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Pharmacokinetic modeling of dynamic contrast-enhanced (DCE)-MRI in PI-RADS category 3 peripheral zone lesions: preliminary study evaluating DCE-MRI as an imaging biomarker for detection of clinically significant prostate cancers

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Abstract

Purpose

To determine if pharmacokinetic modeling of DCE-MRI can diagnose CS-PCa in PI-RADS category 3 PZ lesions with subjective negative DCE-MRI.

Materials and methods

In the present IRB approved, bi-institutional, retrospective, case–control study, we identified 73 men with 73 PZ PI-RADS version 2.1 category 3 lesions with MRI-directed-TRUS-guided targeted biopsy yielding: 12 PZ CS-PCa (ISUP Grade Group 2; N = 9, ISUP 3; N = 3), 27 ISUP 1 PCa and 34 benign lesions. An expert blinded radiologist segmented lesions on ADC and DCE images; segmentations were overlayed onto pharmacokinetic DCE-MRI maps. Mean values were compared between groups using univariate analysis. Diagnostic accuracy was assessed by ROC.

Results

There were no differences in age, PSA, PSAD or clinical stage between groups (p = 0.265–0.645). Mean and 10th percentile ADC did not differ comparing CS-PCa to ISUP 1 PCa and benign lesions (p = 0.376 and 0.598) but was lower comparing ISUP ≥ 1 PCa to benign lesions (p < 0.001). Mean Ktrans (p = 0.003), Ve (p = 0.003) but not Kep (p = 0.387) were higher in CS-PCa compared to ISUP 1 PCa and benign lesions. There were no differences in DCE-MRI metrics comparing ISUP ≥ 1 PCa and benign lesions (p > 0.05). AUC for diagnosis of CS-PCa using Ktrans and Ve were: 0.69 (95% CI 0.52–0.87) and 0.69 (0.49–0.88).

Conclusion

Pharmacokinetic modeling of DCE-MRI parameters in PI-RADS category 3 lesions with subjectively negative DCE-MRI show significant differences comparing CS-PCa to ISUP 1 PCa and benign lesions, in this study outperforming ADC. Studies are required to further evaluate these parameters to determine which patients should undergo targeted biopsy for PI-RADS 3 lesions.

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Author notes

  1. Jorge Abreu-Gomez

    Present address: Department of Medical Imaging, Joint Department of Medical Imaging, University of Toronto, 585 University Avenue 1PMB-298, Toronto, ON, M5G 2N2, Canada

  2. Gregory O. Cron

    Present address: Centre for Cancer Therapeutics, Ottawa Health Research Institute, Ottawa, ON, Canada

Authors and Affiliations

  1. Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Jorge Abreu-Gomez, Christopher Lim & Nima Sadoughi

  2. Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

    Nicola Schieda

  3. Department of Medical Imaging, Joint Department of Medical Imaging, University of Toronto, 585 University Avenue 1PMB-298, Toronto, ON, M5G 2N2, Canada

    Satheesh Krishna

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Abreu-Gomez, J., Lim, C., Cron, G.O. et al. Pharmacokinetic modeling of dynamic contrast-enhanced (DCE)-MRI in PI-RADS category 3 peripheral zone lesions: preliminary study evaluating DCE-MRI as an imaging biomarker for detection of clinically significant prostate cancers. Abdom Radiol 46, 4370–4380 (2021). https://doi.org/10.1007/s00261-021-03035-6

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