Evaluation of clinically significant prostate cancer using biparametric magnetic resonance imaging: An evolving concept
Manik Mahajan1, Vikrant Gupta1, Puneet Gupta2, Poonam Sharma3, Deepak Abrol4
1 Department of Radio-Diagnosis and Imaging, Government Medical College, Jammu, Jammu and Kashmir, India
2 Department of Radio-Diagnosis and Imaging, ASCOMS Hospital, Jammu, Jammu and Kashmir, India, India
3 Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India
4 Department of Radiation Oncology, Government Medical College, Kathua, Jammu and Kashmir, India
House No 109, Sector-7, Channi Himmat, Jammu - 180 015, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Multiparametric magnetic resonance imaging (mp-MRI) of prostate involves a combination of T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced (DCE) scans. However, controversy exists in the literature regarding the true value of DCE in the detection of clinically significant (CS) prostate cancer (PCa).
Aim: The aim of this study is to compare the role of biparametric MRI (bp-MRI) and mp-MRI in the detection of CS PCa.
Materials and Methods: Thirty-six patients with raised serum prostate-specific antigen levels were included. Bp-MRI was performed in all patients, whereas mp-MRI was performed in 30 cases only. The findings were characterized on the basis of prostate imaging reporting and data system (PI-RADS) v2 grading. PI-RADS v2 score of 3 or more was considered CS PCa. All patients underwent transrectal ultrasound-guided biopsy. Gleason score >6 was considered CS. Statistical analysis was done using the SPSS software and results interpreted.
Results: CS PCa was observed in 31 cases on histopathology. On bp-MRI, CS PCa was seen in 31 patients. Five cases of PI-RADS v2 score 3 were seen on bp-MRI and 3 of them were upgraded to PI-RADS 4 on DCE images. One case of PI-RADS 3 had low Gleason score on biopsy, whereas 1 case of PI-RADS 2 had CS PCa on biopsy. No significant difference was observed between bp-MRI and mp-MRI in the detection of CS PCa.
Conclusions: Both bp-MRI and mp-MRI have high sensitivity, specificity, and diagnostic accuracy and were nearly identical in the detection of CS PCa with no significant advantage of DCE images.