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      • Record: found
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      The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

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          Abstract

          Objective

          Prostate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).

          Materials and methods

          The study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.

          Results

          Significant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.

          Conclusion

          DCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

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          Most cited references35

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          PI-RADS version 2.1: one small step for prostate MRI

          T. Barrett, A Rajesh, A.B. Rosenkrantz … (2019)
          Article 0 comments Cited 53 times – based on 0 reviews     Review now
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            Head-to-Head Comparison Between Biparametric and Multiparametric MRI for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

            Sungmin Woo, Chong Suh, Sang Youn Kim … (2018)
            Article 0 comments Cited 52 times – based on 0 reviews     Review now
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              Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis.

              Scott Eggener, Aytekin Oto, Cheng-San Yang … (2011)
              The objective of our study was to investigate whether quantitative parameters derived from diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) correlate with Gleason score and angiogenesis of prostate cancer. Seventy-three patients who underwent preoperative MRI and radical prostatectomy were included in our study. A radiologist and pathologist located the dominant tumor on the MR images based on histopathologic correlation. For each dominant tumor, the apparent diffusion coefficient (ADC) value and quantitative DCE-MRI parameters (i.e., contrast agent transfer rate between blood and tissue [K(trans)], extravascular extracellular fractional volume [v(e)], contrast agent backflux rate constant [k(ep)], and blood plasma fractional volume on a voxel-by-voxel basis [v(p)]) were calculated and the Gleason score was recorded. The mean blood vessel count, mean vessel area fraction, and vascular endothelial growth factor (VEGF) expression of the dominant tumor were determined using CD31, CD34, and VEGF antibody stains. Spearman correlation analysis between MR and histopathologic parameters was conducted. The mean tumor diameter was 15.2 mm (range, 5-28 mm). Of the 73 prostate cancer tumors, five (6.8%) had a Gleason score of 6, 46 (63%) had a Gleason score of 7, and 22 (30.1%) had a Gleason score of greater than 7. ADC values showed a moderate negative correlation with Gleason score (r = -0.376, p = 0.001) but did not correlate with tumor angiogenesis parameters. Quantitative DCE-MRI parameters did not show a significant correlation with Gleason score or VEGF expression (p > 0.05). Mean blood vessel count and mean vessel area fraction parameters estimated from prostate cancer positively correlated with k(ep) (r = 0.440 and 0.453, respectively; p = 0.001 for both). There is a moderate correlation between ADC values and Gleason score and between k(ep) and microvessel density of prostate cancer. Although the strength of the correlations is insufficient for immediate diagnostic utility, these results warrant further investigation on the potential of multiparametric MRI to facilitate noninvasive assessment of prostate cancer aggressiveness and angiogenesis.
              Article 0 comments Cited 51 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ilinca Cosma: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draft
                Cornelia Tennstedt-Schenk: Role: Formal analysisRole: InvestigationRole: Resources
                Sven Winzler: Role: Data curationRole: Visualization
                Marios Nikos Psychogios: Role: MethodologyRole: Software
                Alexander Pfeil: Role: MethodologyRole: SoftwareRole: Writing – review & editing
                Ulf Teichgraeber: Role: MethodologyRole: ResourcesRole: Software
                Ansgar Malich: Role: ConceptualizationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – review & editing
                Ismini Papageorgiou:
                ORCID: http://orcid.org/0000-0001-5810-0483
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Pascal A. T. Baltzer: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 23 December 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 12
                Electronic Location Identifier: e0227031
                Affiliations
                [1 ] Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
                [2 ] Institute of Radiology, Suedharz Hospital Nordhausen, Nordhausen, Germany
                [3 ] Institute for Pathology, Muehlhausen, Germany
                [4 ] Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
                [5 ] Department of Internal Medicine, University Hospital Jena, Jena, Germany
                Medical University of Vienna, AUSTRIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-5810-0483
                Article
                Publisher ID: PONE-D-19-30220
                DOI: 10.1371/journal.pone.0227031
                PMC ID: 6927639
                PubMed ID: 31869380
                SO-VID: cefe285a-82ea-4ca5-8487-4688ff08ff51
                Copyright © © 2019 Cosma et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 30 October 2019
                Date accepted : 10 December 2019
                Page count
                Figures: 3, Tables: 3, Pages: 16
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancers and Neoplasms
                Subject: Genitourinary Tract Tumors
                Subject: Prostate Cancer
                Subject: Medicine and Health Sciences
                Subject: Urology
                Subject: Prostate Diseases
                Subject: Prostate Cancer
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Exocrine Glands
                Subject: Prostate Gland
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Exocrine Glands
                Subject: Prostate Gland
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Medicine and Health Sciences
                Subject: Radiology and Imaging
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Lesions
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Lesions
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Cancer Detection and Diagnosis
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancer Detection and Diagnosis
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Brain Mapping
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Medicine and Health Sciences
                Subject: Radiology and Imaging
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Neuroimaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Neuroimaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Biopsy
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Statistical Hypothesis Testing
                Subject: Chi Square Tests
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics
                Subject: Statistical Methods
                Subject: Statistical Hypothesis Testing
                Subject: Chi Square Tests
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

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