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Updated: Feb 8, 2026

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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Quantitative Apparent Diffusion Coefficient Derived From Diffusion-Weighted Imaging Has the Potential to Avoid

Stephan H Polanec, Thomas H Helbich, Hubert Bickel

  • 1Clinical Institute of Pathology, Medical University of Vienna.

Investigative Radiology
|July 10, 2018
PubMed
Abstract

Insights

Apparent diffusion coefficient (ADC) measurements from MRI can help avoid unnecessary prostate biopsies for PI-RADS 4 and 5 lesions. This quantitative analysis shows potential to reduce biopsies by up to 33%.

Area of Science:

  • Radiology
  • Urology
  • Oncology

Background:

  • Multiparametric MRI (mpMRI) is crucial for detecting prostate cancer.
  • Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions require further investigation, often including biopsy.
  • Reducing unnecessary biopsies is essential to minimize patient risk and healthcare costs.

Purpose of the Study:

  • To evaluate the utility of diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC) measurements.
  • To determine if ADC values can obviate the need for biopsies in PI-RADS 4 and 5 prostate lesions.
  • To assess the diagnostic performance and reproducibility of ADC measurements.

Main Methods:

  • Retrospective analysis of 101 PI-RADS 4 and 5 prostate lesions (52 malignant, 49 benign).
  • Two independent readers measured minimum, mean, and maximum ADC values from DWI.
  • Receiver operating characteristic (ROC) analysis and interreader agreement statistics were calculated.

Main Results:

  • Minimum ADC values demonstrated the best diagnostic performance (AUC: 0.779-0.814) and interreader agreement (-8.6% to 9.9%).
  • Rule-in and rule-out thresholds for prostate cancer were established.
  • A potential to avoid unnecessary biopsies in 32.7% of cases was identified.

Conclusions:

  • Quantitative ADC measurements in mpMRI-detected PI-RADS 4 and 5 lesions can aid in clinical decision-making.
  • ADC analysis offers a non-invasive method to potentially reduce unnecessary MRI-guided prostate biopsies.
  • This approach could improve efficiency and patient outcomes by up to 33%.

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