European Radiology

, Volume 29, Issue 12, pp 6682–6689 | Cite as

Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging

  • Li-Hua Xiang
  • Yan Fang
  • Jing Wan
  • Guang Xu
  • Ming-Hua Yao
  • Shi-Si Ding
  • Hui Liu
  • Rong WuEmail author



To analyze the diagnostic value of adding SWE to MRI for the diagnosis of clinically significant prostate cancer with false-negative MRI results.


This was a retrospective study of 367 patients who underwent MRI, SWE, and prostate biopsy between March 2016 and November 2018 at the Shanghai Tenth People’s Hospital. Serum prostate-specific antigen (PSA) and free PSA (fPSA) were measured preoperatively. Diagnostic value and accuracy was determined for MRI alone and MRI + SWE using the receiver operator characteristic curve (ROC) analysis.


MRI misdiagnosed 17.9% (21/117) clinically significant prostate cancers, including 15 lesions in the peripheral zone and 6 in the central zone. Both qualitative and quantitative SWE could help detect 66.7% (10/15) significant prostate cancers with false-negative MRI, but there was no association with the Gleason score (p > 0.05). When considering the sextant of the peripheral zone, a significant association was not seen with histopathology in qualitative SWE (p = 0.071) and quantitative SWE (p = 0.598). Among age, PSA, fPSA, volume of the prostate gland, fPSA/PSA, and PSAD, only PSAD (p = 0.019) was associated with SWE results in patients with negative MRI.


Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.

Key Points

• MRI plays an important role in clinically significant prostate cancers diagnosis.

• SWE plays an important role in clinically significant prostate cancers with negative MRI.

• Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.


Prostate cancer Biopsy Magnetic resonance imaging 



95% confidence intervals


Apparent diffusion coefficient


Atypical adenomatous hyperplasia


Acute/chronic prostatitis


Atypical small acinar hyperplasia


Area under the ROC


Benign prostatic hyperplasia


Dynamic contrast enhancement


Diffusion-weighted imaging


Free PSA


High-grade prostate intraepithelial neoplasia


Low-grade prostate intraepithelial neoplasia


Multiparameter magnetic resonance imaging


National Cancer Institute


Negative predictive value


Non-specific granulomatous prostatitis


Prostate cancer


Prostate Imaging Reporting and Data System


Positive predictive value


Prostate-specific antigen


PSA density


Receiver operator characteristic


Region of interest


Clinically significant prostate cancer


Shear-wave elastography


T1-Weighted imaging


T2-Weighted imaging


Transperineal prostate biopsy guided by transrectal ultrasound




Volume of the prostate gland



This study has received funding through Grant SHDC12016233 from the Shanghai Hospital Development Center, Grant 17411967400 from the Science and Technology Commission of Shanghai Municipality, and Grants 81471673 and 81671699 from the National Natural Science Foundation of China.

Compliance with ethical standards


The scientific guarantor of this publication is Rong Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6274_MOESM1_ESM.docx (9.4 mb)
ESM 1 (DOCX 9660 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Li-Hua Xiang
    • 1
    • 2
  • Yan Fang
    • 1
    • 2
  • Jing Wan
    • 1
    • 2
  • Guang Xu
    • 1
    • 2
  • Ming-Hua Yao
    • 1
    • 2
  • Shi-Si Ding
    • 1
    • 2
  • Hui Liu
    • 1
    • 2
  • Rong Wu
    • 1
    • 3
    Email author
  1. 1.Department of Medical Ultrasound, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  2. 2.Ultrasound Research and Education InstituteTongji University School of MedicineShanghaiChina
  3. 3.Department of Ultrasound, Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina

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