Objectives:To identify the group of patients who could safely avoid prostate biopsy based on the findings of multiparametric prostate resonance imaging (MRmp), parameterized with PI-RADS v2, using prostate biopsy as reference test and to assess the sensitivity and specificity of mpMR in identifying clinically significant prostate cancer using prostate biopsy as a reference test.Patients and Methods:Three hundred and forty two patients with suspected prostate cancer were evaluated with mpMR and prostate biopsy. Agreement between imaging findings and histopathological findings was assessed using the Kappa index. The accuracy of mpMR in relation to biopsy was assessed by calculations of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:A total of 342 biopsies were performed. In 201 (61.4%), mpMR had a negative result for cancer, which was confirmed on biopsy in 182 (53%) of the cases, 17 (4.9%) presented non-clinically significant cancer and only 2 (0.5%) clinically significant cancer. 131 (38.3%) patients had a positive biopsy. Clinically significant cancer corresponded to 83 (34.2%), of which 81 (97.5%) had a positive result in mpMR. Considering only the clinically significant cancers the mpMR had a sensitivity of 97.6%, specificity of 76.8%, PPV 57.4% and VPN of 99%.Conclusions:mpMR is a useful tool to safely identify which patients at risk for prostate cancer need to undergo biopsy and has high sensitivity and specificity in identifying clinically significant prostate cancer.
PurposeTo compare diffusion images and coefficients obtained with 4 b-value versus 12 b-value apparent diffusion coefficient (ADC) mapping for characterization of prostate lesions and how these coefficients relate and compare to the PI-RADS™ classification and Gleason grading system.MethodsPatients with indications for prostate cancer testing (n=158) underwent multiparametric 3T magnetic resonance imaging (MRI). Two diffusion sequences were acquired, one with 4 b values and one with 12 b values. ADC maps were calculated for each (ADC4 and ADC12) and the respective coefficients were tested for correlation with PI-RADS™ classification and Gleason score.ResultsThe ADC12 sequence produced images of superior quality and sharpness than ADC4. Normal-area means (ADC4, 1793.3×10−6mm2/s; ADC12, 1100×10−6mm2/s) were significantly lower than those of lesion areas (ADC4, 1105.9×10−6mm2/s; ADC12, 689.4×10−6mm2/s) (p<0.001). Both techniques behaved similarly and correlated well with PI-RADS™ classification, distinguishing scores 3, 4, and 5 and with means tending to decline with increasing Gleason grade. ADC12 mapping yielded higher specificity than ADC4 (82.6% vs. 72.3%).ConclusionsDiffusion with 12 values is a viable technique for examination of the prostate. It produced higher-quality images than current techniques and correlates well with PI-RADS™ classification and Gleason score.
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