Diagnostic performance of diffusion-weighted imaging combined with dynamic contrast-enhanced magnetic resonance imaging for prostate cancer: a systematic review and meta-analysis

Background The diagnostic performance of diffusion-weighted imaging (DWI) combined with dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) for the detection of prostate cancer (PCa) has not been studied systematically to date. Purpose To investigate the value of DWI combined with DCE-MRI quantitative analysis in the diagnosis of PCa. Material and Methods A systematic search was conducted through PubMed, MEDLINE, the Cochrane Library, and EMBASE databases without any restriction to language up to 10 December 2019. Studies that used a combination of DWI and DCE-MRI for diagnosing PCa were included. Results Nine studies with 778 participants were included. The combination of DWI and DCE-MRI provide accurate performance in diagnosing PCa with pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios of 0.79 (95% confidence interval [CI] = 0.76–0.81), 0.85 (95% CI = 0.83–0.86), 6.58 (95% CI = 3.93–11.00), 0.24 (95% CI = 0.17–0.34), and 36.43 (95% CI = 14.41–92.12), respectively. The pooled area under the summary receiver operating characteristic curve was 0.9268. Moreover, 1.5-T MR scanners demonstrated a slightly better performance than 3.0-T scanners. Conclusion Combined DCE-MRI and DWI could demonstrate a highly accurate area under the curve, sensitivity, and specificity for detecting PCa. More studies with large sample sizes are warranted to confirm these results.