Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers.

PURPOSE To prospectively determine the accuracy of experienced and less experienced readers in the interpretation of combined T2-weighted fast spin-echo (SE) magnetic resonance (MR) images and dynamic contrast material-enhanced MR images compared with T2-weighted fast SE alone, with respect to differentiation of stage T2 versus stage T3 prostate carcinoma, with histologic analysis serving as the reference standard. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained, and 124 consecutive men (age range, 42-74 years; median age, 63 years) with biopsy-proved prostate cancer underwent MR imaging and were candidates for radical prostatectomy. T2-weighted fast SE MR images and multisection dynamic contrast-enhanced MR images with a 2-second time resolution for the whole prostate were obtained. The T2-weighted and fused color-coded parametric dynamic contrast-enhanced MR images with T2-weighted images were evaluated prospectively and scored with regard to local extent by one experienced reader and evaluated retrospectively by two less experienced readers working in consensus by using a five-point scale; images with a score greater than or equal to four were considered indicative of T3 disease. Results were correlated with whole-mount section histopathologic findings, and receiver operating characteristics analysis was performed. RESULTS Twenty-five patients were excluded because of positive findings in the lymph nodes (n = 16), preoperative biopsy-proved seminal vesicle invasion (n = 5), and an absent dynamic dataset (n = 4). Ninety-nine patients were included in this study. The overall sensitivity, specificity, and accuracy of MR staging performance in prostate cancer with dynamic contrast-enhanced MR imaging was 69% (24 of 35 patients), 97% (62 of 64 patients), and 87% (86 of 99 patients), respectively, for the experienced reader. This difference was not significant (P = .48) when results were compared with results from the T2-weighted images. Staging performance for the less experienced readers with parametric dynamic contrast-enhanced MR imaging, however, resulted in significant improvement of the area under the receiver operating characteristics curve (A(z)) compared with T2-weighted MR imaging alone (A(z) = .66 and .82, respectively; P = .01). CONCLUSION The use of multisection dynamic contrast-enhanced MR imaging in staging prostate cancer showed significant improvement in staging performance for the less experienced readers but had no benefit for the experienced reader.

[1]  D. Carter.  TNM Classification of Malignant Tumors , 1998 .

[2]  C. Metz.  Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.

[3]  Mark Rijpkema,et al.  Combined quantitative dynamic contrast‐enhanced MR imaging and 1H MR spectroscopic imaging of human prostate cancer , 2004, Journal of magnetic resonance imaging : JMRI.

[4]  C. Tempany,et al.  Invasion of the neurovascular bundle by prostate cancer: evaluation with MR imaging. , 1991, Radiology.

[5]  R Alagappan,et al.  Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. , 1997, Radiology.

[6]  P. Pasqualetti,et al.  Enhancement patterns of prostate cancer in dynamic MRI , 2003, European Radiology.

[7]  A W Partin,et al.  Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. , 1997, JAMA.

[8]  J A Swets,et al.  Staging prostate cancer with MR imaging: a combined radiologist-computer system. , 1997, Radiology.

[9]  P. Carroll,et al.  Prostate cancer localization with endorectal MR imaging and MR spectroscopic imaging: effect of clinical data on reader accuracy. , 2004, Radiology.

[10]  J R Thornbury,et al.  Prostate cancer staging: should MR imaging be used?--A decision analytic approach. , 2000, Radiology.

[11]  Henkjan J Huisman,et al.  Discrimination of prostate cancer from normal peripheral zone and central gland tissue by using dynamic contrast-enhanced MR imaging. , 2003, Radiology.

[12]  H. Huisman,et al.  Accurate estimation of pharmacokinetic contrast‐enhanced dynamic MRI parameters of the prostate , 2001, Journal of magnetic resonance imaging : JMRI.

[13]  Gabriel P. Krestin,et al.  Contrast‐Enhanced Endorectal Coil MRI in Local Staging of Prostate Carcinoma , 1995, Journal of computer assisted tomography.

[14]  Y. Yamashita,et al.  The value of dynamic MR imaging for hypointensity lesions of the peripheral zone of the prostate. , 1998, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[15]  P. Carroll,et al.  Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal--pelvic phased-array coils. , 1994, Radiology.

[16]  T Okada,et al.  Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. , 2001, Urology.

[17]  P. Carroll,et al.  Local staging of prostatic carcinoma: comparison of transrectal sonography and endorectal MR imaging. , 1996, AJR. American journal of roentgenology.

[18]  P. Carroll,et al.  Prostate cancer: effect of postbiopsy hemorrhage on interpretation of MR images. , 1995, Radiology.

[19]  Michael W Kattan,et al.  Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. , 2004, Radiology.

[20]  C. Tempany,et al.  MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease. , 1992, AJR. American journal of roentgenology.

[21]  N Karssemeijer,et al.  Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging. , 1996, Radiology.

[22]  J R Thornbury,et al.  Dynamic TurboFLASH subtraction technique for contrast-enhanced MR imaging of the prostate: correlation with histopathologic results. , 1997, Radiology.

[23]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[24]  B R Rosen,et al.  Dynamic Gd‐DTPA enhanced MRI measurement of tissue cell volume fraction , 1995, Magnetic resonance in medicine.

[25]  C. Gatsonis,et al.  Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial. , 1990, The New England journal of medicine.

[26]  S B Malkowicz,et al.  Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease. , 1998, Urology.

[27]  C. Tempany.  MR staging of prostate cancer. How we can improve our accuracy with decisions aids and optimal techniques. , 1996, Magnetic resonance imaging clinics of North America.

[28]  L J van Erning,et al.  MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique. , 1994, Radiology.

[29]  D. Mitchell,et al.  Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. , 1994, Radiology.

[30]  S. Kitano,et al.  Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast‐enhancement in patients with localized prostate cancer: Mapping studies with biopsy specimens , 1999, International journal of urology : official journal of the Japanese Urological Association.

[31]  Jelle O. Barentsz,et al.  Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis , 2002, European Radiology.

[32]  J R Thornbury,et al.  Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. , 1996, AJR. American journal of roentgenology.

[33]  C. Langlotz,et al.  Staging of prostatic cancer: accuracy of MR imaging. , 1995, Radiology.

[34]  A. Schned,et al.  Staging of prostate cancer with endorectal MR imaging: lessons from a learning curve. , 1995, Radiographics : a review publication of the Radiological Society of North America, Inc.

[35]  M Recht,et al.  Method for the quantitative assessment of contrast agent uptake in dynamic contrast‐enhanced MRI , 1994, Magnetic resonance in medicine.

[36]  K. Yamada,et al.  Visualization of prostate cancer using dynamic contrast-enhanced MRI: comparison with transrectal power Doppler ultrasound. , 2003, The British journal of radiology.

[37]  C W Piccoli,et al.  Staging of prostate cancer: results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques. , 1994, Radiology.