PURPOSE: This study evaluates the diagnostic value of the ESUR scoring system (PI-RADS) regarding prostate cancer detection using MR-guided in-bore biopsies (IB-GB) as the reference standard.
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METHODS: 566 lesions in 235 consecutive patients (65.7±7.9 years, PSA 9.9±8.5ng/ml) with a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the prostate at 3T were scored using the PI-RADS scoring system. PI-RADS single (PSsingle), summed (PSsum), and overall (PSoverall) scores were determined. All lesions were histologically verified by IB-GB.
RESULTS: Lesions with a PSsum below 9 contained no prostate cancer (PCa) with Gleason score (GS)≥4+3=7. A PSsum of 13-15 (PSoverall V) resulted in 87.8% (n=108) in PCa and in 42.3% (n=52) in GS≥4+3=7. Transition zone (TZ) lesions with a PSsum of 13-15 (PSoverall V) resulted in 76.3% (n=36) in PCa and in 26.3% (n=10) in GS≥4+3=7, whereas for peripheral zone (PZ) lesions cancer detection rate at this score was 92.9% (n=79) and 49.4% (n=42) for GS≥4+3=7. Using a threshold of PSsum≥10, sensitivity was 86.0%, and negative predictive value (NPV) was 86.2%. For higher grade PCa sensitivity was 98.6%, and NPV was 99.5%.
CONCLUSION: A PSsum below 9 excluded a higher grade PCa, whereas lesions with a PSsum ≥13 (PSoverall V) represented in 88% PCa, and in 42% higher grade PCa. The PSsum or PSoverall demonstrated a better diagnostic value for PZ lesions with higher detection rates for higher grade PCa compared to TZ lesions.
Schimmöller L, Quentin M, Arsov C, Hiester A, Kröpil P, Rabenalt R, Albers P, Antoch G, Blondin D. Are you the author?
Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany; Univ Dusseldorf, Medical Faculty, Department of Urology, Moorenstr. 5, D-40225 Dusseldorf, Germany. ; ; ; ; ; ; ; ;
Reference: Eur J Radiol. 2014 Aug 30. pii: S0720-048X(14)00398-2.