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Diagnostic Accuracy of a Rapid Biparametric MRI Protocol for Detection of Histologically Proven Prostate Cancer

  • Author Footnotes
    1 Verena C. Obmann and Shivani Pahwa contributed equally to this work and are co-first authors.
    Verena C. Obmann
    Footnotes
    1 Verena C. Obmann and Shivani Pahwa contributed equally to this work and are co-first authors.
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
    Search for articles by this author
  • Author Footnotes
    1 Verena C. Obmann and Shivani Pahwa contributed equally to this work and are co-first authors.
    Shivani Pahwa
    Footnotes
    1 Verena C. Obmann and Shivani Pahwa contributed equally to this work and are co-first authors.
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
    Search for articles by this author
  • William Tabayayong
    Affiliations
    Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
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  • Yun Jiang
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH
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  • Gregory O'Connor
    Affiliations
    School of Medicine, Case Western Reserve University, Cleveland, OH
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  • Sara Dastmalchian
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
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  • John Lu
    Affiliations
    School of Medicine, Case Western Reserve University, Cleveland, OH
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  • Soham Shah
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH
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  • Karin A. Herrmann
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
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  • Raj Paspulati
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
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  • Gregory MacLennan
    Affiliations
    Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH

    Department of Pathology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH
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  • Lee Ponsky
    Affiliations
    Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH
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  • Author Footnotes
    2 Robert Abouassaly and Vikas Gulani are co-last authors.
    Robert Abouassaly
    Footnotes
    2 Robert Abouassaly and Vikas Gulani are co-last authors.
    Affiliations
    Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
    Search for articles by this author
  • Author Footnotes
    2 Robert Abouassaly and Vikas Gulani are co-last authors.
    Vikas Gulani
    Correspondence
    Address correspondence to: Vikas Gulani, M.D., Ph.D., Department of Radiology, University Hospitals Cleveland Medical Center, Bolwell B120, 11100 Euclid Avenue, Cleveland, OH 44106-0500.
    Footnotes
    2 Robert Abouassaly and Vikas Gulani are co-last authors.
    Affiliations
    Department of Radiology, Case Western Reserve University, Cleveland, OH

    Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH

    Department of Urology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH

    Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
    Search for articles by this author
  • Author Footnotes
    1 Verena C. Obmann and Shivani Pahwa contributed equally to this work and are co-first authors.
    2 Robert Abouassaly and Vikas Gulani are co-last authors.
Published:September 07, 2018DOI:https://doi.org/10.1016/j.urology.2018.08.032

      Abstract

      Objective

      To evaluate the performance of a rapid, low cost, noncontrast MRI examination as a secondary screening tool in detection of clinically significant prostate cancer.

      Methods

      In this prospective single institution study, 129 patients with elevated prostate-specific antigen levels or abnormal digital rectal examination findings underwent MRI with an abbreviated biparamatric MRI protocol consisting of high-resolution axial T2- and diffusion-weighted images. Index lesions were classified according to modified Prostate Imaging – Reporting and Data System (mPI-RADS) version 2.0. All patients underwent standard transrectal ultrasound-guided biopsy after MRI with the urologist being blinded to MRI results. Subsequently, all patients with suspicious lesions (mPI-RADS 3, 4, or 5) underwent cognitively guided targeted biopsy after discussion of MRI results with the urologist. Sensitivity and negative predictive value for identification of clinically significant prostate cancer (Gleason score 3+4 and above) were determined.

      Results

      Rapid biparametric MRI discovered 176 lesions identified in 129 patients. Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%.

      Conclusion

      We found that a bp-MRI examination can detect clinically significant lesions and changed patient management in 10.8% of the patients. A rapid MRI protocol can be used as a useful secondary screening tool in men presenting with suspicion of prostate cancer.
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