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European Radiology
Published in: European Radiology 10/2018

01-10-2018 | Magnetic Resonance

Computer-aided diagnosis prior to conventional interpretation of prostate mpMRI: an international multi-reader study

Authors: Matthew D. Greer, Nathan Lay, Joanna H. Shih, Tristan Barrett, Leonardo Kayat Bittencourt, Samuel Borofsky, Ismail Kabakus, Yan Mee Law, Jamie Marko, Haytham Shebel, Francesca V. Mertan, Maria J. Merino, Bradford J. Wood, Peter A. Pinto, Ronald M. Summers, Peter L. Choyke, Baris Turkbey

Published in: European Radiology | Issue 10/2018

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Abstract

Objectives

To evaluate if computer-aided diagnosis (CAD) prior to prostate multi-parametric MRI (mpMRI) can improve sensitivity and agreement between radiologists.

Methods

Nine radiologists (three each high, intermediate, low experience) from eight institutions participated. A total of 163 patients with 3-T mpMRI from 4/2012 to 6/2015 were included: 110 cancer patients with prostatectomy after mpMRI, 53 patients with no lesions on mpMRI and negative TRUS-guided biopsy. Readers were blinded to all outcomes and detected lesions per PI-RADSv2 on mpMRI. After 5 weeks, readers re-evaluated patients using CAD to detect lesions. Prostatectomy specimens registered to MRI were ground truth with index lesions defined on pathology. Sensitivity, specificity and agreement were calculated per patient, lesion level and zone—peripheral (PZ) and transition (TZ).

Results

Index lesion sensitivity was 78.2% for mpMRI alone and 86.3% for CAD-assisted mpMRI (p = 0.013). Sensitivity was comparable for TZ lesions (78.7% vs 78.1%; p = 0.929); CAD improved PZ lesion sensitivity (84% vs 94%; p = 0.003). Improved sensitivity came from lesions scored PI-RADS < 3 as index lesion sensitivity was comparable at PI-RADS ≥ 3 (77.6% vs 78.1%; p = 0.859). Per patient specificity was 57.1% for CAD and 70.4% for mpMRI (p = 0.003). CAD improved agreement between all readers (56.9% vs 71.8%; p < 0.001).

Conclusions

CAD-assisted mpMRI improved sensitivity and agreement, but decreased specificity, between radiologists of varying experience.

Key Points

• Computer-aided diagnosis (CAD) assists clinicians in detecting prostate cancer on MRI.
• CAD assistance improves agreement between radiologists in detecting prostate cancer lesions.
• However, this CAD system induces more false positives, particularly for less-experienced clinicians and in the transition zone.
• CAD assists radiologists in detecting cancer missed on MRI, suggesting a path for improved diagnostic confidence.
Appendix
Available only for authorised users
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Metadata
Title
Computer-aided diagnosis prior to conventional interpretation of prostate mpMRI: an international multi-reader study
Authors
Matthew D. Greer
Nathan Lay
Joanna H. Shih
Tristan Barrett
Leonardo Kayat Bittencourt
Samuel Borofsky
Ismail Kabakus
Yan Mee Law
Jamie Marko
Haytham Shebel
Francesca V. Mertan
Maria J. Merino
Bradford J. Wood
Peter A. Pinto
Ronald M. Summers
Peter L. Choyke
Baris Turkbey
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5374-6

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