Multiparametric MRI for Suspected Recurrent Prostate Cancer after HIFU:Is DCE still needed?
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To assess the added value of the dynamic contrast-enhanced sequence (DCE) to combination T2-weighted imaging (T2w) + diffusion-weighted imaging (DWI) in detecting prostate cancer (PCa) recurrence after HIFU (high-intensity focused ultrasound).
Forty-five males with clinical and biological suspected PCa recurrence were retrospectively selected. All underwent multi-parametric MRI (mpMRI) before biopsies. Two readers independently assigned a Likert score of cancer likelihood on T2w + DWI + DCE and T2w + DWI images. Prostatic biopsies were taken as the gold standard.
Recurrent PCa was identified at biopsy for 37 patients (82%). Areas under the receiver-operating curve of T2w + DWI and T2w + DWI + DCE imaging were not significantly different for both readers. Using a Likert score ≥ 3 for the PCa diagnosis threshold, sensitivity at the lobe level for the (1) senior and (2) junior reader for T2w +DWI +DCE sensitivity was (1) 0.97 and (2) 0.94 vs. (1) 0.94 and (2) 0.97 for T2w + DWI.
Accuracy of mpMRI was not significantly improved by adding DCE to T2w + DWI. Sensitivity was high for T2w + DWI + DCE and T2w + DWI with no significant difference for either the junior or senior reader.
• MpMRI has the capability to detect PCa recurrence in post-HIFU monitoring.
• The sensitivity of T2w and DWI for detecting PCa recurrence was not improved by DCE.
• Readers with different degrees of experience did not improve their performance with DCE.
KeywordsProstate cancer Neoplasm recurrence, local High-intensity focused ultrasound ablation Diffusion magnetic resonance imaging Contrast media
Apparent diffusion coefficient
Anterior fibromuscular stroma
Area under the ROC curve
Clinically significant cancer
Dynamic contrast enhancement sequence
Diffusion- weighted imaging
External beam radiation therapy
High-intensity focused ultrasound
Multiparametric magnetic resonance imaging
Magnetic resonance imaging
Region of interest
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Raphaele Renard Penna.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Alexandre Lafourcade and Lisa Belin (Hopital Pitié Salpétrière) kindly provided statistical advice for this manuscript.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was not required because the methodology of the study was retrospective on imaging materials, without any supplementary interventions than routine practice for medical care.
• diagnostic or prognostic study
• performed at one institution
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