. 2018 Sep 18;9(73):33804-33817.

doi: 10.18632/oncotarget.26100.

Can computer-aided diagnosis assist in the identification of prostate cancer on prostate MRI? a multi-center, multi-reader investigation

Sonia Gaur¹, Nathan Lay², Stephanie A Harmon^{1

3}, Sreya Doddakashi¹, Sherif Mehralivand^{1

4

5}, Burak Argun⁶, Tristan Barrett⁷, Sandra Bednarova⁸, Rossanno Girometti⁸, Ercan Karaarslan⁹, Ali Riza Kural⁶, Aytekin Oto¹⁰, Andrei S Purysko¹¹, Tatjana Antic¹², Cristina Magi-Galluzzi¹³, Yesim Saglican¹⁴, Stefano Sioletic¹⁵, Anne Y Warren¹⁶, Leonardo Bittencourt¹⁷, Jurgen J Fütterer¹⁸, Rajan T Gupta¹⁹, Ismail Kabakus²⁰, Yan Mee Law²¹, Daniel J Margolis²², Haytham Shebel²³, Antonio C Westphalen²⁴, Bradford J Wood²⁵, Peter A Pinto⁴, Joanna H Shih²⁶, Peter L Choyke¹, Ronald M Summers², Baris Turkbey¹

Affiliations

¹ Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
² Imaging Biomarkers and Computer-aided Diagnosis Lab, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
³ Clinical Research Directorate/ Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.
⁴ Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
⁵ Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
⁶ Department of Urology, Acibadem University, Istanbul, Turkey.
⁷ Department of Radiology, University of Cambridge, Cambridge, UK.
⁸ Department of Radiology, University of Udine, Udine, Italy.
⁹ Department of Radiology, Acibadem University, Istanbul, Turkey.
¹⁰ Department of Radiology, University of Chicago, Chicago, IL, USA.
¹¹ Department of Radiology, Cleveland Clinic, Cleveland, OH, USA.
¹² Department of Pathology, University of Chicago, Chicago, IL, USA.
¹³ Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
¹⁴ Department of Pathology, Acibadem University, Istanbul, Turkey.
¹⁵ Department of Pathology, University of Udine, Udine, Italy.
¹⁶ Department of Pathology, University of Cambridge, Cambridge, UK.
¹⁷ Department of Radiology, Federal Fluminense University, Rio de Janeiro, Brazil.
¹⁸ Department of Radiology, Radboud University, Nijmegen, The Netherlands.
¹⁹ Department of Radiology, Duke University, Durham, NC, USA.
²⁰ Department of Radiology, Hacettepe University, Ankara, Turkey.
²¹ Department of Radiology, Singapore General Hospital, Singapore.
²² Weill Cornell Imaging, Cornell University, New York, NY, USA.
²³ Department of Radiology, Mansoura University, Mansoura, Egypt.
²⁴ UCSF Department of Radiology, University of California-San Francisco, San Francisco, CA, USA.
²⁵ Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
²⁶ Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

PMID: 30333911
PMCID: PMC6173466
DOI: 10.18632/oncotarget.26100

Can computer-aided diagnosis assist in the identification of prostate cancer on prostate MRI? a multi-center, multi-reader investigation

Sonia Gaur et al. Oncotarget. 2018.

. 2018 Sep 18;9(73):33804-33817.

doi: 10.18632/oncotarget.26100.

Authors

Affiliations

¹ Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
² Imaging Biomarkers and Computer-aided Diagnosis Lab, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
³ Clinical Research Directorate/ Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.
⁴ Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
⁵ Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
⁶ Department of Urology, Acibadem University, Istanbul, Turkey.
⁷ Department of Radiology, University of Cambridge, Cambridge, UK.
⁸ Department of Radiology, University of Udine, Udine, Italy.
⁹ Department of Radiology, Acibadem University, Istanbul, Turkey.
¹⁰ Department of Radiology, University of Chicago, Chicago, IL, USA.
¹¹ Department of Radiology, Cleveland Clinic, Cleveland, OH, USA.
¹² Department of Pathology, University of Chicago, Chicago, IL, USA.
¹³ Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
¹⁴ Department of Pathology, Acibadem University, Istanbul, Turkey.
¹⁵ Department of Pathology, University of Udine, Udine, Italy.
¹⁶ Department of Pathology, University of Cambridge, Cambridge, UK.
¹⁷ Department of Radiology, Federal Fluminense University, Rio de Janeiro, Brazil.
¹⁸ Department of Radiology, Radboud University, Nijmegen, The Netherlands.
¹⁹ Department of Radiology, Duke University, Durham, NC, USA.
²⁰ Department of Radiology, Hacettepe University, Ankara, Turkey.
²¹ Department of Radiology, Singapore General Hospital, Singapore.
²² Weill Cornell Imaging, Cornell University, New York, NY, USA.
²³ Department of Radiology, Mansoura University, Mansoura, Egypt.
²⁴ UCSF Department of Radiology, University of California-San Francisco, San Francisco, CA, USA.
²⁵ Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
²⁶ Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

