Related Experiment Video
Updated: May 5, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Prediction of Clinically Significant Prostate Cancer Using Multiparametric MRI, Biparametric MRI, and Clinical
Maximilian Oberneder1, Thomas Henzler2, Martin Kriegmair1
1Urologische Klinik München-Planegg, Planegg, Germany.
Introduction:
Multiparametric MRI (mpMRI) is gold standard for the primary diagnostic work-up of clinically significant prostate cancer (csPCa). The aim of this study was to assess the benefit of the perfusion sequence and the non-inferiority of an MRI without contrast administration (bpMRI) compared to mpMRI while taking clinical parameters into account.
Methods:
In this retrospective, non-interventional study we examined MRI data from 355 biopsy-naïve patients, performed on a 3T MRI system, evaluated by a board-certified radiologist with over 10 years of experience with subsequent mpMRI-TRUS fusion biopsy.
Discussion:
Only 16/355 (4.5%) patients benefited from dynamic contrast enhanced. In only 3/355 (0.8%) patients, csPCa would have been missed in bpMRI. BpMRI provided sensitivity and specificity (81.4%; 79.4%) comparable to mpMRI (75.2%; 81.8%). Additionally, bpMRI and mpMRI were independent predictors for the presence of csPCa, individually (OR: 15.36; p < 0.001 vs. 12.15; p = 0.006) and after accounting for established influencing factors (OR: 12.81; p < 0.001 vs. 6.50; p = 0.012). When clinical parameters were considered, a more balanced diagnostic performance between sensitivity and specificity was found for mpMRI and bpMRI. Overall, PSA density showed the highest diagnostic performance (area under the curve = 0.81) for the detection of csPCa.
Conclusion:
The premise of the study was confirmed. Therefore, bpMRI should be adopted as soon as existing limitations have been lifted by prospective multi-reader studies.
Insights
Contrast-enhanced MRI (mpMRI) offers minimal benefit for prostate cancer detection. Non-contrast MRI (bpMRI) is a viable alternative, demonstrating comparable diagnostic performance to mpMRI for clinically significant prostate cancer (csPCa).
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Multiparametric MRI (mpMRI) is the standard for diagnosing clinically significant prostate cancer (csPCa).
- Assessing the value of perfusion sequences and the non-inferiority of non-contrast MRI (bpMRI) compared to mpMRI is crucial.
Purpose of the Study:
- To evaluate the added benefit of dynamic contrast-enhanced (DCE) sequences in mpMRI for csPCa detection.
- To determine if bpMRI is non-inferior to mpMRI in diagnosing csPCa, considering clinical parameters.
Main Methods:
- Retrospective analysis of MRI data from 355 biopsy-naïve patients.
- Data acquired using a 3T MRI system and evaluated by an experienced radiologist.
- Subsequent mpMRI-TRUS fusion biopsy was performed for diagnosis.
Main Results:
- Only 4.5% of patients benefited from DCE sequences.
- bpMRI missed only 0.8% of csPCa cases, showing comparable sensitivity (81.4%) and specificity (79.4%) to mpMRI (75.2%; 81.8%).
- Both bpMRI and mpMRI were independent predictors of csPCa, with PSA density showing the highest diagnostic performance (AUC=0.81).
Conclusions:
- The study confirms that bpMRI is a non-inferior alternative to mpMRI for csPCa diagnosis.
- bpMRI should be considered for clinical adoption, pending further validation in multi-reader studies.
- Clinical parameters, particularly PSA density, significantly aid in csPCa detection.
More Related Videos
05:49Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking
Published on: October 10, 2019
06:08A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
