Defining the incremental value of 3D T2-weighted imaging in the assessment of prostate cancer extracapsular extension.
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Caglic, I., Povalej Brzan, P., Warren, A., Bratt, O., Shah, N., & Barrett, T. (2019). Defining the incremental value of 3D T2-weighted imaging in the assessment of prostate cancer extracapsular extension.. European radiology, 29 (10), 5488-5497. https://doi.org/10.1007/s00330-019-06070-6
Objectives To assess the added value of 3D-T2 weighted imaging (T2WI) over conventional 2D-T2WI in diagnosing extracapsular extension (ECE). Methods 75 patients undergoing 3T MRI before radical prostatectomy were included. PI-RADS ≥4 lesions were assessed for ECE on 2D-T2W images using a 5-point Likert scale (1=no ECE, 5=definite ECE) and the length of tumour prostatic capsular contact. A second read using 3D-T2W images and reformats evaluated ECE and the maximal 3D capsular contact length and surface. Results 106 lesions were identified at MRI. ECE was confirmed by histology in 54% (57/106) of lesions and 64% (48/75) of patients. Sensitivity and specificity for 3D-T2 reads was 75.4% versus 64.9% (p=0.058), respectively and 83.7% versus 85.7% (p=0.705) for 2D-T2 reads, respectively. 3D-T2W reads showed significantly higher mean subjective Likert scores of 3.7 ± 1.4 versus 3.3 ± 1.4 (p=0.001) in ECE positive lesions and lower mean Likert score of 1.5 ± 1 versus 1.6 ± 0.9 (p=0.27) in ECE negative lesions compared to 2D-T2W reads. 3D contact significantly increased sensitivity from 59.6% to 73.7% (p=0.03), whilst maintaining the same specificity of 87.8% (p=1). High grade group tumours (≥ Gleason 4+3) showed significantly higher ECE prevalence than low grade tumours (88% versus 44%, p<0.001) and a PPV for ECE of 90.9% with ≥5 mm of contact versus PPV of 90.4% at ≥12.5 mm for lower grade tumours. Conclusions 3D-T2WI significantly increases sensitivity and confidence in calling ECE. The capsular contact length threshold differed between low and high grade cancers.
External DOI: https://doi.org/10.1007/s00330-019-06070-6
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288329