Abdominal Radiology

, Volume 44, Issue 3, pp 1052–1061 | Cite as

Characteristics of missed prostate cancer lesions on 3T multiparametric-MRI in 518 patients: based on PI-RADSv2 and using whole-mount histopathology reference

  • Amirhossein Mohammadian BajgiranEmail author
  • Sohrab Afshari Mirak
  • Sepideh Shakeri
  • Ely R. Felker
  • Danielle Ponzini
  • Preeti Ahuja
  • Anthony E. Sisk
  • David S. Lu
  • Steven S. Raman



To determine the characteristics of missed prostate cancer (PCa) lesions on 3T multiparametric-MRI (mpMRI) based on PI-RADSv2 with whole-mount histopathology (WMHP) correlation.

Materials and methods

This IRB-approved, HIPAA-compliant study, included 614 consecutive men with 3T mpMRI prior to prostatectomy at a single tertiary center between 12/2009 and 4/2017. Clinical, mpMRI, and pathologic features were obtained. PI-RADSv2-based MRI detected lesions were matched with previously finalized WMHP by a genitourinary (GU) radiologist and a GU pathologist. Patients with no mpMRI detected PCa lesion, but with at least one lesion ≥ 1 cm on WMHP, were reviewed retrospectively and assigned a PI-RADSv2 score. Tumor characteristics were compared between missed and detected lesions.


The final cohort included 518 patients with 1085 WMHP lesions. 51.9% (563/1085) of lesions were missed on 3T mpMRI. 71.4% (402/563), 21.7% (122/563), 4.4% (25/563), and 2.5% (14/563) of the missed lesions were Gleason scores (GS) 3 + 3, 3 + 4, 4 + 3, and 8 − 10, respectively. Missed PCa lesions had significantly lower proportion of GS ≥ 7 (p < 0.001) and smaller size for overall (p < 0.001) and index subcohorts (p < 0.001), as compared to detected lesions. 34.5% (194) of overall and 71.2% (79) index missed lesions were larger than 1 cm. In 13.7% (71/518) of patients without MR detected PCa, 149 lesions were detected on WMHP, with 70 (47%) lesions ≥ 1 cm. In retrospective review of these lesions, 42.9% (30), 18.6% (13), 21.5% (15), 10% (7), and 7% (5) were PI-RADSv2 1, 2, 3, 4, and 5, respectively.


3T mpMRI has an excellent per patients diagnostic performance for PCa and majority of missed lesions are clinically nonsignificant.


Magnetic resonance imaging Prostate Neoplasm 



The study was supported in part by the department of Radiology and Pathology Integrated Diagnostics (IDx) program and specialized program of research excellence (SPORE) of PCa.

Compliance with ethical standards

Ethical approval

This study was performed in accordance with the 1996 Health Information Portability and Accountability Act (HIPAA) and under waiver of informed consent by the institutional review board (IRB).

Supplementary material

261_2018_1823_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amirhossein Mohammadian Bajgiran
    • 1
    Email author
  • Sohrab Afshari Mirak
    • 1
  • Sepideh Shakeri
    • 1
  • Ely R. Felker
    • 1
  • Danielle Ponzini
    • 1
  • Preeti Ahuja
    • 1
  • Anthony E. Sisk
    • 2
  • David S. Lu
    • 1
  • Steven S. Raman
    • 1
  1. 1.Department of RadiologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of PathologyDavid Geffen School of Medicine at UCLALos AngelesUSA

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