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Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla

European Radiology volume 24, pages 344–352 (2014)Cite this article

An Erratum to this article was published on 07 February 2014

Abstract

Objectives

To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer (PCa) by multiparametric magnetic resonance imaging (mpMRI) in a consecutive cohort of patients with magnetic resonance/transrectal ultrasound (MR/TRUS) fusion-guided biopsy.

Methods

Suspicious lesions on mpMRI at 3.0 T were scored according to the PI-RADS system before MR/TRUS fusion-guided biopsy and correlated to histopathology results. Statistical correlation was obtained by a Mann–Whitney U test. Receiver operating characteristics (ROC) and optimal thresholds were calculated.

Results

In 64 patients, 128/445 positive biopsy cores were obtained out of 95 suspicious regions of interest (ROIs). PCa was present in 27/64 (42 %) of the patients. ROC results for the aggregated PI-RADS scores exhibited higher areas under the curve compared to those of the Likert score. Sensitivity/specificity for the following thresholds were calculated: 73 %/92 % and 85 %/67 % for PI-RADS scores of 9 and 10, respectively; 85 %/56 % and 60 %/97 % for Likert scores of 3 and 4, respectively.

Conclusions

The standardised ESUR PI-RADS system is beneficial to indicate the likelihood of PCa of suspicious lesions on mpMRI. It is also valuable to identify locations to be targeted with biopsy. The aggregated PI-RADS score achieved better results compared to the single five-point Likert score.

Key points

• The ESUR PI-RADS scoring system was evaluated using multiparametric 3.0-T MRI.

• To investigate suspicious findings, transperineal MR/TRUS fusion-guided biopsy was used.

• PI-RADS can guide biopsy locations and improve detection of clinically significant cancer.

• Biopsy procedures can be optimised, reducing unnecessary negative biopsies for patients.

• The PI-RADS scoring system may contribute to more effective prostate MRI.

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Abbreviations

ADC:

apparent diffusion coefficient

BI-RADS:

Breast Imaging Reporting and Data System

CI:

confidence interval

DCE:

dynamic contrast enhanced

DICOM:

Digital Imaging and Communication in Medicine

DRE:

digital rectal examination

DWI:

diffusion-weighted imaging

ESUR:

European Society of Urogenital Radiology

HASTE:

half-Fourier acquisition turbo spin echo

MRI:

magnetic resonance imaging

MRS:

magnetic resonance spectroscopy

PCa:

prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

prostate specific antigen

ROC:

receiver operating characteristic

T1w:

T1-weighted

T2w:

T2-weighted

TRUS:

transrectal ultrasound

References

  1. 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 6:197–206

    PubMed  Article  Google Scholar 

  2. Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71

    PubMed  Article  Google Scholar 

  3. Kirkham AP, Emberton M, Allen C (2006) How good is MRI at detecting and characterising cancer within the prostate? Eur Urol 50:1163–1174

    PubMed  Article  Google Scholar 

  4. 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 59:477–494

    PubMed  Article  Google Scholar 

  5. Hoeks CM, Barentsz JO, Hambrock T et al (2011) Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 261:46–66

    PubMed  Article  Google Scholar 

  6. Dickinson L, Ahmed HU, Allen C et al (2013) Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? J Magn Reson Imaging 37:48–58

    PubMed  Article  Google Scholar 

  7. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    PubMed Central  PubMed  Article  Google Scholar 

  8. Molleran V, Mahoney MC (2010) The BI-RADS breast magnetic resonance imaging lexicon. Magn Reson Imaging Clin N Am 18:171–185

    PubMed  Article  Google Scholar 

  9. Portalez D, Rollin G, Leandri P et al (2010) Prospective comparison of T2w-MRI and dynamic-contrast-enhanced MRI, 3D-MR spectroscopic imaging or diffusion-weighted MRI in repeat TRUS-guided biopsies. Eur Radiol 20:2781–2790

    PubMed  Article  Google Scholar 

  10. Schimmöller L, Quentin M, Arsov C et al (2013) Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard. Eur Radiol. doi:10.1007/s00330-013-2922-y

    Google Scholar 

  11. Roethke M, Blondin D, Schlemmer HP, Franiel T (2013) PI-RADS classification: structured reporting for MRI of the prostate. Rofo 185:253–261

    Article  Google Scholar 

  12. Hadaschik BA, Kuru TH, Tulea C et al (2011) A novel stereotactic prostate biopsy system integrating pre-interventional magnetic resonance imaging and live ultrasound fusion. J Urol 186:2214–2220

    PubMed  Article  Google Scholar 

  13. Kuru TH, Roethke M, Popeneciu V et al (2012) Phantom study of a novel stereotactic prostate biopsy system integrating preinterventional magnetic resonance imaging and live ultrasonography fusion. J Endourol 26:807–813

