Frederic Dietzel, Abstract Co-Author: Nothing to Disclose

Lars Schimmoeller MD, Presenter: Nothing to Disclose

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

Patric Kroepil MD, 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

Andreas Hiester, Abstract Co-Author: Nothing to Disclose

Robert Rabenalt, Abstract Co-Author: Nothing to Disclose

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

This study evaluates the correlation of the ESUR scoring system (PI-RADS) with prostate cancer detection using MR-guided in-bore prostate biopsies as the reference standard.

566 lesions in 295 consecutive patients (65.9±7.7 years, PSA 9.9±8.3ng/ml) with a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the prostate at 3T were scored according to PI-RADS. All lesions were histologically verified by targeted MR-guided in-bore biopsy.

Lesions with a summed PI-RADS score below 9 contained no prostate cancer (PCa) with Gleason score (GS) ≥4+3=7. A summed PI-RADS score of 13-15 resulted in 87.8% (n=108) in PCa and in 42.3% (n=52) in GS≥4+3=7. Transitional zone (TZ) lesions with a score of 13-15 resulted in 76.3% (n=36) in PCa and in 26.3% (n=10) in GS ≥4+3=7, whereas for peripheral zone (PZ) lesions cancer detection rate at this score was 92.9% (n=79) and 49.4% (n=42) for GS≥4+3=7. Using a threshold of ≥10, sensitivity was 86.0%, and negative predictive value (NPV) was 86.2%. For higher grade PCa sensitivity was 98.6%, and NPV was 99.5%.

The summed PI-RADS score showed a very good correlation to tumor detection rates, especially for higher grade PCa. PZ lesions demonstrated a better correlation to the PI-RADS score with higher detection rates for higher grade PCa compared to TZ lesions. A cut-off limit of 10 for PI-RADS leads to good sensitivity and high NPV. PI-RADS achieve for higher grade PCa detection nearly 100% sensitivity and NPV with a cut-off limit of 10.

A summed PI-RADS score below 9 excluded a higher grade PCa, whereas lesions with a score ≥13 represented in 88% PCa, and in 42% higher grade PCa. Nonetheless further improvement of PI-RADS is required to reduce unnecessary over diagnostics.

Dietzel, F, Schimmoeller, L, Quentin, M, Kroepil, P, Antoch, G, Blondin, D, Arsov, C, Hiester, A, Rabenalt, R, Albers, P, Power of the ESUR Scoring System: Prostate Cancer Detection Based on Targeted MR-guided in-bore Biopsy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009267.html