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

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.