Multiparametric MRI of prostate with three functional techniques in patients with PSA-elevation before initial TRUS-guided biopsy.

OBJECTIVE - Multiparametric MR imaging (mp-MRI) of the prostate is increasingly being used for local staging and detection for recurrence of prostate cancer (PCA). In patients with elevated PSA, mp-MRI could provide information on the position of the cancer, allowing adjustments to be made to the needle depth and direction before repeat transrectal ultrasound (TRUS)-guided biopsy to ensure accurate sampling of lesions. The purpose of the prospective study was to evaluate mp-MRI of the prostate in patients with PSA-elevation before initial TRUS-guided biopsy.

METHODS - Mp-MRI was performed in 94 patients using a 1.5-T scanner and 16-channel phased-array body coil. T2WI, DWI, DCE MRI and MR spectroscopy were obtained. TRUS-guided random biopsies and additional targeted biopsies of suspicious MRI areas were performed.

RESULTS - Additional targeted biopsies were obtained in 17/43 (40%) patients with PCA. 11/17 targeted biopsies contained PCA. 5/11 PCA were diagnosed only by additional targeted biopsies. Sensitivity of mp-MRI in patients was 97.7%, specificity 11.8%. Mp-MRI was false negative in one patient. Sensitivity of mp-MRI in 207 lesions was 80.9%, specificity 44.7%. In a logistic regression model, the ADC-value was the only significant parameter to differentiate malignant and benign lesions.

CONCLUSIONS - Mp-MRI should be performed in patients with PSA-elevation before initial TRUS-guided biopsy to allow additional targeted biopsies from suspicious areas of MRI. We recommend mp-MRI with T2WI, DWI, DCE MRI and MR spectroscopy. DWI as the most reliable technique should be used in every mp-MRI. Advances in knowledge: DWI is the most reliable technique in Mp-MRI of the prostate.

Br J Radiol. 2015 Aug 13:20150422. [Epub ahead of print]

Hauth E1, Hohmuth H2, Cozub-Poetica C1, Bernand S2, Beer M3, Jaeger H1.

1 Radiologische Praxis, Germany.
2 Uropraxis, Ulm, Germany.
3 Department of Diagnostic and Interventional Radiology, University Hospital Ulm.