    PubMed  Article  Google Scholar 

  14. Vargas HA, Akin O, Shukla-Dave A et al (2012) Performance characteristics of MR imaging in the evaluation of clinically low-risk prostate cancer: a prospective study. Radiology 265:478–487

    PubMed  Article  Google Scholar 

  15. Weinreb JC, Blume JD, Coakley FV et al (2009) Prostate cancer: sextant localization at MR imaging and MR spectroscopic imaging before prostatectomy–results of ACRIN prospective multi-institutional clinicopathologic study. Radiology 251:122–133

    PubMed  Article  Google Scholar 

  16. Futterer JJ, Engelbrecht MR, Jager GJ et al (2007) Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging. Eur Radiol 17:1055–1065

    PubMed  Article  Google Scholar 

  17. Lee SH, Park KK, Choi KH et al (2010) Is endorectal coil necessary for the staging of clinically localized prostate cancer? Comparison of non-endorectal versus endorectal MR imaging. World J Urol 28:667–672

    PubMed  Article  Google Scholar 

  18. Park BK, Kim B, Kim CK, Lee HM, Kwon GY (2007) Comparison of phased-array 3.0-T and endorectal 1.5-T magnetic resonance imaging in the evaluation of local staging accuracy for prostate cancer. J Comput Assist Tomogr 31:534–538

    PubMed  Article  Google Scholar 

  19. Scheenen TW, Heijmink SW, Roell SA et al (2007) Three-dimensional proton MR spectroscopy of human prostate at 3 T without endorectal coil: feasibility. Radiology 245:507–516

    PubMed  Article  Google Scholar 

  20. Klotz L (2012) Active surveillance for favorable-risk prostate cancer: background, patient selection, triggers for intervention, and outcomes. Curr Urol Rep 13:153–159

    PubMed  Article  Google Scholar 

  21. Rosenkrantz AB, Kim S, Lim RP et al (2013) Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. Radiology. doi:10.1148/radiol.13122233

    Google Scholar 

  22. Harnden P, Naylor B, Shelley MD, Clements H, Coles B, Mason MD (2008) The clinical management of patients with a small volume of prostatic cancer on biopsy: what are the risks of progression? A systematic review and meta-analysis. Cancer 112:971–981

    PubMed  Article  Google Scholar 

  23. Ahmed HU, Hu Y, Carter T et al (2011) Characterizing clinically significant prostate cancer using template prostate mapping biopsy. J Urol 186:458–464

    PubMed  Article  Google Scholar 

  24. Roethke M, Anastasiadis AG, Lichy M et al (2012) MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol 30:213–218

    CAS  PubMed  Article  Google Scholar 

  25. Vargas HA, Akin O, Afaq A et al (2012) Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 188:1732–173826

    PubMed  Article  Google Scholar 

  26. Anastasiadis AG, Lichy MP, Nagele U et al (2006) MRI-guided biopsy of the prostate increases diagnostic performance in men with elevated or increasing PSA levels after previous negative TRUS biopsies. Eur Urol 50:738–748

    CAS  PubMed  Article  Google Scholar 

  27. 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 186:1281–1285

    PubMed Central  PubMed  Article  Google Scholar 

  28. Ukimura O, Desai MM, Palmer S et al (2012) 3-Dimensional elastic registration system of prostate biopsy location by real-time 3-dimensional transrectal ultrasound guidance with magnetic resonance/transrectal ultrasound image fusion. J Urol 187:1080–1086

    PubMed  Article  Google Scholar 

  29. Baumann M, Mozer P, Daanen V, Troccaz J (2012) Prostate biopsy tracking with deformation estimation. Med Image Anal 16:562–576

    PubMed  Article  Google Scholar 

  30. Kasivisvanathan V, Dufour R, Moore CM et al (2013) Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. J Urol 189:860–866

    PubMed  Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany

    M. C. Roethke, S. Schultze, M. Fenchel & H.-P. Schlemmer

  2. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany

    T. H. Kuru & B. A. Hadaschik

  3. Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany

    D. Tichy & A. Kopp-Schneider

Authors
  1. M. C. Roethke
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  2. T. H. Kuru
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  3. S. Schultze
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  5. A. Kopp-Schneider
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  6. M. Fenchel
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  7. H.-P. Schlemmer
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  8. B. A. Hadaschik
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Correspondence to M. C. Roethke.

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Roethke, M.C., Kuru, T.H., Schultze, S. et al. Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla. Eur Radiol 24, 344–352 (2014). https://doi.org/10.1007/s00330-013-3017-5

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  • DOI: https://doi.org/10.1007/s00330-013-3017-5

Keywords

  • ESUR score
  • MR/TRUS fusion-guided biopsy
  • Multiparametric MRI
  • PI-RADS
  • Prostate cancer