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Updated: Dec 23, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data
Ahmed El-Shater Bosaily1, Elena Frangou2, Hashim U Ahmed3
1Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK.
Background:
Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned.
Objective:
To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences.
Design, Setting, And Participants:
PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images.
Outcome Measurements And Statistical Analysis:
For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive.
Results And Limitations:
Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen.
Conclusions:
Contrast adds little when MP-MRI is used to exclude significant prostate cancer.
Patient Summary:
An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
Insights
Dynamic contrast-enhanced imaging (DCE) offers minimal improvement for multiparametric MRI (MP-MRI) in diagnosing significant prostate cancer. This study found DCE does not significantly enhance accuracy when ruling out tumors, suggesting it may not be necessary.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Multiparametric magnetic resonance imaging (MP-MRI) is a standard tool for prostate cancer diagnosis.
- Recent studies question the necessity of advanced imaging sequences, such as dynamic contrast-enhanced (DCE) MRI.
Purpose of the Study:
- To evaluate if dynamic contrast-enhanced (DCE) MRI enhances the diagnostic accuracy of T2 and diffusion-weighted sequences for prostate cancer detection.
- To determine the added value of DCE in multiparametric MRI protocols.
Main Methods:
- A multicentre trial involving 497 biopsy-naïve men using standardized 1.5T MP-MRI (T2, diffusion, and DCE).
- Transperineal prostate mapping (TPM) biopsy at 5mm intervals was performed.
- Radiologists assigned Likert scores (1-5) for significant tumor presence, first using T2 + diffusion, then adding DCE.
Main Results:
- Sensitivity (95% vs 94%), specificity (38% vs 37%), PPV (51% vs 51%), and NPV (91% vs 90%) showed no significant difference with or without DCE.
- The number of patients avoiding biopsy was similar (121/497 vs 123/497).
- No dominant Gleason 4+ tumors were missed with DCE, compared to one case missed with T2 + diffusion alone.
Conclusions:
- Dynamic contrast-enhanced imaging provides minimal additional benefit to T2 and diffusion sequences in multiparametric MRI for excluding significant prostate cancer.
- The routine use of contrast agents in MP-MRI for prostate cancer may not be necessary for accurate diagnosis.
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