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  • Original Article
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Clinical Research

Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images

Prostate Cancer and Prostatic Diseases volume 18, pages 128–136 (2015)Cite this article

Subjects

Abstract

Background:

Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences.

Methods:

Thirty-seven men with mean age of 69.7 (interquartile range, 66–74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1–5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics.

Results:

Receiver–operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55–0.80) to 0.80 (95% CI, 0.69–0.91) and from 0.67 (95% CI, 0.55–0.80) to 0.84 (95% CI, 0.76–0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review.

Conclusions:

mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.

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Acknowledgements

This work was undertaken at the Comprehensive Biomedical Centre, University College Hospital London, which received a proportion of the funding from the National Institute for Health Research. The work was supported by the CRUK/EPSRC KCL/UCL comprehensive cancer imaging centre. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. M Arya acknowledges Orchid (male cancer charity) and Barts and London charity.

Disclosure

M. Abd-Alazeez receives funding from the Egyptian government. ND was supported by UK EPSRC grants EP/I018700/1 and EP/H046410/1.

Author information

Authors and Affiliations

  1. Department of Urology, University College Hospital NHS Foundation Trust, London, UK

    M Abd-Alazeez, H U Ahmed, M Emberton & M Arya

  2. Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt

    M Abd-Alazeez

  3. Department of Radiology, University College London Hospital, London, UK

    N Ramachandran, N Dikaios, A Kirkham, S Taylor, S Halligan & S Punwani

  4. Centre for Medical Imaging, University College London, London, UK

    N Dikaios, S Taylor, S Halligan & S Punwani

  5. Division of Surgery and Interventional Science, University College London, London, UK

    H U Ahmed & M Emberton

  6. Barts Cancer Institute, Queen Mary University of London, London, UK

    M Arya

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  1. M Abd-Alazeez
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Correspondence to M Abd-Alazeez.

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Appendix

Appendix

The appendix presents a sub-analysis of the data based on a definition of clinical significance of prostate cancer. Clinically significant disease was defined as either a lesion of Gleason 3+4 and/or lesion size >0.2 cm3.31 We have previously used this definition for the classification of clinically significant disease at diagnosis.32, 33

Within the appendix we evaluate the presence of clinically significant tumor based on two separate mp-MRI score thresholds (3 and 4).

Significant prostate cancer was present in 32/37 (86%) men and 46/74 (62%) hemiglands.

Table 1A Patient demographics
Full size table
Table 2A Reader performance at the hemigland level with mp-MRI score >3 as positive
Full size table
Table 3A Reader performance at the hemigland level with mp-MRI score >4 as positive
Full size table

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Abd-Alazeez, M., Ramachandran, N., Dikaios, N. et al. Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images. Prostate Cancer Prostatic Dis 18, 128–136 (2015). https://doi.org/10.1038/pcan.2014.55

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