Standardisation of prostate multiparametric MRI across a hospital network: a London experience

Abstract Objectives National guidelines recommend prostate multiparametric (mp) MRI in men with suspected prostate cancer before biopsy. In this study, we explore prostate mpMRI protocols across 14 London hospitals and determine whether standardisation improves diagnostic quality. Methods An MRI physicist facilitated mpMRI set-up across several regional hospitals, working together with experienced uroradiologists who judged diagnostic quality. Radiologists from the 14 hospitals participated in the assessment and optimisation of prostate mpMRI image quality, assessed according to both PiRADSv2 recommendations and on the ability to “rule in” and/or “rule out” prostate cancer. Image quality and sequence parameters of representative mpMRI scans were evaluated across 23 MR scanners. Optimisation visits were performed to improve image quality, and 2 radiologists scored the image quality pre- and post-optimisation. Results 20/23 mpMRI protocols, consisting of 111 sequences, were optimised by modifying their sequence parameters. Pre-optimisation, only 15% of T2W images were non-diagnostic, whereas 40% of ADC maps, 50% of high b-value DWI and 41% of DCE-MRI were considered non-diagnostic. Post-optimisation, the scores were increased with 80% of ADC maps, 74% of high b-value DWI and 88% of DCE-MRI to be partially or fully diagnostic. T2W sequences were not optimised, due to their higher baseline quality scores. Conclusions Targeted intervention at a regional level can improve the diagnostic quality of prostate mpMRI protocols, with implications for improving prostate cancer detection rates and targeted biopsies.

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Image quality and diagnostic accuracy of complex-averaged high b value images in diffusion-weighted MRI of prostate cancer

Abdominal Radiology ◽

10.1007/s00261-019-01961-0 ◽

2019 ◽

Vol 44 (6) ◽

pp. 2244-2253 ◽

Cited By ~ 1

Author(s):

Hamed Kordbacheh ◽

Ravi Teja Seethamraju ◽

Elisabeth Weiland ◽

Berthold Kiefer ◽

Marcel Dominik Nickel ◽

...

Keyword(s):

Prostate Cancer ◽

Image Quality ◽

Diagnostic Accuracy ◽

B Value ◽

Diffusion Weighted Mri ◽

High B Value ◽

Diffusion Weighted

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The Primacy of High B-Value 3T-DWI Radiomics in the Prediction of Clinically Significant Prostate Cancer

Diagnostics ◽

10.3390/diagnostics11050739 ◽

2021 ◽

Vol 11 (5) ◽

pp. 739

Author(s):

Alessandro Bevilacqua ◽

Margherita Mottola ◽

Fabio Ferroni ◽

Alice Rossi ◽

Giampaolo Gavelli ◽

...

Keyword(s):

Prostate Cancer ◽

Quantitative Imaging ◽

B Value ◽

Support Vector ◽

Svm Classifier ◽

Primary Role ◽

High B Value ◽

Wilcoxon Rank Sum Test ◽

Apparent Diffusion ◽

Clinically Significant

Predicting clinically significant prostate cancer (csPCa) is crucial in PCa management. 3T-magnetic resonance (MR) systems may have a novel role in quantitative imaging and early csPCa prediction, accordingly. In this study, we develop a radiomic model for predicting csPCa based solely on native b2000 diffusion weighted imaging (DWIb2000) and debate the effectiveness of apparent diffusion coefficient (ADC) in the same task. In total, 105 patients were retrospectively enrolled between January–November 2020, with confirmed csPCa or ncsPCa based on biopsy. DWIb2000 and ADC images acquired with a 3T-MRI were analyzed by computing 84 local first-order radiomic features (RFs). Two predictive models were built based on DWIb2000 and ADC, separately. Relevant RFs were selected through LASSO, a support vector machine (SVM) classifier was trained using repeated 3-fold cross validation (CV) and validated on a holdout set. The SVM models rely on a single couple of uncorrelated RFs (ρ < 0.15) selected through Wilcoxon rank-sum test (p ≤ 0.05) with Holm–Bonferroni correction. On the holdout set, while the ADC model yielded AUC = 0.76 (95% CI, 0.63–0.96), the DWIb2000 model reached AUC = 0.84 (95% CI, 0.63–0.90), with specificity = 75%, sensitivity = 90%, and informedness = 0.65. This study establishes the primary role of 3T-DWIb2000 in PCa quantitative analyses, whilst ADC can remain the leading sequence for detection.

