title: Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy.
abstract: OBJECTIVE
  To find the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted transrectal ultrasound (TRUS)-guided biopsy using visual coregistration (TB) in patients with elevated prostate-specific antigen (PSA), normal digital rectal examination, and no previous biopsy.
  
  
  METHODS
  Fifty-five patients at two institutions underwent mpMRI, consisting of anatomical T2 -weighted imaging (T2 W), diffusion-weighted imaging (DWI), proton magnetic resonance spectroscopy ((1) H-MRS), and dynamic contrast-enhanced MRI (DCE-MRI), followed by TB in addition to 12 core systematic TRUS-guided biopsy (SB). Histopathological scorings of biopsy (n = 38) and prostatectomy (n = 17) specimens were used as the reference standard for calculation of diagnostic accuracy values. Clinically significant prostate cancer (SPCa) was defined as 3 mm core length of Gleason score 3+3 or any Gleason grade 4.
  
  
  RESULTS
  The sensitivity, specificity, accuracy, and area under the curve (AUC) values for the detection of SPCa on the sextant level for T2 W+DWI+(1) H-MRS+DCE-MRI were 72%, 89%, 85%, and 0.81, respectively. The corresponding values for T2 wi+DWI were 61%, 96%, 87%, and 0.79, respectively. The overall PCa detection rate per core in 53 patients was 21% (138 of 648 cores) for SB and 43% (33 of 77 cores) for TB (P < 0.001).
  
  
  CONCLUSIONS
  Prebiopsy mpMRI is an accurate tool for PCa detection and biopsy targeting in patients with elevated PSA.
authors: Department of Diagnostic Radiology, University of Turku, Turku, Finland.
authors: Ivan
authors: I
authors: Jambor
authors: Esa
authors: E
authors: Kähkönen
authors: Pekka
authors: P
authors: Taimen
authors: Harri
authors: H
authors: Merisaari
authors: Jani
authors: J
authors: Saunavaara
authors: Kalle
authors: K
authors: Alanen
authors: Branislav
authors: B
authors: Obsitnik
authors: Heikki
authors: H
authors: Minn
authors: Viera
authors: V
authors: Lehotska
authors: Hannu J
authors: HJ
authors: Aronen
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D051517:Digital Rectal Examination; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: multiparametric MRI; prostate cancer; targeted prostate biopsy