Magnetic Resonance Elastography Combined With PI-RADS v2.1 for the Identification of Clinically Significant Prostate Cancer

Jie Chen; Yuntian Chen; Guoyong Chen; Liping Deng; Yuan Yuan; Hehan Tang; Zhen Zhang; Tingyu Chen; Hao Zeng; Enyu Yuan; Meng Yin; Jun Chen; Bin Song; Jin Yao

doi:10.1002/jmri.29653

Magnetic Resonance Elastography Combined With PI-RADS v2.1 for the Identification of Clinically Significant Prostate Cancer

J Magn Reson Imaging. 2024 Nov 8. doi: 10.1002/jmri.29653. Online ahead of print.

Authors

Jie Chen^{1

2}, Yuntian Chen^{1

2}, Guoyong Chen^{1

2}, Liping Deng^{1

2}, Yuan Yuan^{1

2}, Hehan Tang^{1

2}, Zhen Zhang^{1

2}, Tingyu Chen^{1

2}, Hao Zeng³, Enyu Yuan^{1

2}, Meng Yin⁴, Jun Chen^{4

5}, Bin Song^{1

2}, Jin Yao^{1

2}

Affiliations

¹ Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
² Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Urology, West China Hospital of Sichuan University, Chengdu, China.
⁴ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.

PMID: 39513399
DOI: 10.1002/jmri.29653

Abstract

Background: Multiparametric MRI may cause overdiagnosis of clinically significant prostate cancer (csPCa) with the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1).

Objectives: To investigate the diagnostic performance of stiffness as a standalone and complementary marker to PI-RADS v2.1 for diagnosing csPCa.

Study type: Prospective.

Subjects: One hundred forty-seven participants with pathologically confirmed prostate lesions (≥1 cm), including 71 with csPCa.

Field strength/sequence: T1-weighted fast spin-echo, T2-weighted fast spin-echo, single-shot echo-planar diffusion-weighted imaging, fast 3D gradient-echo T1-weighted dynamic contrast-enhanced imaging, and 3D single-shot spin-echo based echo-planar MR elastography at 3.0 T.

Assessment: The PI-RADS v2.1 score was assessed by three radiologists independently. Lesion shear stiffness (SS) values at 60 Hz and 90 Hz were measured. A modified PI-RADS integrating stiffness with PI-RADS v2.1 was developed. Diagnostic performance for csPCa was compared between stiffness, PI-RADS v2.1 and the modified PI-RADS.

Statistical test: Spearman's correlation, Fleiss κ and intraclass correlation, Pearson correlation, one-way analysis of variance, area under the receiver operating characteristic curve (AUC), and the Delong test. Significance level was P < 0.05.

Results: In the peripheral zone, csPCa (N = 35) had significantly higher SS than non-csPCa at 60 Hz (3.22 ± 0.66 kPa vs. 2.56 ± 0.56 kPa) and at 90 Hz (5.64 ± 1.30 kPa vs. 4.48 ± 0.84 kPa). PI-RADS v2.1 showed 100% sensitivity, 58% specificity, and 0.79 AUC for detecting csPCa. SS achieved 97% sensitivity, 52% specificity, and 0.80 AUC at 60 Hz, while SS had 63% sensitivity, 87% specificity, and 0.78 AUC at 90 Hz. The modified PI-RADS, combing SS at 60 Hz with PI-RADS v2.1, resulted in a significantly increased AUC (0.86) compared to that of PI-RADS v2.1, with a sensitivity of 97% and specificity of 75%.

Data conclusion: Stiffness can help identifying csPCa in the peripheral zone. Combining stiffness with the PI-RADS v2.1 improved the diagnostic accuracy and specificity for csPCa.

Evidence level: 1 TECHNICAL EFFICACY: Stage 2.

Keywords: Prostate Imaging Reporting and Data System; clinically significant prostate cancer; elastography.

Abstract

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