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Updated: Mar 18, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Association of Prostate Multiparametric MRI Parameters with Gleason Score: A Fusion Biopsy-Based Correlation
Davut Ünsal Çapkan1, Mehmet Hamdi Şahan2
1Department of Radiology, Gaziantep Private Medicalpoint Hospital, Gaziantep, Turkiye.
Introduction:
This study aimed to investigate the relationship between imaging parameters obtained from Multiparametric Magnetic Resonance İmaging (MPMRI) and Gleason Scores (GS) derived from targeted prostate biopsies performed using MRI/Ultrasound (US) fusion guidance.
Materials And Methods:
A total of 120 consecutive patients who underwent 1.5T MP-MRI followed by MRI/US fusion-guided prostate biopsy were included. In total, 202 MRI-identified targets were sampled. For each lesion, anatomical location, Prostate-Specific Antigen (PSA), prostate volume, Prostate Density (PD), apparent diffusion Coefficient (ADC) values, neurovascular bundle invasion, and PI-RADS v2.1 score were recorded. GS results were statistically compared with imaging and clinical parameters. Pearson’s correlation was calculated to investigate the associations, and the diagnostic ability of ADC values was evaluated by Receiver Operating Characteristic (ROC) analysis.
Results:
Of the 202 targets, 138 (68.3%) were benign, 35 (17.3%) had GS 3+4 (low-grade), and 29 (14.4%) had GS ≥4+3 (high-grade) malignancy. ADC values were negatively correlated with age, PSA, PD, and PI-RADS score. Most lesions were located in the peripheral zone, particularly in the mid-gland and apical regions. Malignant lesions were frequently found in the peripheral zone and right mid-gland. ADC values showed strong diagnostic performance, with cut-offs of 0.78 ×10−3 mm2/s for low-grade (sensitivity: 79.69%, specificity: 86.21%) and 0.70 ×10−3mm2/s for highgrade malignancies (sensitivity: 92.03%, specificity: 92.49%).
Discussion:
This echoes previous reports indicating that ADC value negatively correlated with GS, supporting the application of MP-MRI-derived parameters in the assessment of prostate cancer.
Conclusion:
Correlation of MP-MRI-derived imaging parameters with histopathology results allows meaningful exploitation in clinical decision-making in prostate cancer diagnosis. Both the PI-RADS score and the ADC value were validated as reliable predictors of tumor aggressiveness. Although MRI-targeted fusion biopsies have gained more and more popularity in clinical practice, based on our data, no conclusion can be drawn as to their effect in decreasing the number of unnecessary prostate biopsies.
Insights
Multiparametric MRI (MPMRI) apparent diffusion coefficient (ADC) values correlate with Gleason Scores in prostate cancer. Higher ADC values indicate lower-grade tumors, aiding in assessing aggressiveness.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Multiparametric Magnetic Resonance Imaging (MPMRI) is crucial for prostate cancer assessment.
- Gleason Scores (GS) from biopsies determine tumor aggressiveness.
- MRI/Ultrasound (US) fusion guidance enhances biopsy precision.
Purpose of the Study:
- To investigate the correlation between MPMRI imaging parameters and biopsy-derived Gleason Scores (GS).
- To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) values in predicting tumor grade.
Main Methods:
- 120 patients underwent 1.5T MP-MRI and MRI/US fusion-guided biopsy.
- 202 MRI-identified targets were analyzed for anatomical location, PSA, prostate volume, Prostate Density (PD), ADC values, and PI-RADS v2.1 score.
- Statistical analysis included Pearson's correlation and Receiver Operating Characteristic (ROC) analysis.
Main Results:
- ADC values showed a negative correlation with age, PSA, PD, and PI-RADS score.
- Malignant lesions were predominantly found in the peripheral zone.
- ADC values demonstrated strong diagnostic performance for low-grade (cut-off: 0.78 ×10-3 mm2/s) and high-grade (cut-off: 0.70 ×10-3 mm2/s) malignancies.
Conclusions:
- ADC values negatively correlate with Gleason Scores, supporting their use in prostate cancer assessment.
- Both PI-RADS score and ADC value are reliable predictors of tumor aggressiveness.
- MPMRI parameters aid clinical decision-making in prostate cancer diagnosis.
