Accuracy of multiparametric MR imaging with PI-RADS V2 assessment in detecting infiltration of the neurovascular bundles prior to prostatectomy

To evaluate the accuracy of assessment of neurovascular bundle (NVB) infiltration using multiparametric magnetic resonance imaging (mpMRI) and PI-RADS V2 prior to prostatectomy.

The ethics committee approved this retrospective study with waiver of informed consent. N=198 consecutive patients with biopsy proved cancer underwent standardized mpMRI at 3T prior to surgery. NVB infiltration was assessed for each side (a total of 396). Maximum PI-RADS V2 scores were determined for the posterolateral areas adjacent to the NVBs. Imaging results were correlated with postoperative pathology and standard descriptive statistics were calculated.

Overall T-staging sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of mpMRI were 64.4%, 89.2%, 82.4%, 76.2% and 78.3%, respectively. In 396 cases NVB infiltration was predicted with 75.3%, 94.0%, 80.2%, 92.1 % and 89.4 % sensitivity, specificity, PPV, NPV and accuracy, respectively. Analyses of 396 NVB and their adjacent PI-RADS V2 scores with pathology revealed significantly more NVB-infiltrations in suspect scores of 5 and 4 vs. uncertain scores of 3-1 (81/264 vs. 16/132, p=0.0001). Considering scores higher than 3 as a criterion of infiltration demonstrated moderate sensitivity and poor specificity (83.5% and 38.8%, respectively). Interobserver agreement of a second reading of a random sample was good (κ=0.64) for NVB infiltrations and moderate (κ=0.59) for PI-RADS V2.

Assessment of infiltration of the neurovascular bundles using mpMRI has valuable diagnostic performance, yet PI-RADS V2 Scores demonstrate limited eligibility. Combined findings offer crucial information for the planning of prostatectomy.

European journal of radiology. 2017 Nov 27 [Epub]

Markus Sauer, Julius M Weinrich, Christoph Fraune, Georg Salomon, Pierre Tennstedt, Gerhard Adam, Dirk Beyersdorff

Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany. Electronic address: ., Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany., Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.

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