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Updated: Apr 17, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient
M Abd-Alazeez1, N Ramachandran2, N Dikaios3
11] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Background:
Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences.
Methods:
Thirty-seven men with mean age of 69.7 (interquartile range, 66-74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1-5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics.
Results:
Receiver-operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55-0.80) to 0.80 (95% CI, 0.69-0.91) and from 0.67 (95% CI, 0.55-0.80) to 0.84 (95% CI, 0.76-0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review.
Conclusions:
mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.
Insights
Multiparametric MRI (mp-MRI) effectively detects radiorecurrent prostate cancer. The optimal mp-MRI protocol includes T2-weighted imaging and high b-value diffusion-weighted imaging for accurate diagnosis.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Multiparametric magnetic resonance imaging (mp-MRI) is increasingly utilized for prostate cancer detection.
- Limited data exists on mp-MRI's efficacy in diagnosing radiorecurrent prostate cancer.
- This study aimed to evaluate mp-MRI for detecting prostate cancer recurrence after radiotherapy and assess the contribution of its functional sequences.
Purpose of the Study:
- To assess the diagnostic performance of mp-MRI in detecting radiorecurrent prostate cancer.
- To determine the added value of functional MRI sequences (ADC and DCE) in this setting.
- To identify the optimal mp-MRI protocol for radiorecurrent prostate cancer detection.
Main Methods:
- Thirty-seven patients with biochemical failure post-radiotherapy underwent mp-MRI, including T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE) imaging.
- Two radiologists independently interpreted the mp-MRI studies using a sequential read paradigm.
- mp-MRI findings were correlated with transperineal systematic template prostate mapping (TPM) biopsy results at the hemigland level.
Main Results:
- The area under the receiver-operator characteristic curve (AUC) for detecting radiorecurrent prostate cancer improved with full mp-MRI compared to T2-weighted imaging alone.
- Adding ADC maps and DCE imaging did not significantly enhance the AUC for either reader.
- Inter-reader agreement improved from moderate (k=0.39) to substantial (k=0.65) with the full mp-MRI protocol.
Conclusions:
- mp-MRI is a valuable tool for detecting prostate cancer recurrence after radiotherapy.
- The combination of T2-weighted imaging and high b-value diffusion-weighted imaging represents the optimal mp-MRI protocol.
- Adding ADC maps and DCE imaging does not significantly improve diagnostic accuracy for radiorecurrent prostate cancer.
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