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Histology core‐specific evaluation of the E uropean S ociety of U rogenital R adiology ( ESUR ) standardised scoring system of multiparametric magnetic resonance imaging ( mpMRI ) of the prostate
Author(s) -
Kuru Timur H.,
Roethke Matthias C.,
Rieker Philip,
Roth Wilfried,
Fenchel Michael,
Hohenfellner Markus,
Schlemmer HeinzPeter,
Hadaschik Boris A.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12259
Subject(s) - prostate cancer , medicine , prostate , magnetic resonance imaging , biopsy , diffusion mri , multiparametric mri , histopathology , receiver operating characteristic , core biopsy , effective diffusion coefficient , in vivo magnetic resonance spectroscopy , histology , dynamic contrast , radiology , nuclear medicine , cancer , pathology , breast cancer
Objectives To evaluate the P rostate I maging R eporting and D ata S ystem ( PIRADS ) in multiparametric magnetic resonance imaging ( mpMRI ) based on single cores and single‐core histology. To calculate positive ( PPV ) and negative predictive values ( NPV ) of different modalities of mpMRI .Patients and Methods We performed MRI ‐targeted transrectal ultrasound‐guided perineal prostate biopsies on 50 patients (mean age 66 years, mean PSA level of 9.9 ng/mL) with suspicion of prostate cancer. The biopsy trajectories of every core taken were documented in three dimensions (3 D ) in a 3 D ‐prostate model. Every core was evaluated separately for prostate cancer and the performed biopsy trajectories were projected on mpMRI images. PIRADS scores of 1177 cores were then assessed by a histology ‘blinded’ uro‐radiologist in T 2‐weighted ( T2W ), dynamic contrast‐enhanced ( DCE ), diffusion‐weighted imaging ( DWI ) and magnetic resonance spectroscopy ( MRS ).Results The PIRADS score was significantly higher in cores positive for cancer than in negative cores. There was a significant correlation between the PIRADS score and histopathology for every modality. Receiver operating characteristic ( ROC ) analysis showed excellent specificity for T2W (90% peripheral zone/97% transition zone) and DWI (98%/97%) images regardless of the prostate region observed. These numbers decreased for DCE (80%/93%) and MRS (76%/83%). All modalities had NPVs of 99%, if a PIRADS score threshold of 2 (for T2W , DCE , and MRS ) or 3 (for DWI ) was used. However, PPVs were low.Conclusions Our results show that PIRADS scoring is feasible for clinical routine and allows standardised reporting. PIRADS can be used as a decision‐support system for targeting of suspicious lesions. mpMRI has a high NPV for prostate cancer and, thus, might be a valuable tool in the initial diagnostic evaluation.