This NIHR HTA-funded evidence synthesis aimed at assessing the diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy (MRS), enhanced dynamic contrast-enhanced MRI (DCE-MRI), and diffusion weighted MRI (DW-MRI) in localising prostate abnormalities for biopsy in men with prior negative biopsy for whom harbouring malignancy was still suspected.
MRS, DCE-MRI and DW-MRI were compared with T2-weighted magnetic resonance imaging (T2-MRI) and transrectal ultrasound-guided biopsy (TRUS) against a reference standard of biopsied tissues (histopathology).
Fifty-one studies involving over 10,000 men were included in this assessment. MRS had higher sensitivity and specificity than T2-MRI. Few studies reported DCE-MRI or DW-MRI. The cost-effectiveness of MRS compared with T2-MRI and TRUS was sensitive to several key parameters. If MRS and DW-MRI can be shown to have high sensitivity for detecting moderate/high-risk cancer, while avoiding the need for men with no cancer/low-risk disease undergoing biopsy, they could represent a cost-effective approach to diagnosis. However, further studies are required to demonstrate this. In particular, comparisons of the individual and combined components of a multiparametric magnetic resonance (MR) approach (MRS, DCE-MRI and DW-MRI) with both a MR-biopsy session and an extended TRUS-guided biopsy scheme would be useful. For more information see http://www.nets.nihr.ac.uk/projects/hta/0914601.
Moira Cruickshank; firstname.lastname@example.org
Mowatt G, Scotland G, Boachie C, Cruickshank M, Ford J, Fraser C, et al.The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 2013;17(20)