Purpose To evaluate predictors of false-positive (FP) and false-negative (FN) results for prostate cancer at prostate multiparametric MRI (mpMRI) using the Prostate Imaging and Reporting Data System version 2 (PI-RADS v2). Materials and Methods This was a single-center retrospective cohort study of 2548 consecutive patients who underwent prostate mpMRI examinations (October 2016-July 2022) containing zero or one PI-RADS v2 category 3-5 lesions. Prostate mpMRI examinations were interpreted by 13 radiologists. FP results were defined as prospective PI-RADS v2 score of 3 or higher but benign or grade group 1 prostate cancer at subsequent combined targeted and systematic biopsy. FN results were defined as prospective PI-RADS v2 score 2 or lower but grade group 2 or higher prostate cancer at subsequent combined targeted and systematic biopsy. Predictors of FP and FN results were assessed by logistic regression. Results Among the 2548 patients (mean age, 65.7 years ± 7.6 [SD]; all male) analyzed, 52.0% (831 of 1597) had FP results and 15.8% (150 of 951) had FN results at mpMRI. FP results were more likely for younger patients (odds ratio [OR], 0.95/y; P < .001), smaller lesions (OR, 0.62/mm; P < .001), transition zone lesions (OR, 1.74 vs peripheral zone; P = .006), and patients with low prostate-specific antigen (PSA) density (OR, 0.55 per 0.1 ng/mL2 increase; P < .001). FN results were more likely for older patients (OR, 1.03/y; P = .01) and patients with high PSA density (OR, 2.05 per 0.1 ng/mL2 increase; P < .001). Conclusion PSA density and patient age independently predicted FP and FN results for detection of prostate cancer at mpMRI using PI-RADS v2. These factors are not part of the PI-RADS v2 algorithm and may inform mpMRI interpretation to improve prostate cancer diagnosis. Keywords: MR Imaging, Prostate, PI-RADS, Prostate MRI, Prostate Cancer ©RSNA, 2025.
Radiology. Imaging cancer. 2025 Mar [Epub]
Bassel Salka, Jonathan P Troost, Sonia Gaur, Prasad R Shankar, Abdel Rahman Diab, Cindy Hakim, Benjamin M Mervak, Shokoufeh Khalatbari, Matthew S Davenport
Department of Urology, Henry Ford Health System, Detroit, Mich., Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Mich., Department of Radiology, Massachusetts General Hospital, Boston, Mass., Department of Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio., University of Michigan Medical School, Ann Arbor, Mich., Department of Radiology, Michigan Medicine, Ann Arbor, Mich.