Multiparametric prostate mr imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences : Are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy Journal Article


Authors: Donati, O. F.; Jung, S. I.; Vargas, H. A.; Gultekin, D. H.; Zheng, J.; Moskowitz, C. S.; Hricak, H.; Zelefsky, M. J.; Akin, O.
Article Title: Multiparametric prostate mr imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences : Are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy
Abstract: Purpose: To compare diagnostic accuracy of T2-weighted magnetic resonance (MR) imaging with that of multiparametric (MP) MR imaging combining T2-weighted imaging with diffusion-weighted (DW) MR imaging, dynamic contrast material-enhanced (DCE) MR imaging, or both in the detection of locally recurrent prostate cancer (PCa) after radiation therapy (RT). Materials and Methods: This retrospective HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Fifty-three men (median age, 70 years) suspected of having post-RT recurrence of PCa underwent MP MR imaging, including DW and DCE sequences, within ±months after biopsy. Two readers independently evaluated the likelihood of PCa with a five-point scale for T2-weighted imaging alone, T2-weighted imaging with DW imaging, T2-weighted imaging with DCE imaging, and T2-weighted imaging with DW and DCE imaging, with at least a 4-week interval between evaluations. Areas under the receiver operating characteristic curve (AUC) were calculated. Interreader agreement was assessed, and quantitative parameters (apparent diffusion coefficient [ADC], volume transfer constant [Ktrans], and rate constant [kep]) were assessed at sextantand patient-based levels with generalized estimating equations and the Wilcoxon rank sum test, respectively. Results: At biopsy, recurrence was present in 35 (66%) of 53 patients. In detection of recurrent PCa, T2-weighted imaging with DW imaging yielded higher AUCs (reader 1, 0.79-0.86; reader 2, 0.75-0.81) than T2-weighted imaging alone (reader 1, 0.63-0.67; reader 2, 0.46-0.49 [P ? .014 for all]). DCE sequences did not contribute significant incremental value to T2-weighted imaging with DW imaging (reader 1, P . .99; reader 2, P = .35). Interreader agreement was higher for combinations of MP MR imaging than for T2-weighted imaging alone (k = 0.34-0.63 vs k = 0.17-0.20). Medians of quantitative parameters differed significantly (P < .0001 to P = .0233) between benign tissue and PCa (ADC, 1.64 31023 mm2/sec vs 1.13 31023 mm2/sec; Ktrans, 0.1±min21 vs 0.33 min21; kep, 0.3±min21 vs 0.62 min21). Conclusion: MP MR imaging has greater accuracy in the detection of recurrent PCa after RT than T2-weighted imaging alone, with no additional benefit if DCE is added to T2-weighted imaging and DW imaging. © 2013 RSNA.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; intensity modulated radiation therapy; area under the curve; cancer combination chemotherapy; cancer radiotherapy; radiation dose; nuclear magnetic resonance imaging; recurrent cancer; magnetic resonance imaging; diagnostic accuracy; sensitivity and specificity; prostate specific antigen; neoplasm recurrence, local; image analysis; image interpretation, computer-assisted; observer variation; retrospective study; biopsy; prostate cancer; gleason score; prostatic neoplasms; quantitative analysis; prostate tumor; prostate biopsy; brachytherapy; intermethod comparison; contrast media; area under curve; disease duration; informed consent; gadolinium dtpa; diffusion weighted imaging; diffusion magnetic resonance imaging; statistics, nonparametric; rank sum test; predictive value; roc curve; receiver operating characteristic; nuclear magnetic resonance scanner; diagnostic test accuracy study; apparent diffusion coefficient; dynamic contrast material enhanced magnetic resonance imaging; multiparametric magnetic resonance imaging; t2 weighted magnetic resonance imaging; volume transfer constant
Journal Title: Radiology
Volume: 268
Issue: 2
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2013-08-01
Start Page: 440
End Page: 450
Language: English
DOI: 10.1148/radiol.13122149
PROVIDER: scopus
PUBMED: 23481164
DOI/URL:
Notes: --- - "Export Date: 4 September 2013" - "CODEN: RADLA" - "Source: Scopus"
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MSK Authors
  1. Junting Zheng
    131 Zheng
  2. Michael J Zelefsky
    619 Zelefsky
  3. Chaya S. Moskowitz
    173 Moskowitz
  4. Hedvig Hricak
    330 Hricak
  5. Oguz Akin
    177 Akin
  6. Sungil Jung
    4 Jung
  7. Olivio Fabrizio Manolo Donati
    16 Donati