A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness with a Quantitative Multiparametric Magnetic Resonance Imaging Approach

Marnix C. Maas, Geert J.S. Litjens, Alan J. Wright, Ulrike I. Attenberger, Masoom A. Haider, Thomas H. Helbich, Berthold Kiefer, Katarzyna Macura, Daniel J.A. Margolis, Anwar R. Padhani, Kirsten M. Selnæs, Geert M. Villeirs, Jurgen J. Fütterer, Tom W.J. Scheenen

Research output: Contribution to journalArticle

Abstract

The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. Materials and Methods Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. Results Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89-0.96] and 0.86 [0.75-0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57-0.90], P < 0.001). The best separation of GG1-2 from GG3-5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78-0.98]). Conclusions Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.

Original languageEnglish (US)
Pages (from-to)437-447
Number of pages11
JournalInvestigative radiology
Volume54
Issue number7
DOIs
StatePublished - Jul 1 2019

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Validation Studies
Multicenter Studies
Magnetic Resonance Imaging
Neoplasms
Area Under Curve
ROC Curve
Prostatic Neoplasms
Logistic Models
Prostate Cancer, Hereditary, 7
Prostate
Confidence Intervals
Biopsy

Keywords

  • Gleason group
  • interpatient variation
  • intersite variation
  • mpMRI
  • multicenter
  • prostate cancer
  • quantitative validation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness with a Quantitative Multiparametric Magnetic Resonance Imaging Approach. / Maas, Marnix C.; Litjens, Geert J.S.; Wright, Alan J.; Attenberger, Ulrike I.; Haider, Masoom A.; Helbich, Thomas H.; Kiefer, Berthold; Macura, Katarzyna; Margolis, Daniel J.A.; Padhani, Anwar R.; Selnæs, Kirsten M.; Villeirs, Geert M.; Fütterer, Jurgen J.; Scheenen, Tom W.J.

In: Investigative radiology, Vol. 54, No. 7, 01.07.2019, p. 437-447.

Research output: Contribution to journalArticle

Maas, MC, Litjens, GJS, Wright, AJ, Attenberger, UI, Haider, MA, Helbich, TH, Kiefer, B, Macura, K, Margolis, DJA, Padhani, AR, Selnæs, KM, Villeirs, GM, Fütterer, JJ & Scheenen, TWJ 2019, 'A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness with a Quantitative Multiparametric Magnetic Resonance Imaging Approach', Investigative radiology, vol. 54, no. 7, pp. 437-447. https://doi.org/10.1097/RLI.0000000000000558
Maas, Marnix C. ; Litjens, Geert J.S. ; Wright, Alan J. ; Attenberger, Ulrike I. ; Haider, Masoom A. ; Helbich, Thomas H. ; Kiefer, Berthold ; Macura, Katarzyna ; Margolis, Daniel J.A. ; Padhani, Anwar R. ; Selnæs, Kirsten M. ; Villeirs, Geert M. ; Fütterer, Jurgen J. ; Scheenen, Tom W.J. / A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness with a Quantitative Multiparametric Magnetic Resonance Imaging Approach. In: Investigative radiology. 2019 ; Vol. 54, No. 7. pp. 437-447.
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abstract = "The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. Materials and Methods Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. Results Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4{\%} [14{\%}] and 8{\%} [46{\%}], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95{\%} confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89-0.96] and 0.86 [0.75-0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57-0.90], P < 0.001). The best separation of GG1-2 from GG3-5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78-0.98]). Conclusions Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.",
keywords = "Gleason group, interpatient variation, intersite variation, mpMRI, multicenter, prostate cancer, quantitative validation",
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T1 - A Single-Arm, Multicenter Validation Study of Prostate Cancer Localization and Aggressiveness with a Quantitative Multiparametric Magnetic Resonance Imaging Approach

AU - Maas, Marnix C.

AU - Litjens, Geert J.S.

AU - Wright, Alan J.

AU - Attenberger, Ulrike I.

AU - Haider, Masoom A.

AU - Helbich, Thomas H.

AU - Kiefer, Berthold

AU - Macura, Katarzyna

AU - Margolis, Daniel J.A.

AU - Padhani, Anwar R.

AU - Selnæs, Kirsten M.

AU - Villeirs, Geert M.

AU - Fütterer, Jurgen J.

AU - Scheenen, Tom W.J.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. Materials and Methods Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. Results Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89-0.96] and 0.86 [0.75-0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57-0.90], P < 0.001). The best separation of GG1-2 from GG3-5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78-0.98]). Conclusions Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.

AB - The aims of this study were to assess the discriminative performance of quantitative multiparametric magnetic resonance imaging (mpMRI) between prostate cancer and noncancer tissues and between tumor grade groups (GGs) in a multicenter, single-vendor study, and to investigate to what extent site-specific differences affect variations in mpMRI parameters. Materials and Methods Fifty patients with biopsy-proven prostate cancer from 5 institutions underwent a standardized preoperative mpMRI protocol. Based on the evaluation of whole-mount histopathology sections, regions of interest were placed on axial T2-weighed MRI scans in cancer and noncancer peripheral zone (PZ) and transition zone (TZ) tissue. Regions of interest were transferred to functional parameter maps, and quantitative parameters were extracted. Across-center variations in noncancer tissues, differences between tissues, and the relation to cancer grade groups were assessed using linear mixed-effects models and receiver operating characteristic analyses. Results Variations in quantitative parameters were low across institutes (mean [maximum] proportion of total variance in PZ and TZ, 4% [14%] and 8% [46%], respectively). Cancer and noncancer tissues were best separated using the diffusion-weighted imaging-derived apparent diffusion coefficient, both in PZ and TZ (mean [95% confidence interval] areas under the receiver operating characteristic curve [AUCs]; 0.93 [0.89-0.96] and 0.86 [0.75-0.94]), followed by MR spectroscopic imaging and dynamic contrast-enhanced-derived parameters. Parameters from all imaging methods correlated significantly with tumor grade group in PZ tumors. In discriminating GG1 PZ tumors from higher GGs, the highest AUC was obtained with apparent diffusion coefficient (0.74 [0.57-0.90], P < 0.001). The best separation of GG1-2 from GG3-5 PZ tumors was with a logistic regression model of a combination of functional parameters (mean AUC, 0.89 [0.78-0.98]). Conclusions Standardized data acquisition and postprocessing protocols in prostate mpMRI at 3 T produce equivalent quantitative results across patients from multiple institutions and achieve similar discrimination between cancer and noncancer tissues and cancer grade groups as in previously reported single-center studies.

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KW - interpatient variation

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KW - mpMRI

KW - multicenter

KW - prostate cancer

KW - quantitative validation

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