European Radiology

, Volume 22, Issue 5, pp 1149–1157 | Cite as

Is it possible to model the risk of malignancy of focal abnormalities found at prostate multiparametric MRI?

  • Olivier Rouvière
  • Matthieu Papillard
  • Nicolas Girouin
  • Romain Boutier
  • Muriel Rabilloud
  • Benjamin Riche
  • Florence Mège-Lechevallier
  • Marc Colombel
  • Albert Gelet



To evaluate whether focal abnormalities (FAs) depicted by prostate MRI could be characterised using simple semiological features.


134 patients who underwent T2-weighted, diffusion-weighted and dynamic contrast-enhanced MRI at 1.5 T before prostate biopsy were prospectively included. FAs visible at MRI were characterised by their shape, the degree of signal abnormality (0 = normal to 3 = markedly abnormal) on individual MR sequences, and a subjective score (SS1 = probably benign to SS3 = probably malignant). FAs were then biopsied under US guidance.


56/233 FAs were positive at biopsy. The subjective score significantly predicted biopsy results (P < 0.01). As compared to SS1 FAs, the odds ratios (OR) of malignancy of SS2 and SS3 FAs were 9.9 (1.8–55.9) and 163.8 (11.5–2331). Unlike FAs’ shape, a simple combination of MR signal abnormalities (into “low-risk”, “intermediate” and “high-risk” groups) significantly predicted biopsy results (P < 0.008). As compared to “low risk” FAs, the OR of malignancy of “intermediate” and “high-risk” FAs were 4.5 (1.1–18.4) and 52.7 (6.8–407) in the overall population and 5.4 (1.1–27.2) and 118.2 (6.1–2301) in PZ.


A simple combination of signal abnormalities of individual MR sequences can significantly stratify the risk of malignancy of FAs, holding promise of a more standardised interpretation of MRI by readers with varying experience.

Key Points

Using multiparameter(mp)-MRI, experienced uroradiologists can stratify the malignancy risk of prostatic lesions

The shape of prostatic focal abnormalities in the peripheral zone does not help predicting malignancy.

A simple combination of findings at mp-MRI can help less-experienced radiologists


Prostate cancer MRI Diffusion-weighted MRI Dynamic contrast-enhanced MRI Prostate biopsy 