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Clinical impact of ultra-high b-value (3000 s/mm2) diffusion-weighted magnetic resonance imaging in prostate cancer at 3T: comparison with b-value of 2000 s/mm2

British Journal of Radiology ◽

10.1259/bjr.20210465 ◽

2021 ◽

pp. 20210465

Author(s):

Tsutomu Tamada ◽

Ayumu Kido ◽

Yu Ueda ◽

Mitsuru Takeuchi ◽

Takeshi Fukunaga ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Performance ◽

Signal To Noise Ratio ◽

B Value ◽

Single Shot ◽

Signal To Noise ◽

High B Value ◽

Diffusion Weighted ◽

Significant Difference ◽

Noise Ratio

Objective: High b-value diffusion-weighted imaging (hDWI) with a b-value of 2000 s/mm2 provides insufficient image contrast between benign and malignant tissues and an overlap of apparent diffusion coefficient (ADC) between Gleason grades (GG) in prostate cancer (PC). We compared image quality, PC detectability, and discrimination ability for PC aggressiveness between ultra-high b-value DWI (uhDWI) of 3000 s/mm2 and hDWI. Methods: The subjects were 49 patients with PC who underwent 3T multiparametric MRI. Single-shot echo-planar DWI was acquired with b-values of 0, 2000, and 3000 s/mm2. Anatomical distortion of prostate (AD), signal intensity of benign prostate (PSI), and lesion conspicuity score (LCS) were assessed using a 4-point scale; and signal-to-noise ratio, contrast-to-noise ratio, and mean ADC (×10–3 mm2/s) of lesion (lADC) and surrounding benign region (bADC) were measured. Results: PSI was significantly lower in uhDWI than in hDWI (p < 0.001). AD, LCS, signal-to-noise ratio, and contrast-to-noise ratio were comparable between uhDWI and hDWI (all p > 0.05). In contrast, lADC was significantly lower than bADC in both uhDWI and hDWI (both p < 0.001). In comparison of lADC between tumors of ≤GG2 and those of ≥GG3, both uhDWI and hDWI showed significant difference (p = 0.007 and p = 0.021, respectively). AUC for separating tumors of ≤GG2 from those of ≥GG3 was 0.731 in hDWI and 0.699 in uhDWI (p = 0.161). Conclusion: uhDWI suppressed background signal better than hDWI, but did not contribute to increased diagnostic performance in PC. Advances in knowledge: Compared with hDWI, uhDWI could not contribute to increased diagnostic performance in PC.

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Automated prostate cancer detection usingT2-weighted and high-b-value diffusion-weighted magnetic resonance imaging

Medical Physics ◽

10.1118/1.4918318 ◽

2015 ◽

Vol 42 (5) ◽

pp. 2368-2378 ◽

Cited By ~ 48

Author(s):

Jin Tae Kwak ◽

Sheng Xu ◽

Bradford J. Wood ◽

Baris Turkbey ◽

Peter L. Choyke ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Cancer Detection ◽

B Value ◽

Resonance Imaging ◽

Prostate Cancer Detection ◽

High B Value ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging

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New RESOLVE-Based Diffusional Kurtosis Imaging in MRI-Visible Prostate Cancer: Effect of Reduced b Value on Image Quality and Diagnostic Effectiveness

American Journal of Roentgenology ◽

10.2214/ajr.15.15990 ◽

2016 ◽

Vol 207 (2) ◽

pp. 330-338 ◽

Cited By ~ 4

Author(s):

Yu-Dong Zhang ◽

Chen-Jiang Wu ◽

Mei-Ling Bao ◽

Hai Li ◽

Xu Yan ◽

...

Keyword(s):

Prostate Cancer ◽

Image Quality ◽

B Value ◽

Diffusional Kurtosis Imaging

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The diagnostic accuracy of high b-value diffusion- and T2-weighted imaging for the detection of prostate cancer: a meta-analysis

Abdominal Radiology ◽

10.1007/s00261-017-1400-4 ◽

2017 ◽

Vol 43 (7) ◽

pp. 1787-1797 ◽

Cited By ~ 3

Author(s):

Tom J. Syer ◽

Keith C. Godley ◽

Donnie Cameron ◽

Paul N. Malcolm

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

B Value ◽

High B Value

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Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis

Acta Radiologica ◽

10.1177/0284185117702181 ◽

2017 ◽

Vol 59 (1) ◽

pp. 105-113 ◽

Cited By ~ 9

Author(s):

Keith Craig Godley ◽

Tom Joseph Syer ◽

Andoni Paul Toms ◽

Toby Oliver Smith ◽

Glyn Johnson ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Cancer Detection ◽

Diagnostic Performance ◽

Visual Assessment ◽

B Value ◽

B Values ◽

Prostate Cancer Detection ◽

High B Value

Background The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual as well as quantitative means of detecting tumor, the apparent diffusion coefficient (ADC). Recently higher b-values have been used to improve DWI’s diagnostic performance. Purpose To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, less than ten patients, and data for creating a 2 × 2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% confidence interval [CI], 0.57–0.61) and 0.92 (95% CI, 0.91–0.92), respectively, and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant ( P = 0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.

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