Elaine Ni Mhurchu MBBCh, Presenter: Nothing to Disclose

Fardod O'Kelly, Abstract Co-Author: Nothing to Disclose

Conor D. Collins MBBCh, Abstract Co-Author: Nothing to Disclose

Gerald Lennon, Abstract Co-Author: Nothing to Disclose

David Mulvin, Abstract Co-Author: Nothing to Disclose

David Galvin, Abstract Co-Author: Nothing to Disclose

David Quinlan, Abstract Co-Author: Nothing to Disclose

Colm Jude McMahon MBBCh, Abstract Co-Author: Nothing to Disclose

To assess the value of PIRADs scoring in predicting positive biopsy in patients with previous negative biopsy and elevated PSA, where the repeat biopsy is MR directed, trans-rectal ultrasound guided.

HIPAA compliant, IRB approved study. 52 patients (mean age 64 years, range 52-76), with previous negative prostate biopsy and elevated PSA (mean =14.4 , range =7-34.4 ) underwent combined targeted and 12 sample sectoral biopsy over a 14 month period. Each patient’s MRI was retrospectively reviewed, blinded to biopsy result and each area of abnormality on MRI was scored according to PIRADs scheme, with separate T2, DWI, and overall scores per lesion.

Positive biopsy was obtained in 24/52 patients (overall yield of 46%). Predictive values based on most suspicious lesion overall per patient. PIRADs scores 1-5 (clinically significant cancer highly unlikely, unlikely, equivocal, likely, highly likely respectively). The positive predictive values of T2 PIRADS scores of 1,2,3,4 and 5 were,0, 33,33, 58 and 100% respectively. The positive predictive value of DWI PIRADS score of 1,2,3,4 and 5, was 0,N/A(no scores of 2), 0, 42 and 57% respectively. Only patients with overall score of 3-5 were biopsied, the positive predictive value of overall PIRADs score of 3, 4, 5 was 14, 57 and 100% respectively.

PIRADs provides a useful framework for reporting likelihood of prostate cancer, facilitating communication and guiding expectation of clinicians and patients in the setting of MRI assessment for occult prostate cancer and targeted biopsy.

In patients with raised PSA and previous negative prostate biopy, the use of MRI can help target repeat biopsy and predict the likelihood of a positive result.

Ni Mhurchu, E, O'Kelly, F, Collins, C, Lennon, G, Mulvin, D, Galvin, D, Quinlan, D, McMahon, C, Pi-RADS in Practice - The Predictive Value of Pi-RADS Scoring in Targeted Prostate Biopsies for Patients with Elevated PSA, and Previous Negative Biopsies.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015733.html