To investigate, if and how omitting gadolinium-based contrast agents (GBCA) and dynamic contrast-enhanced imaging (DCE) influences diagnostic accuracy and tumor detection rates of prostate MRI.
In this retrospective study, 236 patients were included. The results of biparametric (bpMRI) and multiparametric magnetic resonance imaging (mpMRI) were compared using the PI-RADS version 2 scoring system. The distribution of lesions to PIRADS score levels, tumor detection rates, diagnostic accuracy and RoC analysis were calculated and compared to the results of histopathological analysis or 5-year follow-up for benign findings.
Omitting DCE changed PI-RADS scores in 9.75% of patients, increasing the number of PI-RADS 3 scores by 8.89% when compared to mpMRI. No change of more than one score level was observed. BpMRI did not show significant differences in diagnostic accuracy or tumor detection rates. (AuC of 0.914 vs 0.917 in ROC analysis). Of 135 prostate carcinomas (PCa), 94.07% were scored identically, and 5.93% were downgraded only from PI-RADS 4 to PI-RADS 3 by bpMRI. All of them were low-grade PCa with Gleason Score 6 or 7a. No changes were observed for PCa ≥ 7b.
Omitting DCE did not lead to significant differences in diagnostic accuracy or tumor detection rates when using the PI-RADS 2 scoring system. According to these data, it seems reasonable to use a biparametric approach for initial routine prostate MRI. This could decrease examination time and reduce costs without significantly lowering the diagnostic accuracy.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V, Futterer JJ, European Society of Urogenital R (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757. https://doi.org/10.1007/s00330-011-2377-y
Auer T, Edlinger M, Bektic J, Nagele U, Herrmann T, Schafer G, Aigner F, Junker D (2017) Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol 35(5):687–693. https://doi.org/10.1007/s00345-016-1920-5
Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S (2016) PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol 69(1):16–40. https://doi.org/10.1016/j.eururo.2015.08.052
Girouin N, Mege-Lechevallier F, Tonina Senes A, Bissery A, Rabilloud M, Marechal JM, Colombel M, Lyonnet D, Rouviere O (2007) Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol 17(6):1498–1509. https://doi.org/10.1007/s00330-006-0478-9
Futterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P, Hulsbergen-Van de Kaa CA, Witjes JA, Krabbe PF, Heerschap A, Barentsz JO (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241(2):449–458. https://doi.org/10.1148/radiol.2412051866
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(1):146–152. https://doi.org/10.1002/jmri.20793
Yoshimitsu K, Kiyoshima K, Irie H, Tajima T, Asayama Y, Hirakawa M, Ishigami K, Naito S, Honda H (2008) Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: correlation with stepwise histopathology. J Magn Reson Imaging 27(1):132–139. https://doi.org/10.1002/jmri.21181
Kim CK, Park BK, Lee HM, Kwon GY (2007) Value of diffusion-weighted imaging for the prediction of prostate cancer location at 3T using a phased-array coil: preliminary results. Invest Radiol 42(12):842–847. https://doi.org/10.1097/RLI.0b013e3181461d21
Greer MD, Shih JH, Lay N, Barrett T, Kayat Bittencourt L, Borofsky S, Kabakus IM, Law YM, Marko J, Shebel H, Mertan FV, Merino MJ, Wood BJ, Pinto PA, Summers RM, Choyke PL, Turkbey B (2017) Validation of the dominant sequence paradigm and role of dynamic contrast-enhanced imaging in PI-RADS version 2. Radiology 285(3):859–869. https://doi.org/10.1148/radiol.2017161316
Puech P, Sufana-Iancu A, Renard B, Lemaitre L (2013) Prostate MRI: can we do without DCE sequences in 2013? Diagn Interv Imaging 94(12):1299–1311. https://doi.org/10.1016/j.diii.2013.09.010
Stanzione A, Imbriaco M, Cocozza S, Fusco F, Rusconi G, Nappi C, Mirone V, Mangiapia F, Brunetti A, Ragozzino A, Longo N (2016) Biparametric 3T Magnetic Resonance Imaging for prostatic cancer detection in a biopsy-naive patient population: a further improvement of PI-RADS v2? Eur J Radiol 85(12):2269–2274. https://doi.org/10.1016/j.ejrad.2016.10.009
Scialpi M, Prosperi E, D’Andrea A, Martorana E, Malaspina C, Palumbo B, Orlandi A, Falcone G, Milizia M, Mearini L, Aisa MC, Scialpi P, Bianchi G, Sidoni A, C DED (2017) Biparametric versus multiparametric MRI with non-endorectal coil at 3T in the detection and localization of prostate cancer. Anticancer Res 37(3):1263–1271. https://doi.org/10.21873/anticanres.11443
Mussi TC, Martins T, Garcia RG, Filippi RZ, Lemos GC, Baroni RH (2017) Are dynamic contrast-enhanced images necessary for prostate cancer detection on multiparametric magnetic resonance imaging? Clin Genitourin Cancer 15(3):e447–e454. https://doi.org/10.1016/j.clgc.2016.10.001
Sanz-Requena R, Marti-Bonmati L, Perez-Martinez R, Garcia-Marti G (2016) Dynamic contrast-enhanced case-control analysis in 3T MRI of prostate cancer can help to characterize tumor aggressiveness. Eur J Radiol 85(11):2119–2126. https://doi.org/10.1016/j.ejrad.2016.09.022
Hansford BG, Peng Y, Jiang Y, Vannier MW, Antic T, Thomas S, McCann S, Oto A (2015) Dynamic contrast-enhanced MR imaging curve-type analysis: is it helpful in the differentiation of prostate cancer from healthy peripheral zone? Radiology 275(2):448–457. https://doi.org/10.1148/radiol.14140847
