Related Experiment Video
Updated: May 25, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
An interpretable 1⁸F-PSMA PET/CT-MRI model for optimizing prostate biopsy decisions.
Shuaitao Xiong1,2, Jiangyu Ma3, Han Li1
1Department of Urology, Beijing Hospital, National Center of Gerontology; National Clinical Research Center for Gerontology; The Key Laboratory of Geriatrics of NHC; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
A new multimodal model integrating 18F-PSMA PET/CT and MRI accurately predicts clinically significant prostate cancer (csPCa) in biopsy-naïve men. This tool can significantly reduce unnecessary biopsies while maintaining oncological safety.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
- Machine Learning
Background:
- Distinguishing indolent from clinically significant prostate cancer (csPCa) in biopsy-naïve men is challenging.
- Current diagnostic methods can lead to unnecessary prostate biopsies.
Purpose of the Study:
- Develop and validate an interpretable multimodal model to predict csPCa.
- Integrate 18F-PSMA PET/CT, mpMRI, and clinical variables for improved biopsy decision-making.
Main Methods:
- Retrospective analysis of 302 biopsy-naïve patients.
- Extracted radiomic features from 18F-PSMA PET and mpMRI using a dual-level ROI strategy.
- Developed a Fusion model combining radiomics and clinical data, validated using AUC, DCA, and CIC; SHAP values used for feature interpretation.
Main Results:
- The Fusion model achieved AUCs of 0.92 (internal) and 0.92 (external validation).
- In PI-RADS 3 cases, the model yielded an AUC of 0.97, outperforming standard assessments.
- Risk stratification with the Fusion model could avoid 72-83% of unnecessary biopsies with low missed diagnosis rates (4-9.5%).
- PET-derived intensity and textural features were identified as dominant predictors by SHAP analysis.
Conclusions:
- The interpretable Fusion model integrating 18F-PSMA PET/CT and mpMRI shows superior diagnostic performance for csPCa.
- This approach can serve as an effective non-invasive triage tool, reducing unnecessary biopsies and enhancing oncological safety.
