On-table monitoring of prostate MRI could enable tailored utilisation of gadolinium contrast.

Abstract

Objectives: To compare the impact of on-table monitoring vs standard-of-care multiparametric MRI (mpMRI) for the utilisation of gadolinium contrast use in prostate MRI.

Materials and methods: This retrospective observation study of prospectively acquired data was conducted at a single institution over an 18-month period. A cohort of patients undergoing MRI for suspected prostate cancer (PCa) underwent on-table monitoring where their T2 and DWI images were reviewed by a supervising radiologist during the scan to decide whether to acquire dynamic contrast-enhanced (DCE) sequences. MRI scans were reported using PI-RADS v2.1, patients were followed up with biopsy for at least 12 months. The rate of gadolinium administration, biopsy rates, and diagnostic accuracy were compared to that of a standard-of-care control group undergoing mpMRI during the same period using propensity score matching. Estimates of cost savings were also calculated.

Results: 1410 patients were identified and after propensity score matching 598 patients were analysed, with 178 undergoing on-table monitoring. Seventy-five and eight tenths (135/178) of patients did not receive gadolinium. Contrast was used mainly for indeterminate lesions (27/43) and significant artefacts on bpMRI (14/43). When comparing the monitored cohort to a non-monitored control group, there was a comparable number of biopsies performed (52.2% vs 49.5%, p = 0.54), PI-RADS 3/5 scoring rates (10.1% vs 7.4%, p = 0.27), sensitivity (98.3% vs 99.2%, p = 0.56), and specificity (63.9% vs 70.7%, p = 0.18) for detection of clinically-significant PCa. When acquired, DCE was deemed helpful in 67.4% (29/43) of cases and improved both PI-QUALv2 and reader confidence scores. There was an estimated saving of £56,677 over the 18-month study.

Conclusion: On-table monitoring significantly reduced the need for gadolinium contrast without compromising diagnostic accuracy and biopsy rates.

Key points: Question Default use of gadolinium contrast in prostate MRI is not always of clinical benefit and has associated side effects and healthcare costs. Findings On-table monitoring avoided the use of gadolinium in 75.8% of patients, reducing associated costs whilst maintaining clinically significant cancer detection, and diagnostic accuracy and improving reader confidence. Clinical relevance On-table monitoring offers personalised patient protocolling with a significant reduction in the use of gadolinium and its associated side effects and costs, potentially maximising the advantages of both multiparametric and biparametric prostate MRI.