Related Experiment Video
Updated: Jul 12, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Diagnostic impact of DWI absence on prostate lesion assessment using PI-RADS 2.1
Negar Firoozeh1, Sung Yoon Park2, Yaw Nyame3
1Department of Radiology, University of Washington, Seattle, WA, USA.
Objective:
To compare Prostate Imaging Reporting and Data System (PI-RADS) scores derived from a standard multiparametric prostate MRI (mpMRI) protocol with those from a protocol consisting only of T2-weighted and dynamic contrast-enhanced images (T2+DCE MRI).
Methods:
In this retrospective, single-center, cross-sectional study approved by the IRB and compliant with HIPAA, 492 MRI exams performed in 2022 were analyzed. PI-RADS scores from mpMRIs were extracted from medical records, and new scores were generated for T2+DCE MRI following PI-RADS guidelines. Score differences were evaluated using Wilcoxon signed-rank and McNemar's tests, stratified by lesion location (peripheral zone, PZ, and transition zone, TZ). Diagnostic accuracies of the two methods were compared using ROC curves, and logistic regression was employed to identify predictors of score changes.
Results:
Notable differences in PI-RADS scores were observed were observed in the PZ (P = 0.03) and TZ (P < 0.001). 4.8 % of PZ and 4.0 % of TZ PI-RADS 3-5 lesions were misclassified as PI-RADS 1-2 on T2W+DCE MRI (PZ vs TZ, P = 0.64). However, ROC curve analyses revealed no significant difference in diagnostic accuracy between mpMRI (Az = 0.77) and T2+DCE MRI (Az = 0.75, P = 0.07). PSA density was identified as a predictor of score changes from PI-RADS 3-5 to 1-2, although the effect size was modest.
Conclusions:
Although T2+DCE MRI yields different PI-RADS scores compared to mpMRI, the clinical impact on diagnostic accuracy and decision-making is overall small. This supports the continued use of T2+DCE MRI, particularly when diffusion-weighted imaging is compromised.
Insights
Multiparametric prostate MRI (mpMRI) and T2-weighted + dynamic contrast-enhanced (T2+DCE) MRI yield different Prostate Imaging Reporting and Data System (PI-RADS) scores. However, T2+DCE MRI shows comparable diagnostic accuracy, supporting its use when diffusion-weighted imaging is unavailable.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Multiparametric prostate MRI (mpMRI) is standard for prostate cancer detection.
- Prostate Imaging Reporting and Data System (PI-RADS) scores guide diagnosis and management.
- The role of reduced MRI protocols needs evaluation.
Purpose of the Study:
- To compare PI-RADS scores from standard mpMRI with those from a T2-weighted and dynamic contrast-enhanced (T2+DCE) MRI protocol.
- To assess the diagnostic accuracy and clinical impact of T2+DCE MRI compared to mpMRI.
Main Methods:
- Retrospective analysis of 492 MRI exams.
- PI-RADS scoring for both mpMRI and T2+DCE protocols.
- Statistical comparison of scores and diagnostic accuracy using ROC curves.
- Identification of predictors for score changes.
Main Results:
- Notable differences in PI-RADS scores were observed between mpMRI and T2+DCE MRI in both peripheral and transition zones.
- A small percentage of lesions were misclassified between PI-RADS categories.
- No significant difference in diagnostic accuracy was found between the two protocols (Az = 0.77 vs. 0.75, P = 0.07).
- PSA density predicted score changes from PI-RADS 3-5 to 1-2.
Conclusions:
- T2+DCE MRI yields different PI-RADS scores than mpMRI.
- The clinical impact on diagnostic accuracy and decision-making is minimal.
- T2+DCE MRI is a viable alternative, especially when diffusion-weighted imaging is compromised.
