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Updated: Feb 26, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Abbreviated Biparametric Prostate MR Imaging in Men with Elevated Prostate-specific Antigen
Christiane K Kuhl1, Robin Bruhn1, Nils Krämer1
1From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.).
Abbreviated biparametric prostate magnetic resonance (MR) imaging offers diagnostic accuracy and cancer detection rates equivalent to full multiparametric MR imaging. This faster, contrast-agent-free approach effectively detects clinically significant prostate cancer missed by biopsy.
Area of Science:
- Radiology and Imaging Science
- Oncology
- Urology
Background:
- Elevated prostate-specific antigen (PSA) with negative transrectal ultrasonography (US)-guided biopsy necessitates further diagnostic evaluation for prostate cancer.
- Full multiparametric contrast-enhanced prostate MR imaging is the current standard but involves longer scan times and contrast agent administration.
Purpose of the Study:
- To compare the diagnostic accuracy of abbreviated biparametric prostate MR imaging versus full multiparametric contrast-enhanced prostate MR imaging for clinically significant prostate cancer.
- To evaluate the cancer detection rate and inter-reader agreement for biparametric prostate MR imaging.
Main Methods:
- Retrospective analysis of prospectively acquired data from 542 men with PSA ≥ 3 ng/mL and prior negative biopsy.
- All men underwent full multiparametric MR imaging; radiologists initially reviewed abbreviated (biparametric) sequences (T2-weighted and diffusion-weighted imaging) within 9 minutes.
- Diagnostic accuracy was compared using McNemar test; inter-reader agreement for biparametric interpretation was assessed on 100 cases.
Main Results:
- Biparametric MR imaging detected clinically significant prostate cancer in 138 men with a diagnostic accuracy of 89.1% (483/542).
- Full multiparametric MR imaging detected one additional cancer but resulted in 11 more false positives; its accuracy was 87.2% (473/542).
- Inter-reader agreement for biparametric MR imaging interpretation was substantial (κ = 0.81).
Conclusions:
- Abbreviated biparametric prostate MR imaging demonstrates diagnostic accuracy and cancer detection rates comparable to full multiparametric protocols.
- This rapid, contrast-agent-free MR imaging technique effectively identifies clinically significant prostate cancer missed by initial biopsies.
- Biparametric prostate MR imaging offers a valuable, efficient alternative for evaluating men with elevated PSA and negative biopsies.
