PURPOSE: This study evaluated the accuracy of MR sequences (T2-, diffusion-weighted, and dynamic contrast-enhanced (T2WI, DWI, and DCE) imaging) at 3T, based on the European Society of Urogenital Radiology (ESUR) scoring system (Prostate Imaging Reporting and Data System (PI-RADS)) using MR-guided in-bore prostate biopsies as reference standard.
METHODS: In 235 consecutive patients (aged 65.7 ± 7.9 years; median prostate-specific antigen (PSA) 8 ng/ml) with multiparametric prostate MRI (mp-MRI), 566 lesions were scored according to PI-RADS. Histology of all lesions was obtained by targeted MR-guided in-bore biopsy.
RESULTS: In 200 lesions, biopsy revealed prostate cancer (PCa). The area under the curve (AUC) for cancer detection was 0.70 (T2WI), 0.80 (DWI), and 0.74 (DCE). A combination of T2WI + DWI, T2WI + DCE, and DWI + DCE achieved an AUC of 0.81, 0.78, and 0.79. A summed PI-RADS score of T2WI + DWI + DCE achieved an AUC of 0.81. For higher grade PCa (primary Gleason pattern ≥ 4), the AUC was 0.85 for T2WI + DWI, 0.84 for T2WI + DCE, 0.86 for DWI + DCE, and 0.87 for T2WI + DWI + DCE. The AUC for T2WI + DWI + DCE for transitional-zone PCa was 0.73, and for the peripheral zone 0.88. Regarding higher-grade PCa, AUC for transitional-zone PCa was 0.88, and for peripheral zone 0.96.
CONCLUSION: The combination of T2WI + DWI + DCE achieved the highest test accuracy, especially in patients with higher-grade PCa. The use of ≤ 2 MR sequences led to lower AUC in higher-grade and peripheral-zone cancers.
Written by:
Schimmöller L, Quentin M, Arsov C, Hiester A, Buchbender C, Rabenalt R, Albers P, Antoch G, Blondin D. Are you the author?
Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
Reference: Eur Radiol. 2014 Jun 28. Epub ahead of print.
doi: 10.1007/s00330-014-3276-9
PubMed Abstract
PMID: 24972954
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