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Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis

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Abstract

Purpose

To evaluate the impact of dedicated reader education on accuracy/confidence of peripheral zone index cancer and anterior prostate cancer (PCa) diagnosis with mpMRI; secondary aim was to assess the ability of readers to differentiate low-grade cancer (Gleason 6 or below) from high-grade cancer (Gleason 7+).

Materials and methods

Five blinded radiology fellows evaluated 31 total prostate mpMRIs in this IRB-approved, HIPAA-compliant, retrospective study for index lesion detection, confidence in lesion diagnosis (1–5 scale), and Gleason grade (Gleason 6 or lower vs. Gleason 7+). Following a dedicated education program, readers reinterpreted cases after a memory extinction period, blinded to initial reads. Reference standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of prostate mpMRI experience.

Results

Index cancer detection: pre-education accuracy 74.2%; post-education accuracy 87.7% (p = 0.003). Confidence in index lesion diagnosis: pre-education 4.22 ± 1.04; post-education 3.75 ± 1.41 (p = 0.0004). Anterior PCa detection: pre-education accuracy 54.3%; post-education accuracy 94.3% (p = 0.001). Confidence in anterior PCa diagnosis: pre-education 3.22 ± 1.54; post-education 4.29 ± 0.83 (p = 0.0003). Gleason score accuracy: pre-education 54.8%; post-education 73.5% (p = 0.0005).

Conclusions

A dedicated reader education program on PCa detection with mpMRI was associated with a statistically significant increase in diagnostic accuracy of index cancer and anterior cancer detection as well as Gleason grade identification as compared to pre-education values. This was also associated with a significant increase in reader diagnostic confidence. This suggests that substantial interobserver variability in mpMRI interpretation can potentially be reduced with a focus on education and that this can occur over a fellowship training year.

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Acknowledgments

The authors gratefully acknowledge the contributions of Steven Breault, M.D., Andrew Buck, M.D., Lauren Burke, M.D., Ghaneh Fananapazir, M.D., Alex Kim, M.D., Evan Kulbacki, M.D., Samantha Lipman, B.S., John Madden, M.D, Ph.D., Kathryn Nightingale, Ph.D., Arthur Parsee, M.D., and Jose Pratts, M.D., without whom this project would not have been possible.

Author information

Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA

    Kirema Garcia-Reyes, Christopher R. Kauffman, Kingshuk Roy Choudhury & Rajan T. Gupta

  2. Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA

    Niccolò M. Passoni & Thomas J. Polascik

  3. Department of Biomedical Engineering, Duke University, Room 258, Hudson Hall Annex, Durham, NC, 27708, USA

    Mark L. Palmeri

Authors
  1. Kirema Garcia-Reyes
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  2. Niccolò M. Passoni
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  3. Mark L. Palmeri
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  4. Christopher R. Kauffman
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  5. Kingshuk Roy Choudhury
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  6. Thomas J. Polascik
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  7. Rajan T. Gupta
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Corresponding author

Correspondence to Rajan T. Gupta.

Additional information

This project was performed at the Departments of Radiology, Surgery and Biomedical Engineering at Duke University Medical Center.

Appendix: Multiparametric MRI acquisition parameters

Appendix: Multiparametric MRI acquisition parameters

Array spatial sensitivity-encoding technique (parallel imaging) factor of 2–3 was used in all sequences.

T2-weighted Imaging Parameters

  • TR range/TE range = 3700–4610/84–102 (milliseconds, ms)

  • Matrix size = 448 × 360 (Axial); 384 × 230–260 (Coronal, Sagittal)

  • Echo-train length = 25

  • Number of signals acquired = 3

  • Section thickness = 3 mm

  • Intersection gap = 0 mm

  • FOV = 16 cm

Diffusion-weighted imaging parameters

  • TR range/TE range = 8000/80

  • Matrix size = 160 × 160

  • b values = 0 and 800 s/mm2

  • Number of signals acquired = 6

  • Slice thickness = 3 mm

  • Gap = 0 mm

  • FOV = 16 cm

T1-weighted, 3D, gradient-echo, and free-breathing axial DCE MR images covering the entire prostate were acquired starting 11 s before the IV administration of gadopentetate dimeglumine (Magnevist, Bayer Pharma AG) at a dose of 0.1 mmol/kg, followed by a 20-mL saline flush at a rate of 2.0 mL/s.

DCE MRI Parameters

  • TR range/TE range = 4.09/1.44

  • Matrix size = 192 × 160

  • Flip angle = 15°

Interpolated slice thickness = 3 mm with temporal resolution of 5–6 s for approximately 5–6 min (approximately 70 sets of images were acquired to monitor the time course of contrast agent uptake and clearance within the prostate).

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Garcia-Reyes, K., Passoni, N.M., Palmeri, M.L. et al. Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis. Abdom Imaging 40, 134–142 (2015). https://doi.org/10.1007/s00261-014-0197-7

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  • DOI: https://doi.org/10.1007/s00261-014-0197-7

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