MP53-05 MULTI-PARAMETRIC MRI FOR DETECTION OF RADIO-RECURRENT PROSTATE CANCER: WHAT CONSTITUTES AN OPTIMAL DATASET?

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-05 MULTI-PARAMETRIC MRI FOR DETECTION OF RADIO-RECURRENT PROSTATE CANCER: WHAT CONSTITUTES AN OPTIMAL DATASET? Mohamed Abd-Alazeez, Navin Ramachandran, Nikolaos Dikaios, Hashim Ahmed, Mark Emberton, Alex Kirkham, Manit Arya, Alex Freeman, and Shonit Punwani Mohamed Abd-AlazeezMohamed Abd-Alazeez More articles by this author , Navin RamachandranNavin Ramachandran More articles by this author , Nikolaos DikaiosNikolaos Dikaios More articles by this author , Hashim AhmedHashim Ahmed More articles by this author , Mark EmbertonMark Emberton More articles by this author , Alex KirkhamAlex Kirkham More articles by this author , Manit AryaManit Arya More articles by this author , Alex FreemanAlex Freeman More articles by this author , and Shonit PunwaniShonit Punwani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1636AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Multi-parametric MRI (mp-MRI) has an essential role in detecting clinically significant prostate cancer. In patients with recurrent disease after radiotherapy, it is not clear which functional MRI sequences are more important in this setting. Our objective was to evaluate the performance of different MRI sequence combinations for detection of clinically significant prostate cancer in order to identify the basic sequences required for the best performance in such patients. Methods Our cohort comprised of 37 men that presented with biochemical failure after external beam radiotherapy. All patients underwent mp-MRI in the form of T2-weighted, diffusion weighted (high b-value and ADC) and dynamic contrast enhanced imaging, transperineal systematic template prostate biopsy followed within 10 months. Two independent radiologists reported the MRI images, blinded to disease history as well as all clinical, laboratory and previous imaging data of the patients. MRI reporting was made based on ordinal scale 1-5. Two MRI cutoff thresholds (3/5 and 4/5) were used to define positive MRI result and analysis was done at half prostate level (n=74). Clinically significant prostate cancer disease (Target condition) was defined as cancer with any Gleason 4 and/or cancer core length of ≥ 4 mm. Accuracy figures as well as area under receiver operating characteristic curves with 95% confidence intervals were calculated for both readers. Inter-observer agreement was also assessed using weighted kappa statistics. Results Target condition was found in 32/37 (86%) patients. AUC for reader 1 increased from 0.67 (95%CI, 0.54-0.79) at T2-weighted imaging to 0.87 (95%CI, 0.79-0.96) at mp-MRI. AUC for reader 2 increased from 0.71 (95%CI, 0.59-0.83) at T2-weighted imaging to 0.89 (95%CI, 0.81-0.96) at mp-MRI. There was no statistically significant difference between T2 + high b-value and T2 + high b-balue + ADC + DCE imaging (p two-tailed = 0.47 and 0.36 for readers 1 and 2, respectively). Inter-reader agreement was substantial at mp-MRI level (κ = 0.65, 95%CI 0.51-0.79). Conclusions Mp-MRI showed higher accuracy than T2-weighted imaging in the detection of clinically significant prostate cancer among patients with radio-recurrent disease. We recommend a minimum dataset of T2 and high-b value DWI in this setting. We consider DCE MRI as optional as the performance improvement remains debatable. The ability to localize disease in the post-radiotherapy setting could potentially limit/avoid unnecessary biopsies and be used to guide emerging focal salvage therapies. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e589-e590 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mohamed Abd-Alazeez More articles by this author Navin Ramachandran More articles by this author Nikolaos Dikaios More articles by this author Hashim Ahmed More articles by this author Mark Emberton More articles by this author Alex Kirkham More articles by this author Manit Arya More articles by this author Alex Freeman More articles by this author Shonit Punwani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...