Artificial Intelligence-Assisted Biparametric MRI for Detecting Prostate Cancer—A Comparative Multireader Multicase Accuracy Study

<b>Objectives:</b> To evaluate the diagnostic accuracy of AI-assisted biparametric MRI (AI-bpMRI) in detecting prostate cancer (PCa) as a possible replacement for multiparametric MRI (mpMRI) depending on readers' experience. <b>Methods:</b> This fully crossed, multireader multicase, single-centre, consecutive study retrospectively included men with suspected PCa. Three radiologists with different levels of experience independently scored each participant's biparametric (bp) MRI, mpMRI, and AI-bpMRI according to the PI-RADS V2.1 classification. The AI-assisted image processing was based on a sequential deep learning network. Histopathological findings were used as a reference. The study evaluated the mean areas under the receiver operating characteristic curves (AUCs) using the jackknife method for covariance. AUCs were tested for non-inferiority of AI-bpMRI to mpMRI (non-inferiority margin: -0.05). <b>Results:</b> A total of 105 men (mean age 66 ± 7 years) were evaluated. AI-bpMRI was non-inferior to mpMRI in detecting both Gleason score (GS) ≥ 3 + 4 PCa (AUC difference: 0.03 [95% CI: -0.03, 0.08], <i>p</i> = 0.37) and GS ≥ 3 + 3 PCa (AUC difference: 0.04 [95% CI: -0.01, 0.09], <i>p</i> = 0.14) and was superior to bpMRI in detecting GS ≥ 3 + 3 PCa (AUC difference: 0.07 [95% CI: 0.02, 0.12], <i>p</i> = 0.004). The benefit of AI-bpMRI was greatest for the readers with low or medium experience (AUC difference in detecting GS ≥ 3 + 4 compared to mpMRI: 0.06 [95% CI: -0.03, 0.14], <i>p</i> = 0.19 and 0.06 [95% CI: -0.03, 0.14], <i>p</i> = 0.19, respectively). <b>Conclusions:</b> This study indicates that AI-bpMRI detects PCa with a diagnostic accuracy comparable to that of mpMRI.