclear Medicine, Institute of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern, Switzerland; Department of Urology, University of Bern, Inselspital, Bern, Switzerland; Institute of Pathology, University of Bern, Bern, Switzerland.
Reference: J Urol. 2014 Mar 15. pii: S0022-5347(14)02972-3.
doi: 10.1016/j.juro.2014.03.039
PubMed Abstract
PMID: 24641913
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