title: Impact of multiparametric magnetic resonance imaging on risk group assessment of patients with prostate cancer addressed to external beam radiation therapy.
abstract: OBJECTIVE
  To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on risk group assessment of patients with prostate cancer (PCa) initially addressed to external beam radiation therapy (EBRT).
  
  
  METHODS
  We prospectively performed mpMRI (3.0Tsystem) in 44 patients addressed to EBRT, using a multiparametric protocol (high-resolution multiplanar T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging). Risk group was assessed in accordance with the National comprehensive cancer network (NCCN) categories, by combining prostate-specific-antigen level, Gleason score and the T-stage as established by digital rectal examination (clinical risk assessment; c-RA) versus mpMRI (mpMRI-risk assessment; mpMRI-RA). The agreement between c-RA and mpMRI-RA was investigated using Cohen's kappa.
  
  
  RESULTS
  Patients were included in very low/low risk, intermediate risk, high risk, very high risk and metastatic NCCN categories in 10 (22.7%), 18 (40.9%), 15 (34.1%), 1 (2.3%) and 0 cases using c-RA vs. 8 (18.2%), 14 (31.8%), 14 (31.8%), 4 (9.1%) and 4 (9.1%) cases using mpMRI-RA, respectively, with only moderate agreement (k=0.43). mpMRI-RA determined risk downgrading in 2/44 patients (4.5%), and risk upgrading in 16/44 patients (36.3%). After mpMRI, EBRT remained indicated in all patients.
  
  
  CONCLUSIONS
  mpMRI changed clinical risk stratification in about 41% of patients with PCa, with potential impact on EBRT planning.
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, via Colugna, 50-33100 Udine, Italy. Electronic address: serepul@libero.it.
authors.forename: Serena
authors.initials: S
authors.lastname: Pullini
authors.affiliation: Department of Oncological Radiation Therapy, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Piazzale S. M. della Misericordia, 15-33100 Udine, Italy. Electronic address: signor.marco@aoud.sanita.fvg.it.
authors.forename: Marco Andrea
authors.initials: MA
authors.lastname: Signor
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, via Colugna, 50-33100 Udine, Italy. Electronic address: martypancot@libero.it.
authors.forename: Martina
authors.initials: M
authors.lastname: Pancot
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, via Colugna, 50-33100 Udine, Italy. Electronic address: zuiani.chiara@aoud.sanita.fvg.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zuiani
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, via Colugna, 50-33100 Udine, Italy. Electronic address: bazzocchi.massimo@aoud.sanita.fvg.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bazzocchi
authors.affiliation: Department of Oncological Radiation Therapy, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Piazzale S. M. della Misericordia, 15-33100 Udine, Italy. Electronic address: fongione.sandro@aoud.sanita.fvg.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Fongione
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, via Colugna, 50-33100 Udine, Italy. Electronic address: rgirometti@sirm.org.
authors.forename: Rossano
authors.initials: R
authors.lastname: Girometti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D051517:Digital Rectal Examination / Q000379:methods; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009942:Organometallic Compounds; D010347:Patient Care Planning; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D018570:Risk Assessment
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D005682:Gadolinium; D017430:Prostate-Specific Antigen
keywords: Magnetic Resonance Imaging; Patient Care Planning; Prostatic Neoplasm; Radiotherapy; Risk stratification