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Godley, Keith, Syer, Tom, Toms, Andoni, Smith, Toby 
ORCID: https://orcid.org/0000-0003-1673-2954, Johnson, Glyn, Cameron, Donnie ORCID: https://orcid.org/0000-0001-9841-6909 and Malcolm, Paul
(2018)
Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis.
Acta Radiologica, 59 (1).
pp. 105-113.
ISSN 1600-0455
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Abstract
Background: The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual and also quantitative means of detecting tumor, the Apparent Diffusion Coefficient (ADC). Recently higher b-values have been used to improve DWI’s diagnostic performance. Purpose: To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods: A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, > 10 patients, and data for creating a 2x2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results: Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% CI 0.57–0.61) and 0.92 (95% CI 0.91–0.92) respectively and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant (p=0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion: High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.
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