ABSTRACT
Background Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade ≥2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results A total of 1538 patients (mean age, 67 years ± 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa (P = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI (P = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI (P = .04 and .23, respectively). Conclusion There was no evidence of a difference in PPV for clinically significant PCa between bpMRI- and mpMRI-directed TRUS-guided targeted biopsy. © RSNA, 2024 Supplemental material is available for this article.
Subject(s)
Image-Guided Biopsy , Multiparametric Magnetic Resonance Imaging , Predictive Value of Tests , Prostate , Prostatic Neoplasms , Ultrasonography, Interventional , Humans , Male , Aged , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Retrospective Studies , Cross-Sectional Studies , Image-Guided Biopsy/methods , Multiparametric Magnetic Resonance Imaging/methods , Prostate/diagnostic imaging , Prostate/pathology , Ultrasonography, Interventional/methods , Middle Aged , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging, Interventional/methodsABSTRACT
PURPOSE: To perform a scoping review of the literature evaluating patient preparation for prostate MRI. METHODS: We conducted a search of English language literature, between 1989 and 2022 using MEDLINE and EMBASE for key terms: diet, enema, gel, catheter and anti-spasmodic agents linked to prostate MRI. Studies were reviewed for: level of evidence (LOE), study design and key results. Knowledge gaps were identified. RESULTS: Three studies evaluated dietary modification in 655 patients. LOE was 3. All studies showed improved DWI and T2W image quality (IQ) and reduced DWI artifact. Nine studies evaluated enema use in 1551 patients. Mean LOE was 2.8 (range 2-3). Six studies reported IQ; DWI and T2W IQ were significantly improved with enema in 5/6 and 4/6 studies respectively. Only one study evaluated DWI/T2W lesion visibility which was improved with enema. One study evaluated impact of enema on eventual prostate cancer diagnosis, showing no benefit in false negative reduction. One study (LOE = 2, 150 patients) evaluated rectal gel; however, in combination with enema showing improved DWI and T2W IQ, lesion visibility and PI-QUAL compared to no preparation. Two studies evaluated use of rectal catheter in 396 patients. LOE was 3. One study showed improved DWI and T2W IQ and artifact compared to no preparation; however, the other showed inferior results comparing rectal catheter to enema. Six studies evaluated anti-spasmodic agent use in 888 patients. Mean LOE was 2.8 (range 2-3). Benefit of anti-spasmodic agent use on image quality and artifact on DWI and T2W are conflicting with no clear benefit. CONCLUSION: Data evaluating patient preparation for prostate MRI is limited by level of evidence, study design and conflicting results. The majority of published studies do not evaluate impact of patient preparation on eventual prostate cancer diagnosis.
Subject(s)
Prostate , Prostatic Neoplasms , Male , Humans , Prostate/pathology , Diffusion Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/methods , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Enema , Retrospective StudiesABSTRACT
Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.
