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Updated: Mar 25, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Value of preoperative 3T multiparametric MRI for surgical margin status in patients with prostate cancer
Tsutomu Tamada1, Teruki Sone1, Naoki Kanomata2
1Department of Radiology, Kawasaki Medical School, Kurashiki, Japan.
Purpose:
To examine the value of preoperative multiparametric magnetic resonance imaging (MRI) as a predictor of surgical margin (SM) status in patients with prostate cancer (PC).
Materials And Methods:
The Institutional Review Board approved this retrospective study; the requirement for informed consent was waived. Fifty-six male patients with histologically proven PC underwent preoperative 3T multiparametric MRI including high b value (0, 2000 s/mm(2) ) diffusion-weighted imaging. In each patient, clinical data, such as biopsy Gleason score and D'Amico clinical risk score, and multiparametric MRI findings, such as tumor location, tumor size, tumor extension in the apical or proximal region, tumor apparent diffusion coefficient (ADC), and the presence or absence of MRI findings of extracapsular extension (ECE) were evaluated. Statistical evaluations included the Fisher's exact test, χ(2) test, Mann-Whitney U-test, and logistic regression analysis.
Results:
On histopathological evaluation, 15 patients (27%) were SM-positive (SMP group), and 41 (73%) were SM-negative (SMN group). The tumor ADC was significantly lower in the SMP group than in the SMN group (P = 0.001). The frequency of tumor extension in the apex or base and suspected ECE on MRI were significantly higher in the SMP group than in the SMN group (P = 0.037 and 0.011, respectively). On multivariate analysis, tumor ADC was the only predictor of SM status in PC (P = 0.003).
Conclusion:
PC with positive SM was characterized by tumor extension in the apical and proximal regions, lower tumor ADC, and tumors with positive MRI findings of ECE, compared to tumors with negative SM. J. Magn. Reson. Imaging 2016;44:584-593.
Insights
Preoperative multiparametric MRI can predict surgical margin status in prostate cancer (PC). Lower tumor apparent diffusion coefficient (ADC) and signs of extracapsular extension (ECE) on MRI indicate positive surgical margins.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer (PC) management relies on accurate staging.
- Surgical margin (SM) status is crucial for predicting PC recurrence.
- Preoperative assessment aids in surgical planning and patient counseling.
Purpose of the Study:
- To evaluate the efficacy of preoperative multiparametric magnetic resonance imaging (MRI) in predicting surgical margin (SM) status in patients with prostate cancer (PC).
Main Methods:
- Retrospective analysis of 56 PC patients who underwent preoperative 3T multiparametric MRI.
- Evaluation of clinical data and MRI findings, including tumor apparent diffusion coefficient (ADC) and extracapsular extension (ECE).
- Statistical analysis using Fisher's exact test, chi-squared test, Mann-Whitney U-test, and logistic regression.
Main Results:
- Lower tumor ADC was significantly associated with positive surgical margins (P=0.001).
- Tumor extension in the apex/base and suspected ECE on MRI were more frequent in patients with positive margins (P=0.037 and P=0.011).
- Multivariate analysis identified tumor ADC as the sole independent predictor of SM status (P=0.003).
Conclusions:
- Preoperative multiparametric MRI, particularly tumor ADC and ECE assessment, is valuable for predicting SM status in PC.
- Findings suggest MRI can help identify patients at higher risk for positive surgical margins.
- This information can guide surgical strategies and postoperative management for PC patients.
