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How Often is the Dynamic Contrast Enhanced Score Needed in PI-RADS Version 2?

Albert T Roh1, Richard E Fan2, Geoffrey A Sonn3

  • 1Department of Radiology, Stanford University, Stanford, CA.

Current Problems in Diagnostic Radiology
|May 26, 2019
PubMed
Abstract

Insights

Dynamic contrast enhanced (DCE) imaging is infrequently needed for Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scoring. Prostate-specific antigen density (PSAD) may reduce or replace the need for DCE in prostate MRI.

Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) guidelines assign a limited role to dynamic contrast enhanced (DCE) imaging.
  • This study investigated the actual utilization frequency of DCE in PI-RADS v2 scoring.

Purpose of the Study:

  • To evaluate the necessity of DCE in PI-RADS v2 scoring for prostate MRI.
  • To explore the potential of prostate-specific antigen density (PSAD) as an alternative to DCE.

Main Methods:

  • Retrospective review of 388 patients undergoing prostate MRI and biopsy (January 2016 - December 2017).
  • DCE was indicated based on specific PI-RADS v2 criteria for peripheral and transition zone lesions.
  • Receiver operating characteristic curve analysis assessed PSAD accuracy for differentiating lesions, compared to DCE using McNemar's test.

Main Results:

  • Only 16% of patients (62/388) required DCE for PI-RADS v2 scoring.
  • Clinically significant cancer (Gleason score ≥7) was found in 14% (10/69) of lesions requiring DCE.
  • In equivocal lesions, PSAD thresholds showed comparable accuracy to DCE in identifying significant cancer.

Conclusions:

  • The limited use of DCE (16%) suggests that initial screening prostate MRI could potentially exclude contrast agents.
  • Prostate-specific antigen density (PSAD) demonstrates potential to reduce or replace the need for DCE in PI-RADS v2 assessments.

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