Accuracy of Multiparametric MRI for Prostate Cancer Detection: A Meta-Analysis

This meta-analysis of the current literature found 7 studies meeting their inclusion criteria for assessment of multiparametric MRI for prostate cancer (defined as using both T2-weighted imaging and functional MR techniques DWI and DCEMRI). All studies had to include comparison with either biopsy or surgical histopathology. Studies were assessed for quality using QUADAS-2.

Overall the meta-analysis of pooled data demonstrated a specificity of 0.88 and sensitivity of 0.74 for prostate cancer detection, with variable NPV ranging from 0.65 to 0.94.

The meta-analysis is methodologically sound, but does have a limited pool of only 7 studies to assess. This provides a good overview of the current literature and provides further evidence of the role of MRI in assessment of patients with suspected or diagnosed prostate cancer.

PICO Analysis:
Population: Patients with suspected prostate cancer.
Intervention: Multiparametric prostate MRI.
Comparison: Surgical or Biopsy histopathology.
Outcome: Sensitivity & Specificity.

Reference: Pubmed Full Text

Prostate Cancer: Can Multiparametric MR Imaging Help Identify Patients Who Are Candidates for Active Surveillance?

Retrospective study of 133 patients who underwent multiparametric MRI before radical prostatectomy.  The MRI results were compared to clinical scoring systems, with pathology (tumour<0.5cc) as the reference standard for assessing eligibility for Active Surveillance. 14/133 would have been eligible for AS based on pathologic results, and the MRI was highly accurate for predicting eligibility for AS.

D'Amico system:  sensitivity 93%, PPV 25%, and accuracy 70%.

Epstein criteria: sensitivity 64%, PPV 45%, and accuracy 88%. 

CAPRA system: sensitivity 93%, PPV 20%, and accuracy 59%.
Multiparametric MR: sensitivity 93%, PPV 57%, and accuracy of 92% (P < .005). 

This is limited by its retrospective nature, but provides further evidence of the utility of multiparametric MRI in the evaluation of prostate cancer.

PICO Analysis:
Population:

• 133 patients (mean age, 59.3 years) 
• Mean PSA 6.73 ng/mL (median, 4.39 ng/mL) 

Intervention: Multiparametric MR imaging at 3.0 T before radical prostatectomy.
Comparison: Conventional clinical assessment scores (the D'Amico, Epstein, and CAPRA scoring systems)
Outcome: Radical prostatectomy pathology specimen (gross tumour <0.5cc) as Active Surveillance eligible.

Reference: Turkbey et al., Radiology, July 2013, 268(1): 144-152.
Links: Pubmed Full Text

Clear Cell Renal Cell Carcinoma: Discrimination from Other Renal Cell Carcinoma Subtypes and Oncocytoma at Multiphasic Multidetector CT

The use of multiphasic CT scan may assist in characterizing renal lesions, especially discriminating some subtypes of renal cell carcinoma (RCC) from oncocytoma.  Young et al demonstrated that oncocytomas have peak enhancement in the corticomedullary phase with an average density of 106 Hu.  Clear cell RCC enhancement also peaks in the corticomedullary phase, however their enhancement is higher than oncocytomas with an average of 125 Hu (p=0.045).  The accuracy for discriminating these lesions was 77%.  Chromophobe and papillary RCCs have peak enhancement in the nephrographic phase.  Their average corticomedullary enhancement is 74 Hu and 54 Hu respectively.  

PICO analysis

P- 298 lesions in 274 patients with an average age of 62 (23-87)

I- Retrospective analysis of enhancement characteristics of renal lesions on multiphasic CT

C- Biopsy, partial nephrectomy, and full nephrectomy results

O-Differentiating renal lesions: Subtypes of RCC versus oncocytomas

Radiology, Volume 267: Number 2, May 2013
Links: Pubmed, Full text