Kuhl CK, Bruhn R, Kramer N, Nebelung S, Heidenreich A, Schrading S (2017) Abbreviated biparametric prostate MR imaging in men with elevated prostate-specific antigen. Radiology 285(2):493–505. https://doi.org/10.1148/radiol.2017170129
Di Campli E, Delli Pizzi A, Seccia B, Cianci R, d’Annibale M, Colasante A, Cinalli S, Castellan P, Navarra R, Iantorno R, Gabrielli D, Buffone A, Caulo M, Basilico R (2018) Diagnostic accuracy of biparametric vs multiparametric MRI in clinically significant prostate cancer: comparison between readers with different experience. Eur J Radiol 101:17–23. https://doi.org/10.1016/j.ejrad.2018.01.028
De Visschere P, Lumen N, Ost P, Decaestecker K, Pattyn E, Villeirs G (2017) Dynamic contrast-enhanced imaging has limited added value over T2-weighted imaging and diffusion-weighted imaging when using PI-RADSv2 for diagnosis of clinically significant prostate cancer in patients with elevated PSA. Clin Radiol 72(1):23–32. https://doi.org/10.1016/j.crad.2016.09.011
McDonald RJ, McDonald JS, Kallmes DF, Jentoft ME, Murray DL, Thielen KR, Williamson EE, Eckel LJ (2015) Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 275(3):772–782. https://doi.org/10.1148/radiol.15150025
Fine SW, Amin MB, Berney DM, Bjartell A, Egevad L, Epstein JI, Humphrey PA, Magi-Galluzzi C, Montironi R, Stief C (2012) A contemporary update on pathology reporting for prostate cancer: biopsy and radical prostatectomy specimens. Eur Urol 62(1):20–39. https://doi.org/10.1016/j.eururo.2012.02.055
Delongchamps NB, Rouanne M, Flam T, Beuvon F, Liberatore M, Zerbib M, Cornud F (2011) Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int 107(9):1411–1418. https://doi.org/10.1111/j.1464-410X.2010.09808.x
Rosenkrantz AB, Verma S, Choyke P, Eberhardt SC, Eggener SE, Gaitonde K, Haider MA, Margolis DJ, Marks LS, Pinto P, Sonn GA, Taneja SS (2016) Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 196(6):1613–1618. https://doi.org/10.1016/j.juro.2016.06.079
Steinkohl F, Gruber L, Bektic J, Nagele U, Aigner F, Herrmann TRW, Rieger M, Junker D (2018) Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable? World J Urol 36(3):367–373. https://doi.org/10.1007/s00345-017-2135-0
Sheridan AD, Nath SK, Syed JS, Aneja S, Sprenkle PC, Weinreb JC, Spektor M (2018) Risk of clinically significant prostate cancer associated with prostate imaging reporting and data system category 3 (Equivocal) lesions identified on multiparametric prostate MRI. AJR Am J Roentgenol 210(2):347–357. https://doi.org/10.2214/AJR.17.18516
Krishna S, McInnes M, Lim C, Lim R, Hakim SW, Flood TA, Schieda N (2017) Comparison of prostate imaging reporting and data system versions 1 and 2 for the detection of peripheral zone Gleason Score 3 + 4 = 7 Cancers. AJR Am J Roentgenol 209(6):W365–W373. https://doi.org/10.2214/AJR.17.17964
Tan CH, Hobbs BP, Wei W, Kundra V (2015) Dynamic contrast-enhanced MRI for the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol 204(4):W439–448. https://doi.org/10.2214/AJR.14.13373
Jung JW, Kang HR, Kim MH, Lee W, Min KU, Han MH, Cho SH (2012) Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology 264(2):414–422. https://doi.org/10.1148/radiol.12112025
Grune F, Schrappe M, Basten J, Wenchel HM, Tual E, Stutzer H, Cologne Quality Control N (2004) Phlebitis rate and time kinetics of short peripheral intravenous catheters. Infection 32(1):30–32. https://doi.org/10.1007/s15010-004-1037-4
Deray G, Rouviere O, Bacigalupo L, Maes B, Hannedouche T, Vrtovsnik F, Rigothier C, Billiouw JM, Campioni P, Ferreiros J, Devos D, Alison D, Glowacki F, Boffa JJ, Marti-Bonmati L (2013) Safety of meglumine gadoterate (Gd-DOTA)-enhanced MRI compared to unenhanced MRI in patients with chronic kidney disease (RESCUE study). Eur Radiol 23(5):1250–1259. https://doi.org/10.1007/s00330-012-2705-x
Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB, International Society for Magnetic Resonance in M (2017) Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol 16(7):564–570. https://doi.org/10.1016/S1474-4422(17)30158-8
Ullrich T, Quentin M, Oelers C, Dietzel F, Sawicki LM, Arsov C, Rabenalt R, Albers P, Antoch G, Blondin D, Wittsack HJ, Schimmoller L (2017) Magnetic resonance imaging of the prostate at 1.5 versus 3.0T: a prospective comparison study of image quality. Eur J Radiol 90:192–197. https://doi.org/10.1016/j.ejrad.2017.02.044
Conflict of interest
The authors declare that they have no conflict of interest, nothing to declare.
Research including human participants and ethical approval
This is a retrospective study. Institutional review board approval was granted by means of a general waiver for studies with retrospective data analysis (Ethikkommission, Med. Univ. Innsbruck; 2009-02-20). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
About this article
Cite this article
Junker, D., Steinkohl, F., Fritz, V. et al. Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations?. World J Urol 37, 691–699 (2019). https://doi.org/10.1007/s00345-018-2428-y
- Prostate cancer
- Multiparametric MRI
- Biparametric MRI
- Contrast medium