Related Experiment Video
Updated: Dec 28, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Diagnostic Performance of Mass Enhancement on Dynamic Contrast-Enhanced MRI for Predicting Clinically Significant
Sung Yoon Park1, Byung Kwan Park1, Ghee Young Kwon2
1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Abstract:
OBJECTIVE. Current criteria for positive findings on dynamic contrast-enhanced MRI (DCE-MRI) are unclear. We compared the diagnostic performance of mass enhancement on DCE-MRI versus conventional DCE-MRI criteria for identifying clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). MATERIALS AND METHODS. A total of 173 consecutive patients with MRI- and surgically proven prostate cancer (PCa) were evaluated. Two readers independently interpreted DCE-MRI examinations of the PZ. Criteria denoting a positive DCE-MRI examination included conventional criteria from the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and mass enhancement. The diagnostic performance of and interreader agreement for the two types of enhancement criteria in identifying csPCa in the PZ that met Epstein criteria were investigated. RESULTS. The proportion of csPCa in the PZ was 69.3% (120/173). For both readers, the specificity and positive predictive value of mass enhancement were increased compared with conventional enhancement criteria (specificity, 75.5% vs 5.7% [for reader 1] and 84.9% vs 30.2% [for reader 2], respectively; positive predictive value, 87.1% vs 70.6% [for reader 1] and 91.5% vs 75.3% [for reader 2], respectively). The AUC value of mass enhancement was higher than that of conventional criteria (for reader 1, 0.744 [95% CI, 0.672-0.807] vs 0.528 [95% CI, 0.451-0.605] [p < 0.001], respectively; for reader 2, 0.783 [95% CI, 0.714-0.842] vs 0.602 [95% CI, 0.497-0.700] [p < 0.001], respectively). The weighted kappa value for agreement between the two readers was 0.206 for conventional criteria and 0.613 for mass enhancement. CONCLUSION. PZ lesions with mass enhancement on DCE-MRI are more likely to be csPCa. This enhancement pattern may need to be considered as one of the criteria in PI-RADS.
Insights
Mass enhancement on dynamic contrast-enhanced MRI (DCE-MRI) significantly improves the detection of clinically significant prostate cancer (csPCa) in the peripheral zone. This finding suggests incorporating mass enhancement into prostate imaging guidelines for better diagnostic accuracy.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Current criteria for positive findings on dynamic contrast-enhanced MRI (DCE-MRI) for prostate cancer are not clearly defined.
- There is a need to improve the diagnostic performance of DCE-MRI in identifying clinically significant prostate cancer (csPCa).
Purpose of the Study:
- To compare the diagnostic performance of mass enhancement versus conventional DCE-MRI criteria for identifying csPCa in the peripheral zone (PZ).
Main Methods:
- 173 patients with MRI- and surgically proven prostate cancer (PCa) were evaluated.
- Two independent readers interpreted DCE-MRI examinations of the PZ using conventional Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) criteria and mass enhancement criteria.
- Diagnostic performance and interreader agreement were assessed for both criteria in identifying csPCa meeting Epstein criteria.
Main Results:
- Mass enhancement demonstrated higher specificity and positive predictive value compared to conventional criteria for both readers.
- Area Under the Curve (AUC) values for mass enhancement were significantly higher than for conventional criteria (Reader 1: 0.744 vs 0.528; Reader 2: 0.783 vs 0.602).
- Interreader agreement was substantially better for mass enhancement (weighted kappa = 0.613) than for conventional criteria (weighted kappa = 0.206).
Conclusions:
- Peripheral zone lesions exhibiting mass enhancement on DCE-MRI are more indicative of csPCa.
- Mass enhancement should be considered as a criterion within the Prostate Imaging Reporting and Data System (PI-RADS) framework to enhance diagnostic accuracy.
