title: Dynamic contrast-enhanced imaging has limited added value over T2-weighted imaging and diffusion-weighted imaging when using PI-RADSv2 for diagnosis of clinically significant prostate cancer in patients with elevated PSA.
abstract: OBJECTIVE
  To determine the added value of dynamic contrast-enhanced imaging (DCE) over T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for detection of clinically significant prostate cancer (csPC) in patients with elevated prostate-specific antigen (PSA).
  
  
  METHODS
  Two hundred and forty-five patients with elevated PSA underwent multiparametric (mp) magnetic resonance imaging (MRI) of the prostate before biopsy. mpMRI was performed using a 3 T MRI system without an endorectal coil. Patients underwent transrectal ultrasound-guided systematic 12 core biopsy followed by radical prostatectomy (n=68), radiation therapy (n=91), or clinical follow-up for at least 2 years (n=86). csPC was defined as Gleason score ≥3+4 and/or tumour volume of ≥0.5 ml, and/or tumour stage ≥T3a. The MRI findings were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and an alternative overall assessment category (PI-RADSv2Alt) based on only T2-WI and DWI.
  
  
  RESULTS
  In 144 patients (58.8%), csPC was found within 2 years after MRI. With scoring according to the PI-RADSv2 guidelines, DCE was not needed for determination of the overall assessment category in 80.8% (198/245) of patients. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.79 (95% confidence interval [CI]: 0.74-0.85) for PI-RADSv2 and 0.79 (95% CI: 0.73-0.85) for PI-RADSv2Alt.
  
  
  CONCLUSIONS
  The added value of DCE over T2-WI and DWI is limited when using PI-RADSv2 for diagnosis of csPC in patients with elevated PSA before biopsy. An alternative overall assessment score using only T2-WI and DWI yielded similar performance to PI-RADSv2.
authors.affiliation: Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. Electronic address: Pieter.devisschere@uzgent.be.
authors.forename: P
authors.initials: P
authors.lastname: De Visschere
authors.affiliation: Department of Urology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Lumen
authors.affiliation: Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Ost
authors.affiliation: Department of Urology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Decaestecker
authors.affiliation: Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Pattyn
authors.affiliation: Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Villeirs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D017430:Prostate-Specific Antigen