Multiparametric MRI of the prostate with three functional techniques in patients with PSA elevation before initial TRUS-guided biopsy.
OBJECTIVE
Multiparametric MRI (mp-MRI) of the prostate is increasingly being used for local staging and detection of recurrence of prostate cancer (PCA). In patients with elevated prostate-specific antigen (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 (MAGNETOM Aera(®); Siemens Healthcare, Erlangen, Germany) and 16-channel phased-array body coil (Siemens Healthcare). T2 weighted images (T2WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (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 of 43 (40%) patients with PCA. 11 of 17 targeted biopsies contained PCA. 5 of 11 PCAs were diagnosed only by additional targeted biopsies. Sensitivity of mp-MRI in patients was 97.7% and specificity was 11.8%. mp-MRI was false negative in one patient. Sensitivity of mp-MRI in 207 lesions was 80.9% and specificity was 44.7%. In a logistic regression model, the apparent diffusion coefficient 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.


CONCLUSIONS
DWI is the most reliable technique in mp-MRI of the prostate.
1 Radiologische Praxis, Ulm, Germany.
Elke
E
Hauth
2 Uropraxis, Ulm, Germany.
Horst
H
Hohmuth
1 Radiologische Praxis, Ulm, Germany.
Corina
C
Cozub-Poetica
2 Uropraxis, Ulm, Germany.
Stefan
S
Bernand
3 Department of Diagnostic and Interventional Radiology, University Hospital, Ulm, Germany.
Meinrad
M
Beer
1 Radiologische Praxis, Ulm, Germany.
Horst
H
Jaeger
D000368:Aged; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D007089:Image Enhancement; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D003287:Contrast Media; D017430:Prostate-Specific Antigen