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Updated: Dec 6, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Comparison of multiple abbreviated multiparametric MRI-derived protocols for the detection of clinically significant
Lorenzo Cereser1, Gianluca Giannarini2, Filippo Bonato3
1Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy.
Background:
The aim of this paper was to compare the accuracy of multiple abbreviated multiparametric magnetic resonance imaging (mpMRI)-derived protocols in detecting clinically significant prostate cancer (csPCa).
Methods:
One hundred and eight men undergoing staging 3.0T mpMRI with a Prostate Imaging - Reporting and Data System version 2 (PI-RADSv2)-compliant protocol before radical prostatectomy (RP) were retrospectively evaluated. Two readers (R1, R2) independently analyzed mpMRI, assigning a PI-RADSv2 category to each observation as appearing on each examination sequence. A study coordinator assessed final PI-RADSv2 category by combining readers' assignments according to four protocols: short MRI (sMRI) (diffusion-weighted imaging + axial T2-weighted imaging), contrast-enhanced short MRI (cesMRI) (sMRI + dynamic contrast-enhanced [DCE] imaging), biparametric MRI (diffusion-weighted imaging + multiplanar T2-weigthed imaging), and mpMRI. Using RP pathology as the reference standard for csPCa, we calculated the per-lesion cancer detection rate (CDR) and false discovery rate (FDR) for each MRI protocol (cut-off PI-RADSv2 category ≥3), and the per-PI-RADSv2 category prevalence of csPCa and false positives.
Results:
Pathology after RP found 142 csPCas with median International Society of Urogenital Pathology grade group 2, and stage ≤pT2c in 68.6% of cases. CDR was comparable across the four MRI protocols (74.6% to 75.3% for R1, and 68.3% for R2). FDR was comparable as well (14.4%-14.5% for R1 and 11.1% for R2). sMRI was the minimum protocol equaling mpMRI in terms of CDR, although cesMRI, similarly to mpMRI, was associated with fewer PI-RADSv2 category 3 assignments and higher prevalence of csPCa within PI-RADSv2 category 3 observations (66.7% versus 76.9% for R1, and 100% versus 91.7% for R2, respectively).
Conclusions:
Among multiple abbreviated mpMRI-derived protocols, cesMRI was the one equaling mpMRI in terms of csPCa detection and minimizing PI-RADSv2 category 3 assignments.
