Histology core-specific evaluation of the European Society of Urogenital Radiology (ESUR) standardised scoring system of multiparametric magnetic resonance imaging (mpMRI) of the prostate
Article first published online: 13 AUG 2013
© 2013 The Authors. BJU International © 2013 BJU International
Volume 112, Issue 8, pages 1080–1087, December 2013
How to Cite
Kuru, T. H., Roethke, M. C., Rieker, P., Roth, W., Fenchel, M., Hohenfellner, M., Schlemmer, H.-P. and Hadaschik, B. A. (2013), Histology core-specific evaluation of the European Society of Urogenital Radiology (ESUR) standardised scoring system of multiparametric magnetic resonance imaging (mpMRI) of the prostate. BJU International, 112: 1080–1087. doi: 10.1111/bju.12259
- Issue published online: 4 NOV 2013
- Article first published online: 13 AUG 2013
- Accepted manuscript online: 23 MAY 2013 06:49AM EST
- European Foundation for Urology (EFU)
- hybrid imaging
- To evaluate the Prostate Imaging Reporting and Data System (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 (3D) in a 3D-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 T2-weighted (T2W), dynamic contrast-enhanced (DCE), diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS).
- 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.
- 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.