A Faster Prostate MRI: Comparing a Novel Denoised, Single-Average T₂ Sequence to the Conventional Multiaverage T₂ Sequence Regarding Lesion Detection and PI-RADS Score Assessment

Background: The T₂ w sequence is a standard component of a prostate MRI examination; however, it is time-consuming, requiring multiple signal averages to achieve acceptable image quality.

Purpose/hypothesis: To determine whether a denoised, single-average T₂ sequence (T₂ -R) is noninferior to the standard multiaverage T₂ sequence (T₂ -S) in terms of lesion detection and PI-RADS score assessment.

Study type: Retrospective.

Population: A total of 45 males (age range 60-75 years) who underwent clinically indicated prostate MRI examinations, 21 of whom had pathologically proven prostate cancer.

Field strength/sequence: A 3 T; T₂ w FSE, DWI with ADC maps, and dynamic contrast-enhanced images with color-coded perfusion maps. T₂ -R images were created from the raw data utilizing a single "average" with iterative denoising.

Assessment: Nine readers randomly assessed complete exams including T₂ -R and T₂ -S images in separate sessions. PI-RADS version 2.1 was used. All readers then compared the T₂ -R and T₂ -S images side by side to evaluate subjective preference. An additional detailed image quality assessment was performed by three senior level readers.

Statistical tests: Generalized linear mixed effects models for differences in lesion detection, image quality features, and overall preference between T₂ -R and T₂ -S sequences. Intraclass correlation coefficients (ICC) were used to assess reader agreement for all comparisons. A significance threshold of P = 0.05 was used for all statistical tests.

Results: There was no significant difference between sequences regarding identification of lesions with PI-RADS ≥3 (P = 0.10) or PI-RADS score (P = 0.77). Reader agreement was excellent for lesion identification (ICC = 0.84). There was no significant overall preference between the two sequences regarding image quality (P = 0.07, 95% CI: [-0.23, 0.01]). Reader agreement was good regarding sequence preference (ICC = 0.62).

Data conclusion: Use of single-average, denoised T₂ -weighted images was noninferior in prostate lesion detection or PI-RADS scoring when compared to standard multiaverage T₂ -weighted images.

Evidence level: 3.

Technical efficacy: Stage 3.