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Added value of diffusion-weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial.

  • Eldred-Evans, David1, 2
  • Neves, Joana B3, 4
  • Simmons, Lucy A M3, 4
  • Kanthabalan, Abi3, 4
  • McCartan, Neil3
  • Shah, Taimur T1, 2, 3
  • Arya, Manit1, 2, 3
  • Charman, Susan C5, 6
  • Freeman, Alex7
  • Moore, Caroline M3, 4
  • Punwani, Shonit8, 9
  • Emberton, Mark3, 4
  • Ahmed, Hashim U1, 2, 3
  • 1 Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
  • 2 Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
  • 3 Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK.
  • 4 Department of Urology, UCLH NHS Foundation Trust, London, UK.
  • 5 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
  • 6 Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
  • 7 Department of Pathology, UCLH NHS Foundation Trust, London, UK.
  • 8 Department of Radiology, UCLH NHS Foundation Trust, London, UK.
  • 9 Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK.
Published Article
British Journal of Urology
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2020
DOI: 10.1111/bju.14953
PMID: 31733173


To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification after a previous non-magnetic resonance imaging (MRI)-guided transrectal ultrasonography-guided biopsy underwent a 3-Tesla (3T) multiparametic (mp)MRI consisting of T2-weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver-operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71-0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions. © 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.

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