S. Gaur, N. Lay, S.A. Harmon, S. Doddakashi, S. Mehralivand, B. Argun, T. Barrett, S. Bednarova, R. Girometti, E. Karaarslan, A.R. Kural, A. Oto, A.S. Prysko, T. Antic, C. Magi-Galluzzi, Y. Saglican, S. Sioletic, A.Y. Warren, L. Bittencourt, J.J. Fütterer, R.T. Gupta, I. Kabakus, Y. Mee Law, D.J. Margolis, H. Shebel, A.C. Westphalen, B.J. Wood, P.A. Pinto, J.H. Shih, P.L. Choyke, R.M. Summers & B. Turkbey
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.