title: Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis.
abstract: Background The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual as well as quantitative means of detecting tumor, the apparent diffusion coefficient (ADC). Recently higher b-values have been used to improve DWI's diagnostic performance. Purpose To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, less than ten patients, and data for creating a 2 × 2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% confidence interval [CI], 0.57-0.61) and 0.92 (95% CI, 0.91-0.92), respectively, and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant ( P = 0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.
authors.affiliation: 1 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: Keith Craig
authors.initials: KC
authors.lastname: Godley
authors.affiliation: 2 University of East Anglia, Norwich, UK.
authors.forename: Tom Joseph
authors.initials: TJ
authors.lastname: Syer
authors.affiliation: 1 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: Andoni Paul
authors.initials: AP
authors.lastname: Toms
authors.affiliation: 2 University of East Anglia, Norwich, UK.
authors.forename: Toby Oliver
authors.initials: TO
authors.lastname: Smith
authors.affiliation: 2 University of East Anglia, Norwich, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Johnson
authors.affiliation: 2 University of East Anglia, Norwich, UK.
authors.forename: Donnie
authors.initials: D
authors.lastname: Cameron
authors.affiliation: 1 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: Paul Napier
authors.initials: PN
authors.lastname: Malcolm
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: DWI; MRI; Prostate cancer; diffusion-weighted imaging; high-b-value; magnetic resonance imaging; meta-analysis