Quantitative MRI biomarker for classification of clinically significant prostate cancer: Calibration for reproducibility across echo times.

Purpose: The purpose of the present study is to develop a calibration method to account for differences in echo times (TE) and facilitate the use of restriction spectrum imaging restriction score (RSIrs) as a quantitative biomarker for the detection of clinically significant prostate cancer (csPCa).
Methods: This study included 197 consecutive patients who underwent MRI and biopsy examination; 97 were diagnosed with csPCa (grade group ≥ 2). RSI data were acquired three times during the same session: twice at minimum TE ~75 ms and once at TE = 90 ms (TEmin ₁ , TEmin ₂ , and TE90, respectively). A linear regression model was determined to match the C-maps of TE90 to the reference C-maps of TEmin ₁ within the interval ranging from 95th to 99th percentile of signal intensity within the prostate. RSIrs comparisons were made at the 98th percentile within each patient's prostate. We compared RSIrs from calibrated TE90 (RSIrs _TE90corr ) and uncorrected TE90 (RSIrs _TE90 ) to RSIrs from reference TEmin ₁ (RSIrs _TEmin1 ) and repeated TEmin ₂ (RSIrs _TEmin2 ). Calibration performance was evaluated with sensitivity, specificity and area under the ROC curve (AUC).
Results: Scaling factors for C ₁ , C ₂ , C ₃ , and C ₄ were estimated as 1.68, 1.33, 1.02, and 1.13, respectively. In non-csPCa cases, the 98th percentile of RSIrs _TEmin2 and RSIrs _TEmin1 differed by 0.27 ± 0.86SI (mean ± standard deviation), whereas RSIrs _TE90 differed from RSIrs _TEmin1 by 1.82 ± 1.20SI. After calibration, this bias was reduced to -0.51 ± 1.21SI, representing a 72% reduction in absolute error. For patients with csPCa, the difference was 0.54 ± 1.98SI between RSIrs _TEmin2 and RSIrs _TEmin1 and 2.28 ± 2.06SI between RSIrs _TE90 and RSIrs _TEmin1 . After calibration, the mean difference decreased to -1.03SI, a 55% reduction in absolute error. At the Youden index for patient-level classification of csPCa (8.94SI), RSIrs _TEmin1 has a sensitivity of 66% and a specificity of 72%.
Conclusions: The proposed linear calibration method produces similar quantitative biomarker values for acquisitions with different TE, reducing TE-induced error by 72% and 55% for non-csPCa and csPCa, respectively.
(© 2024 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)