Improving Prostate Cancer Detection With MRI: A Multi-Reader, Multi-Case Study Using Computer-Aided Detection (CAD)

Published:October 07, 2022DOI:

      Rationale and Objectives

      To evaluate whether addition of a computer-aided diagnostic (CAD) generated MRI series improves detection of clinically significant prostate cancer.

      Materials and Methods

      Nine radiologists retrospectively interpreted 150 prostate MRI examinations without and then with an additional random forest-based CAD model-generated MRI series. Characteristics of biopsy negative versus positive (Gleason ≥ 7 adenocarcinoma) groups were compared using the Wilcoxon test for continuous and Pearson's chi-squared test for categorical variables. The diagnostic performance of readers was compared without versus with CAD using MRMC methods to estimate the area under the receiver operator characteristic curve (AUC). Inter-reader agreement was assessed using weighted inter-rater agreement statistics. Analyses were repeated in peripheral and transition zone subgroups.


      Among 150 men with median age 67 ± 7.4 years, those with clinically significant prostate cancer were older (68 ± 7.6 years vs. 66 ± 7.0 years; p < .02), had smaller prostate volume (43.9 mL vs. 60.6 mL; p < .001), and no difference in prostate specific antigen (PSA) levels (7.8 ng/mL vs. 6.9 ng/mL; p = .08), but higher PSA density (0.17 ng/mL/cc vs. 0.10 ng/mL/cc; p < .001). Inter-rater agreement (IRA) for PI-RADS scores was moderate without CAD and significantly improved to substantial with CAD (IRA = 0.47 vs. 0.65; p < .001). CAD also significantly improved average reader AUC (AUC = 0.72, vs. AUC = 0.67; p = .02).


      Addition of a random forest method-based, CAD-generated MRI image series improved inter-reader agreement and diagnostic performance for detection of clinically significant prostate cancer, particularly in the transition zone.

      Key Words


      CAD (Computer-aided diagnostic), AUC (area under the receiver operator characteristic curve), PSA (prostate specific antigen), bpRF (boosted parallel random forest), mpMRI (multiparametric MRI), bpMRI (biparametric MRI), PI-RADS (Prostate Imaging Reporting & Data System), TRW (T2-weighted), DWI (diffusion-weighted imaging), ADC (apparent diffusion coefficient), MRMC (multi-reader multi-case), PPV (positive predictive value), IQR (interquartile ratio), IRA (inter-rater agreement), BPH (benign prostatic hypertrophy)
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