Purpose: To perform a diagnostic test accuracy (DTA) systematic review (SR) and meta-analysis comparing multiparametric (DWI, T2WI, and DCE) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer (PC) in treatment-naïve patients. 

Methods: MEDLINE and EMBASE were searched to identify relevant studies published after January 1, 2012. Articles underwent title, abstract, and full-text screening. Inclusion criteria consisted of patients with suspected PC, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodologic and DTA data was extracted. Risk of bias was assessed using the QUADAS-2 tool. DTA metrics were pooled using bivariate random-effects meta-analysis. Subgroup analysis was conducted to assess for heterogeneity.

Results: From an initial 3502 studies, 31 studies reporting on 9244 patients (4161 with PC) met the inclusion criteria for the meta-analysis; 24 studies reported on mpMRI (6764 patients, 2819 with PC) and 11 studies reported on bpMRI DTA (2480 patients, 1342 with PC). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 85%, 95%-confidence interval [CI] 80-89; bpMRI: 88%, CI 81-92) or specificity (mpMRI: 74%, CI 65-82; bpMRI: 72%, CI 54-86). The summary ROC curves were comparable for mpMRI (0.87) and bpMRI (0.89). 

Conclusions: No significant difference in DTA was found between mpMRI and bpMRI in diagnosing PC in treatment naïve patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium-free alternative to mpMRI.

Biparametric versus Multiparametric Prostate MRI for the Detection of Prostate Cancer in Treatment-Naive Patients: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis