Lars Schimmoeller MD, Presenter: Nothing to Disclose

Michael Quentin MD, Abstract Co-Author: Nothing to Disclose

Frederic Dietzel, Abstract Co-Author: Nothing to Disclose

Christian Buchbender, Abstract Co-Author: Nothing to Disclose

Gerald Antoch MD, Abstract Co-Author: Speaker, Siemens Medical AG Speaker, Bayer AG Speaker, BTG International Ltd

Dirk Blondin MD, Abstract Co-Author: Nothing to Disclose

Christian Arsov MD, Abstract Co-Author: Nothing to Disclose

Robert Rabenalt, Abstract Co-Author: Nothing to Disclose

Peter Albers MD, PhD, Abstract Co-Author: Nothing to Disclose

Andreas Hiester, Abstract Co-Author: Nothing to Disclose

This study evaluates the accuracy of MR-sequences (T2WI, DWI, DCE) at 3T based on the ESUR scoring system (PI-RADS) using MR-guided in-bore prostate biopsies as the reference standard.

In 295 consecutive patients (65.9±7.7 years, PSA value 9.9±8.3 ng/ml; median PSA 8.0 ng/ml, lower/upper quartile 5.8/11.0 ng/ml) with multiparametric prostate MRI (mp-MRI) 566 lesions were scored according to the PI-RADS. Histology of all lesions was obtained by targeted MR-guided in-bore biopsy. Statistical analysis including variance and ROC analysis was conducted for lesions and MR-sequences.

In 200 lesions biopsy revealed a 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 (main 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 0.88 for peripheral zone PCa. Regarding higher grade PCa, AUC for transitional zone PCa was 0.88, and 0.96 for peripheral zone PCa.

The combination of T2WI+DWI+DCE achieved the highest test accuracy, especially in patients with higher grade PCa. The combination of T2WI, DWI, and DCE results in a higher accuracy for peripheral than for transitional zone prostate cancer. DCE have lower impact on cancer detection in the transitional zone.

The use of two or only a single MR-sequences leads to a lower AUC and therefore cannot be recommended. Our data suggest, that the PI-RADS scoring system needs further improvement with respect to weighting and selection of MR-sequences and regarding specific criteria for transitional zone prostate cancer.

Schimmoeller, L, Quentin, M, Dietzel, F, Buchbender, C, Antoch, G, Blondin, D, Arsov, C, Rabenalt, R, Albers, P, Hiester, A, Validation of MR-sequences for Prostate Cancer Diagnostics Based on the PI-RADS Scoring System and Targeted MR-guided in-bore Biopsy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008749.html