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Updated: Jul 14, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
[Application of dynamic contrast enhanced status in multiparametric magnetic resonance imaging for prostatic cancer
Chang Wei Yuan1, De Run Li1, Zhi Hua Li1
1Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Objective:
To evaluate the diagnostic value of dynamic contrast enhanced (DCE) of multiparametric magnetic resonance imaging (mpMRI) for prostate imaging reporting and data system (PI-RADS) 4 lesion in prostate peripheral zone.
Methods:
The clinical data of patients with PI-RADS 4 lesion in prostate peripheral zone who underwent prostate biopsy from January 2018 to September 2021 in Peking University First Hospital were retrospectively included. According to DCE status, the patients were divided into the conventional group (4 points for diffusion-weighted imaging) and the comprehensive group (3 points for diffusion-weighted imaging + 1 point for DCE positive). Pearson's chi-square test or Fisher's exact test for comparison was conducted between prostate cancer and non-cancer patients. Univariate and multivariate Logistic regression were performed to analyze the correlation of positive biopsy with age, total prostate specific antigen (PSA), free PSA/total PSA (f/tPSA), prostate volume (PV), PSA density (PSAD) and DCE status.
Results:
Among the 267 prostate biopsy patients, 217 cases were diagnosed as prostatic cancer (81.27%) and 50 cases were non-cancer (18.73%). Statistical analysis between the prostatic cancer group and the non-cancer group showed that there were significant differences in age, tPSA, PV and PSAD (all P < 0.05), but no significant differences in f/tPSA between the two groups. About different PI-RADS 4 lesion groups, the conventional group and the comprehensive group showed significant difference in biopsy results (P=0.001), and the conventional group had a higher positive rate. The PV of comprehensive group was larger than that of the conventional group. Among the prostate cancer patients diagnosed by biopsy, statistical analysis between the conventional group and comprehensive group showed that there were not significant differences in International Society of Urological Pathology (ISUP) grade and distinguishing clinically significant prostate cancer (all P > 0.05). Logistic univariate analysis showed that the diagnosis of prostate cancer was related to age, tPSA, f/tPSA, PV and DCE group status (all P < 0.05). Multivariate analysis showed that age, tPSA, PV and DCE group status (all P < 0.05) were independent risk factors for the diagnosis of prostatic cancer.
Conclusion:
tPSA, f/tPSA, PV and PSAD are the indicators to improve the diagnosis of prostatic cancer with PI-RADS 4 lesion in peripheral zone lesions. DCE status is worth considering, so that we can select patients for biopsy more accurately, reduce the rate of missed diagnosis of prostate cancer as well as avoid unnecessary prostate puncture.
Insights
Dynamic contrast-enhanced (DCE) MRI improves prostate cancer diagnosis for PI-RADS 4 lesions. Incorporating DCE status aids in selecting patients for biopsy, reducing missed diagnoses and unnecessary procedures.
Area of Science:
- Radiology
- Oncology
- Urology
Context:
- Prostate cancer diagnosis relies on multiparametric magnetic resonance imaging (mpMRI).
- Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions require accurate diagnostic strategies.
- Distinguishing between clinically significant and insignificant prostate cancer is crucial.
Purpose:
- To evaluate the diagnostic value of dynamic contrast-enhanced (DCE) MRI in multiparametric MRI (mpMRI) for PI-RADS 4 lesions in the prostate peripheral zone.
- To assess the correlation of DCE status with prostate cancer diagnosis and patient characteristics.
- To determine if DCE status can improve the accuracy of prostate biopsy selection.
Summary:
- A retrospective study analyzed 267 patients with PI-RADS 4 peripheral zone lesions. Patients were grouped based on DCE status (conventional vs. comprehensive mpMRI).
- Multivariate analysis identified age, total prostate-specific antigen (tPSA), prostate volume (PV), and DCE group status as independent risk factors for prostate cancer diagnosis.
- While DCE status showed a significant difference in biopsy results (P=0.001), it did not significantly impact International Society of Urological Pathology (ISUP) grade or the distinction of clinically significant prostate cancer.
Impact:
- The findings suggest that DCE status is a valuable indicator for improving the accuracy of prostate cancer diagnosis in PI-RADS 4 lesions.
- Integrating DCE status into diagnostic protocols can help optimize patient selection for prostate biopsy.
- This approach may lead to a reduced rate of missed prostate cancer diagnoses and fewer unnecessary prostate punctures.
