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Value of Dynamic Contrast-Enhanced (DCE) MR Imaging in Peripheral Lesions in PI-RADS-4 Patients
Tim Ullrich1, Michael Quentin1, Christian Arsov2
1University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany.
Objective:
To assess the impact of dynamic contrast-enhanced imaging (DCE) in mp-MRI on prostate cancer (PCa) detection in a large patient cohort assigned to PI-RADS category 4.
Method:
This retrospective, single center cohort study includes 193 consecutive patients with PI-RADS assessment category 4 in mp-MRI (T2WI, DWI, DCE) at 3 T with targeted plus systematic biopsy combined as the reference standard. The detection of prostate cancer with and without the use of DCE was compared.
Results:
Overall, the PCa detection rate in PI-RADS-4 patients was 62 % (119/193) with DCE and 52 % (101/193) without the inclusion of lesions upgraded on the basis of DCE. 48 % (92/193) had clinically significant PCa (csPCa; Gleason score ≥ 3 + 4 = 7) and 40 % (78/193) without use of DCE. 38 of the 193 patients (20 %) had peripheral lesions upgraded from PI-RADS category 3 to an overall PI-RADS category 4 due to focal positive DCE findings. Of these 38 patients, 18 had PCa including 14 with csPCa. Thus, 15 % (18/119) of the patients with PCa and 15 % (14/92) of the patients with csPCa were detected only based on additional DCE information.
Conclusion:
DCE prevents underestimation and misclassification of a significant number of cases of peripheral csPCa and might improve detection rates in PI-RADS-4 patients. The current PI-RADS decision rules regarding upgrading PI-RADS-3 lesions to category 4 due to positive DCE imaging are useful for PCa detection.
Key Points:
· Positive peripheral DCE upgraded 20 % of patients in PI-RADS category 4 from category 3.. · Clinically significant PCa was found in almost 40 % of upgraded, peripheral PIRADS-3-lesions.. · 15 % of all csPCa in PI-RADS-4-patients was detected in DCE-upgraded lesions.. · In 7 % of all PI-RADS-4-cases csPCa would had been underestimated without DCE upgrade..
Citation Format:
· Ullrich T, Quentin M, Arsov C et al. Value of Dynamic Contrast-Enhanced (DCE) MR Imaging in Peripheral Lesions in PI-RADS-4 Patients. Fortschr Röntgenstr 2020; 192: 441 - 447.
Insights
Dynamic contrast-enhanced (DCE) MRI significantly improves prostate cancer (PCa) detection in PI-RADS category 4 patients. Incorporating DCE findings aids in identifying clinically significant PCa, preventing underestimation and misclassification.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer (PCa) diagnosis relies on multiparametric magnetic resonance imaging (mp-MRI).
- The Prostate Imaging Reporting and Data System (PI-RADS) categorizes lesion suspicion.
- Dynamic contrast-enhanced (DCE) imaging is a component of mp-MRI.
Purpose of the Study:
- To evaluate the impact of DCE-MRI on PCa detection rates in patients with PI-RADS category 4 lesions.
- To assess if DCE improves the identification of clinically significant PCa (csPCa).
Main Methods:
- Retrospective analysis of 193 patients with PI-RADS category 4 mp-MRI.
- Comparison of PCa detection with and without the use of DCE findings.
- Biopsy (targeted and systematic) served as the reference standard.
Main Results:
- PCa detection rate was 62% with DCE versus 52% without.
- Clinically significant PCa (csPCa) detection increased from 40% to 48% with DCE.
- DCE upgraded 20% of PI-RADS 3 peripheral lesions to category 4, leading to the detection of csPCa in 15% of all PI-RADS 4 csPCa cases.
Conclusions:
- DCE-MRI enhances PCa detection and reduces underestimation of csPCa in PI-RADS 4 lesions.
- The current PI-RADS guidelines for upgrading PI-RADS 3 lesions based on DCE are valuable for improving PCa detection accuracy.
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