  1. 1.
    Girouin N, Mege-Lechevallier F, Tonina Senes A et al (2007) Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol 17:1498–509PubMedCrossRefGoogle Scholar
  2. 2.
    Futterer JJ, Heijmink SW, Scheenen TW et al (2006) Prostate Cancer Localization with Dynamic Contrast-enhanced MR Imaging and Proton MR Spectroscopic Imaging. Radiology 241:449–58PubMedCrossRefGoogle Scholar
  3. 3.
    Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L (2006) Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol 176:2432–7PubMedCrossRefGoogle Scholar
  4. 4.
    Yoshimitsu K, Kiyoshima K, Irie H et al (2008) Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: correlation with stepwise histopathology. J Magn Reson Imaging 27:132–9PubMedCrossRefGoogle Scholar
  5. 5.
    Yoshizako T, Wada A, Hayashi T et al (2008) Usefulness of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of prostate transition-zone cancer. Acta Radiol 49:1207–13PubMedCrossRefGoogle Scholar
  6. 6.
    Lim HK, Kim JK, Kim KA, Cho KS (2009) Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection–a multireader study. Radiology 250:145–51PubMedCrossRefGoogle Scholar
  7. 7.
    Puech P, Potiron E, Lemaitre L et al (2009) Dynamic contrast-enhanced-magnetic resonance imaging evaluation of intraprostatic prostate cancer: correlation with radical prostatectomy specimens. Urology 74:1094–9PubMedCrossRefGoogle Scholar
  8. 8.
    Mazaheri Y, Shukla-Dave A, Hricak H et al (2008) Prostate cancer: identification with combined diffusion-weighted MR imaging and 3D 1H MR spectroscopic imaging–correlation with pathologic findings. Radiology 246:480–8PubMedCrossRefGoogle Scholar
  9. 9.
    Yuen JS, Thng CH, Tan PH et al (2004) Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. J Urol 171:1482–6PubMedCrossRefGoogle Scholar
  10. 10.
    Tanimoto A, Nakashima J, Kohno H, Shinmoto H, Kuribayashi S (2007) Prostate cancer screening: the clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. J Magn Reson Imaging 25:146–52PubMedCrossRefGoogle Scholar
  11. 11.
    Cheikh AB, Girouin N, Colombel M et al (2009) Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy. Eur Radiol 19:770–8PubMedCrossRefGoogle Scholar
  12. 12.
    Ahmed HU, Kirkham A, Arya M et al (2009) Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 6:197–206PubMedCrossRefGoogle Scholar
  13. 13.
    Heidenreich A (2011) Consensus criteria for the use of magnetic resonance imaging in the diagnosis and staging of prostate cancer: not ready for routine use. Eur Urol 59:495–7PubMedCrossRefGoogle Scholar
  14. 14.
    Dickinson L, Ahmed HU, Allen C et al (2011) Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 59:477–94PubMedCrossRefGoogle Scholar
  15. 15.
    Akin O, Sala E, Moskowitz CS et al (2006) Transition zone prostate cancers: features, detection, localization, and staging at endorectal MR imaging. Radiology 239:784–92PubMedCrossRefGoogle Scholar
  16. 16.
    McNeal JE, Haillot O (2001) Patterns of spread of adenocarcinoma in the prostate as related to cancer volume. Prostate 49:48–57PubMedCrossRefGoogle Scholar
  17. 17.
    Haffner J, Potiron E, Bouye S et al (2009) Peripheral zone prostate cancers: location and intraprostatic patterns of spread at histopathology. Prostate 69:276–82PubMedCrossRefGoogle Scholar
  18. 18.
    Lemaitre L, Puech P, Poncelet E et al (2009) Dynamic contrast-enhanced MRI of anterior prostate cancer: morphometric assessment and correlation with radical prostatectomy findings. Eur Radiol 19:470–80PubMedCrossRefGoogle Scholar
  19. 19.
    Bouye S, Potiron E, Puech P, Leroy X, Lemaitre L, Villers A (2009) Transition zone and anterior stromal prostate cancers: zone of origin and intraprostatic patterns of spread at histopathology. Prostate 69:105–13PubMedCrossRefGoogle Scholar
  20. 20.
    Franiel T, Hamm B, Hricak H (2011) Dynamic contrast-enhanced magnetic resonance imaging and pharmacokinetic models in prostate cancer. Eur Radiol 21:616–26PubMedCrossRefGoogle Scholar
  21. 21.
    Tan CH, Wang J, Kundra V (2011) Diffusion weighted imaging in prostate cancer. Eur Radiol 21:593–603PubMedCrossRefGoogle Scholar
  22. 22.
    Jager GJ, Ruijter ET, van de Kaa CA et al (1996) Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol 166:845–52PubMedGoogle Scholar
  23. 23.
    Cornud F, Flam T, Chauveinc L et al (2002) Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. Radiology 224:203–10PubMedCrossRefGoogle Scholar
  24. 24.
    Franiel T, Stephan C, Erbersdobler A et al (2011) Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding - Multiparametric MR imaging for detection and biopsy planning. Radiology 259:162–72PubMedCrossRefGoogle Scholar
  25. 25.
    Mozer P, Baumann M, Chevreau G et al (2009) Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing. J Ultrasound Med 28:455–60PubMedGoogle Scholar
  26. 26.
    Pinto PA, Chung PH, Rastinehad AR et al (2011) Magnetic Resonance Imaging/Ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric Magnetic Resonance imaging. J Urol 186:1281–1285PubMedCrossRefGoogle Scholar
  27. 27.
    Delongchamps NB, Haas GP (2009) Saturation biopsies for prostate cancer: current uses and future prospects. Nat Rev Urol 6:645–52PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Olivier Rouvière
    • 1
    • 2
    • 3
    • 8
    • 9
  • Matthieu Papillard
    • 1
    • 2
    • 3
  • Nicolas Girouin
    • 1
    • 2
    • 3
  • Romain Boutier
    • 1
    • 2
    • 3
  • Muriel Rabilloud
    • 4
    • 5
  • Benjamin Riche
    • 4
    • 5
  • Florence Mège-Lechevallier
    • 6
  • Marc Colombel
    • 7
  • Albert Gelet
    • 7
    • 8
  1. 1.Hospices Civils de Lyon, Department of Urinary and Vascular RadiologyHôpital Edouard HerriotLyonFrance
  2. 2.Université de LyonLyonFrance
  3. 3.Université Lyon 1, faculté de médecine Lyon EstLyonFrance
  4. 4.Hospices Civils de Lyon, Department of BiostatisticsLyonFrance
  5. 5.Université Lyon 1, UMR CNRS 5558, Laboratoire Biostatistiques-SantéPierre-BéniteFrance
  6. 6.Hospices Civils de Lyon, Department of PathologyHôpital Edouard HerriotLyonFrance
  7. 7.Hospices Civils de Lyon, Department of UrologyHôpital Edouard HerriotLyonFrance
  8. 8.Inserm, U556LyonFrance
  9. 9.Department of Urinary and Vascular RadiologyPavillon P Radio, Hôpital Edouard HerriotLyon Cedex 03France

Personalised recommendations