title: Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images.
abstract: BACKGROUND
  Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences.
  
  
  METHODS
  Thirty-seven men with mean age of 69.7 (interquartile range, 66-74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1-5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics.
  
  
  RESULTS
  Receiver-operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55-0.80) to 0.80 (95% CI, 0.69-0.91) and from 0.67 (95% CI, 0.55-0.80) to 0.84 (95% CI, 0.76-0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review.
  
  
  CONCLUSIONS
  mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.
authors: 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
authors: M
authors: M
authors: Abd-Alazeez
authors: Department of Radiology, University College London Hospital, London, UK.
authors: N
authors: N
authors: Ramachandran
authors: 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK.
authors: N
authors: N
authors: Dikaios
authors: 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK.
authors: H U
authors: HU
authors: Ahmed
authors: 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK.
authors: M
authors: M
authors: Emberton
authors: Department of Radiology, University College London Hospital, London, UK.
authors: A
authors: A
authors: Kirkham
authors: 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Barts Cancer Institute, Queen Mary University of London, London, UK.
authors: M
authors: M
authors: Arya
authors: 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK.
authors: S
authors: S
authors: Taylor
authors: 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK.
authors: S
authors: S
authors: Halligan
authors: 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK.
authors: S
authors: S
authors: Punwani
mesh_terms: D000368:Aged; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D011859:Radiography
chemical_list: D003287:Contrast Media
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