Evaluation of Multiparametric MRI of the Prostate: Impact of Standardized Examination Protocols and the Endorectal Coil

Abstract

Purpose: The aim of the present study was to evaluate the patient population, different MRI examination protocols and the patient's acceptance of the endorectal coil in the diagnosis of prostate cancer regarding the current discussion in PI-RADS v2.1. Material and Methods: In our institute, 256 patients were examined with different protocols and separated into six groups. The value of the different MRI protocols was identified by analyzing sensitivity, specificity, negative predictive value and positive predictive value. The patient population was tested for statistically significant differences in their characteristics to detect a distortion of the results. The patients' acceptance of endorectal coil was evaluated by a query. Results: In total 4.7% of the patients would not recommend a MRI examination because of subjective physical strain and 65.6% of all patients subjectively saw a benefit in the examination in regard to an optimal diagnostic process. The protocol groups reached a sensitivity from 66.7%-100%, a specificity from 40%-75%, a positive predictive value from 33.3%-80% and a negative predictive value from 66.7%-100%. Conclusion: MRI of the prostate is a safe and comfortable tool with high sensitivity and negative predictive value and the potential of ruling out a clinically significant prostate cancer. However, a general recommendation for the use of biparametric MRI could not be given, considering a higher sensitivity could be performed when using dynamic contrast-enhanced MRI or spectroscopy.

Prostate MRI: Is Endorectal Coil Necessary?—A Review

“…Prostate MRI has become instrumental in diagnosing prostate cancer, guiding biopsy in patients with elevated prostate specific antigen (PSA), and in local staging of prostate cancer. Advances in technology have yielded high sensitivity and negative predictive values of up to 96% sensitivity [1] and negative predictive value (NPV) of 68-100% [2,3] for the diagnosis of prostate cancer. Moreover, multiparametric MRI (mpMRI) contributes to risk stratification in distinguishing Gleason 3 + 3 from Gleason scores greater than 6.…”