PMID: 30333911
PMCID: PMC6173466
DOI: 10.18632/oncotarget.26100

Abstract

For prostate cancer detection on prostate multiparametric MRI (mpMRI), the Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) and computer-aided diagnosis (CAD) systems aim to widely improve standardization across radiologists and centers. Our goal was to evaluate CAD assistance in prostate cancer detection compared with conventional mpMRI interpretation in a diverse dataset acquired from five institutions tested by nine readers of varying experience levels, in total representing 14 globally spread institutions. Index lesion sensitivities of mpMRI-alone were 79% (whole prostate (WP)), 84% (peripheral zone (PZ)), 71% (transition zone (TZ)), similar to CAD at 76% (WP, p=0.39), 77% (PZ, p=0.07), 79% (TZ, p=0.15). Greatest CAD benefit was in TZ for moderately-experienced readers at PI-RADSv2 <3 (84% vs mpMRI-alone 67%, p=0.055). Detection agreement was unchanged but CAD-assisted read times improved (4.6 vs 3.4 minutes, p<0.001). At PI-RADSv2 ≥ 3, CAD improved patient-level specificity (72%) compared to mpMRI-alone (45%, p<0.001). PI-RADSv2 and CAD-assisted mpMRI interpretations have similar sensitivities across multiple sites and readers while CAD has potential to improve specificity and moderately-experienced radiologists' detection of more difficult tumors in the center of the gland. The multi-institutional evidence provided is essential to future prostate MRI and CAD development.

Keywords: PI-RADSv2; computer-aided diagnosis; multiparametric MRI; prostate cancer; tumor detection.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST Dr. Ronald M. Summers: Patent royalties from iCAD & ScanMed, Research support from Ping An & NVidia, Software licenses to Philips & Ping An. Dr. Bradford J. Wood reports grants from NIH Intramural Research Program , during the conduct of the study; grants and non-financial support from CRADA with Philips, grants and non-financial support from CRADA with Celsion Corp, grants and non-financial support from CRADA with Siemens, grants and non-financial support from CRADA with Biocompatibles BTG, grants and non-financial support from CRADA with NVIDIA, grants and non-financial support from CRADA with Profound Medical, grants and non-financial support from CRADA with XAct Robotics, outside the submitted work; In addition, Dr. Wood has a patent Fusion Patents with royalties paid to NIH and to Dr. Wood by Philips, but this is unrelated to this work.

Figures

**Figure 1**
Index lesion sensitivity in WP, PZ, TZ for MRI-only **(A)** and CAD-assisted **(B)** reads. Sensitivities are plotted for all readers as well as by experience level at each PI-RADSv2 category threshold. PI-RADSv2 category ≥1 threshold used for all lesions detected on MRI and CAD, while PI-RADSv2 category ≥3 threshold used to represent all lesions considered cumulatively suspicious on MRI and CAD. WP = whole prostate, PZ = peripheral zone, TZ = transition zone.

**Figure 2. Benefit of CAD in TZ tumor identification**
CAD (top left) picked up a tumor (arrows) in the right apical anterior TZ, identified by more readers on MRI (T2W top right, ADC map bottom left, b-1500 bottom right) with CAD assistance. ND = not detected, D = detected; the tumor was found by 5 readers with CAD assistance versus 1 reader with mpMRI alone. Radical prostatectomy histopathology mapping revealed Gleason 4+5 prostatic adenocarcinoma within this lesion.

**Figure 3. Study design**
The large multi-institutional framework is shown starting with image acquisition and ending with image interpretation across multiple institutions and readers.

See this image and copyright information in PMC

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Can computer-aided diagnosis assist in the identification of prostate cancer on prostate MRI? a multi-center, multi-reader investigation

Affiliations

Can computer-aided diagnosis assist in the identification of prostate cancer on prostate MRI? a multi-center, multi-reader investigation

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