ABSTRACT
OBJECTIVE: To assess the impact of dynamic contrast-enhanced imaging (DCE) in mp-MRI on prostate cancer (PCa) detection in a large patient cohort assigned to PI-RADS category 4. METHOD: This retrospective, single center cohort study includes 193 consecutive patients with PI-RADS assessment category 4 in mp-MRI (T2WI, DWI, DCE) at 3âT with targeted plus systematic biopsy combined as the reference standard. The detection of prostate cancer with and without the use of DCE was compared. RESULTS: Overall, the PCa detection rate in PI-RADS-4 patients was 62â% (119/193) with DCE and 52â% (101/193) without the inclusion of lesions upgraded on the basis of DCE. 48â% (92/193) had clinically significant PCa (csPCa; Gleason score ≥â3â+ 4â=â7) and 40â% (78/193) without use of DCE. 38 of the 193 patients (20â%) had peripheral lesions upgraded from PI-RADS category 3 to an overall PI-RADS category 4 due to focal positive DCE findings. Of these 38 patients, 18 had PCa including 14 with csPCa. Thus, 15â% (18/119) of the patients with PCa and 15â% (14/92) of the patients with csPCa were detected only based on additional DCE information. CONCLUSION: DCE prevents underestimation and misclassification of a significant number of cases of peripheral csPCa and might improve detection rates in PI-RADS-4 patients. The current PI-RADS decision rules regarding upgrading PI-RADS-3 lesions to category 4 due to positive DCE imaging are useful for PCa detection. KEY POINTS: · Positive peripheral DCE upgraded 20â% of patients in PI-RADS category 4 from category 3.. · Clinically significant PCa was found in almost 40â% of upgraded, peripheral PIRADS-3-lesions.. · 15â% of all csPCa in PI-RADS-4-patients was detected in DCE-upgraded lesions.. · In 7â% of all PI-RADS-4-cases csPCa would had been underestimated without DCE upgrade.. CITATION FORMAT: · Ullrich T, Quentin M, Arsov C etâal. Value of Dynamic Contrast-Enhanced (DCE) MR Imaging in Peripheral Lesions in PI-RADS-4 Patients. Fortschr Röntgenstr 2020; 192: 441â-â447.
Subject(s)
Contrast Media , Magnetic Resonance Imaging/methods , Prostatic Neoplasms/diagnostic imaging , Aged , Biopsy , Cohort Studies , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Neoplasm Grading , Prostate/diagnostic imaging , Prostate/pathology , Prostatic Neoplasms/pathology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: We systematically analyzed the records of patients with PI-RADS™ (Prostate Imaging Reporting and Data System) 3 lesions, which are called equivocal according to PI-RADS version 2, using prostate multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsies. Systematic transrectal ultrasound guided biopsies served as the reference standard. MATERIALS AND METHODS: A total of 120 consecutive patients were retrospectively included in the study. In these patients the overall PI-RADS score was 3 after 3 Tesla T2-weighted imaging, diffusion weighted imaging and dynamic contrast enhanced multiparametric magnetic resonance imaging as well as subsequent targeted magnetic resonance imaging/ultrasound fusion guided biopsies plus systematic 12-core transrectal ultrasound guided biopsies. The study end points were the prostate cancer detection rate, the Gleason score distribution, the prostate cancer location and risk stratification by subgroup analyses. RESULTS: Prostate cancer was detected in 13 of 118 patients for a detection rate of 11%, including 5 patients (4.2%) with a Gleason score of 3 + 4 = 7 or greater. Three of the 212 lesions (1.4%) in the transition zone and 6 of the 64 (9.4%) in the peripheral zone were positive for prostate cancer. Multiparametric magnetic resonance imaging revealed patterns of peripheral prostatitis combined with diffuse stromal hyperplasia in 54% of the patients with prostate cancer. Prostate volume was significantly lower in patients with prostate cancer (p = 0.015) but differences in prostate specific antigen levels were not statistically significant (p = 0.87). Prostate specific antigen density was higher in patients with prostate cancer (0.19 vs 0.12 ng/ml/ml). CONCLUSIONS: Low grade prostate cancer (Gleason score 3 + 3 = 6) can develop in patients with an overall PI-RADS score of 3. Prostate cancer with a Gleason score of 3 + 4 = 7 or greater can be detected by multiparametric magnetic resonance imaging with a high degree of certainty. Gleason score 4 + 3 = 7 or greater prostate cancer is unlikely in PI-RADS 3 lesions. Therefore, these patients should primarily undergo followup multiparametric magnetic resonance imaging. In patients with a combination of multiparametric magnetic resonance imaging aspects of extensive prostatitis and diffuse stromal hyperplasia low prostate volume and/or high prostate specific antigen density biopsy might be considered.