Faculty Bibliography

PURPOSE/OBJECTIVE:To determine whether the presence of an ultrasound hypoechoic region at the site of a MRI region of interest (ROI) results in improved prostate cancer (PCa) detection and predicts clinically significant PCa on MRI - ultrasound fusion targeted prostate biopsy (MRF-TB). MATERIALS AND METHODS/METHODS:Between July 2011 and June 2017, 1058 men who underwent MRF-TB and systematic biopsy by a single surgeon were prospectively entered into an IRB-approved database. MRI ROI were identified and scored for suspicion by a single radiologist. Each MRI ROI was prospectively evaluated for presence of a hypoechoic region at the site (ROI-HyR) by the surgeon and graded as 0,1,2 representing none, poorly demarcated, or well demarcated, respectively. Interaction of MRI suspicion score (mSS) and US grade (USG), and prediction of cancer detection rate (CDR) by USG, was evaluated by univariate and multivariate analysis. RESULTS:For 672 men, overall and Gleason Score (GS)≥7 CDR were 61.2% and 39.6%, respectively. CDR for USG 0,1,2 were 46.2%, 58.6%, 76.0% (p<0.001) for any cancer and 18.7%, 35.2%, 61.1% (p<0.001) for GS≥7, respectively. For MRF-TB only, GS≥7 CDR for USG 0,1,2 was 12.8%, 25.7%, 52.0% (p<0.001), respectively. On univariate analysis, among mSS 2-4, USG was predictive of GS≥7 CDR. Multivariable regression analysis revealed USG, PSAD, and mSS were predictive of GS≥7 PCa on MRF-TB. CONCLUSIONS:Ultrasound findings at the site of MRI ROI independently predict the likelihood of GS≥7 PCa, as men with a well demarcated ROI-HyR at the time of MRF-TB have a higher risk than men without.

PURPOSE/OBJECTIVE:To assess the effect on reader performance of an interactive case-based online tutorial for prostate magnetic resonance imaging (MRI) interpretation using Prostate Imaging and Reporting Data System (PI-RADS). METHODS:An educational website was developed incorporating scrollable multiparametric prostate MRI examinations with annotated solutions based on PI-RADS version 2. Three second-year radiology residents evaluated a separate set of 60 prostate MRI examinations both before and after review of the online case material, identifying and scoring dominant lesions. These 60 examinations included 30 benign cases and 30 cases with a dominant lesion demonstrating Gleason score ≥3 + 4 tumor on fusion-targeted biopsy. The readers' pooled performance was compared between the 2 sessions using logistic regression and Wilcoxon signed rank tests. RESULTS:All readers completed the online material within four-hours. Review of the online material significantly improved sensitivity (from 57.8%-73.3%, P = 0.003) and negative predictive value (from 69.2%-78.2%, P = 0.049), but not specificity (from 70.0%-67.8%, P = 0.692) or positive predictive value (from 59.6%-64.7%, P = 0.389). Reader confidence (1-10 scale; 10 = maximal confidence) also improved significantly (from 5.6 ± 2.7 to 6.3 ± 2.6, P = 0.026). However, accuracy of assigned PI-RADS scores did not improve significantly (from 45.5%-53.3%, P = 0.149). CONCLUSION/CONCLUSIONS:An online interactive case-based website in prostate MRI interpretation improved novice readers' sensitivity and negative predictive value for tumor detection, as well as readers' confidence. This online material may serve as a resource complementing existing traditional methods of instruction by providing a more flexible educational experience among a larger volume of learners. However, further more targeted educational initiatives regarding the proper application of PI-RADS remain warranted.