title: Prostate cancer: performance characteristics of combined T₂W and DW-MRI scoring in the setting of template transperineal re-biopsy using MR-TRUS fusion.
abstract: OBJECTIVE
  To measure the performance characteristics of combined T2-weighted (T₂W) and diffusion-weighted (DW) magnetic resonance imaging (MRI) suspicion scoring prior to MR-transrectal ultrasound (TRUS) fusion template transperineal (TTP) re-biopsy.
  
  
  METHODS
  Thirty-nine patients referred for prostate re-biopsy, with prior MRI examinations, were retrospectively included. The MR images, including T₂W and DW-MRI, had been independently evaluated prospectively by two radiologists using a structured scoring system. An MR-TRUS fusion TTP re-biopsy was used for MR target and non-targeted biopsy cores. Targeting performance and correlation with disease status were evaluated on a per-patient and per-region basis.
  
  
  RESULTS
  The cancer yield was 41% (16/39 patients). MR targeting accurately detected the disease in 12/16 (75%) cancerous patients and missed the disease in 4/16 (25%) patients, all with Gleason 3 + 3 disease. There was a significant relationship (P < 0.01) between MR suspicion score and the significance of cancer. Reader 1 had significantly higher sensitivity in the transition zone (TZ; 0.84) compared with the peripheral zone (PZ; 0.32) (P = 0.04). Inter-reader agreement was moderate for the PZ and substantial for the TZ.
  
  
  CONCLUSIONS
  MRI targeting is beneficial in the setting of TTP MR-TRUS fusion re-biopsy and MR suspicion score relates to prostate cancer clinical significance. A T₂W and DW-MRI structured scoring system results in good inter-reader agreement in this setting.
  
  
  CONCLUSIONS
  • Pre-biopsy MRI aids the detection of high significance cancer during prostate re-biopsy. • MRI suspicion level correlates with the clinical significance of prostate cancer detected. • T₂W and DW-MRI structured scoring of pre-biopsy MRI permits good inter-reader agreement.
authors.affiliation: Department of Radiology, University of Cambridge, Cambridge, UK, eml42@cam.ac.uk.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Lawrence
authors.forename: Sarah Y W
authors.initials: SY
authors.lastname: Tang
authors.forename: Tristan
authors.initials: T
authors.lastname: Barrett
authors.forename: Brendan
authors.initials: B
authors.lastname: Koo
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldman
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Warren
authors.forename: Richard G
authors.initials: RG
authors.lastname: Axell
authors.forename: Andrew
authors.initials: A
authors.lastname: Doble
authors.forename: Ferdia A
authors.initials: FA
authors.lastname: Gallagher
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Gnanapragasam
authors.forename: Christof
authors.initials: C
authors.lastname: Kastner
authors.forename: Evis
authors.initials: E
authors.lastname: Sala
mesh_terms: D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010502:Perineum; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014521:Urethra
references.citation: Urology. 2006 Nov;68(5):1037-41
references.pmid: 17095067
references.citation: Invest Radiol. 2008 Nov;43(11):789-93
references.pmid: 18923258
references.citation: Biometrics. 1997 Jun;53(2):567-78
references.pmid: 9192452
references.citation: Eur Urol. 2012 Jan;61(1):177-84
references.pmid: 21924545
references.citation: Eur Urol. 2012 Nov;62(5):902-9
references.pmid: 22325447
references.citation: J Endourol. 2012 Jul;26(7):807-13
references.pmid: 22283184
references.citation: BJU Int. 2013 Sep;112(5):568-77
references.pmid: 23773772
references.citation: Eur Urol. 2010 Dec;58(6):851-64
references.pmid: 20884114
references.citation: Urology. 2009 Nov;74(5):1094-9
references.pmid: 19773038
references.citation: BJU Int. 2012 Jul;110(2 Pt 2):E69-75
references.pmid: 22093091
references.citation: Eur Urol. 2013 Jan;63(1):125-40
references.pmid: 22743165
references.citation: Radiology. 2014 May;271(2):435-44
references.pmid: 24484061
references.citation: J Urol. 2012 Dec;188(6):2152-2157
references.pmid: 23083875
references.citation: Urology. 2009 Jul;74(1):171-6
references.pmid: 19232691
references.citation: J Urol. 2013 Oct;190(4):1380-6
references.pmid: 23608676
references.citation: J Urol. 2007 Sep;178(3 Pt 2):S14-9
references.pmid: 17644125
references.citation: Radiology. 2011 Apr;259(1):162-72
references.pmid: 21233291
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD006576
references.pmid: 21563156
references.citation: J Urol. 2011 Dec;186(6):2214-20
references.pmid: 22014798
references.citation: J Urol. 2011 Oct;186(4):1281-5
references.pmid: 21849184
references.citation: J Urol. 2013 Jan;189(1):86-91
references.pmid: 23158413
references.citation: Eur Radiol. 2012 Apr;22(4):746-57
references.pmid: 22322308
references.citation: Nat Rev Urol. 2013 Dec;10(12):690-702
references.pmid: 24061531
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: BJU Int. 2012 Feb;109(3):367-71
references.pmid: 21883818
references.citation: J Urol. 2010 Feb;183(2):520-7
references.pmid: 20006859
references.citation: Radiology. 2013 Sep;268(3):761-9
references.pmid: 23564713
references.citation: Eur Radiol. 2013 May;23(5):1415-9
references.pmid: 23179522
references.citation: Radiology. 2013 Nov;269(2):493-503
references.pmid: 23878284
references.citation: J Urol. 1998 Feb;159(2):471-5; discussion 475-6
references.pmid: 9649265
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571