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.
Results
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).
Conclusion
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
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 07, 2022
Accepted:
September 12,
2022
Received in revised form:
September 6,
2022
Received:
August 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
