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PurposeTo investigate the role of qualitative and quantitative DCE-MRI parameters in prostate cancer (PCa) stratified by whole-mount histopathology (WMHP) Gleason score (GS) and PI-RADSv2.MethodsThis retrospective study included 323 PCa tumors in 254 men, who underwent 3T MRI prior to prostatectomy, 7/2009-12/2016. Qualitative DCE curve types included type 1 (progressive), type 2 (plateau) and type 3 (washout). Quantitative DCE-MRI pharmacokinetic (PK) parameters included Ktrans (influx volume transfer coefficient), Kep (efflux reflux rate constant) and iAUC (initial area under the curve). DCE-MRI features of true positive lesions were evaluated for overall, index, transition zone (TZ) and peripheral zone (PZ), based on GS grade (low = 6, high > 6) and PI-RADSv2 score using SPSSv24.ResultsThere were 57 (17.6%) low-grade and 266 (82.4%) high-grade PCa lesions. PI-RADSv2 3, 4 and 5 included 106, 120 and 97 lesions, respectively. 251 (77.7%) and 72 (22.3%) lesions were located in PZ and TZ, respectively. High-grade lesions had significantly higher proportion of Type 3 curves compared to low-grade lesions in overall (70.3% vs. 54.4%) and TZ (73.5% vs. 43.5%). As PI-RADSv2 increased, the proportion of type 3 curve significantly increased for overall (80.4-51.9%), index (80.4-54.7%) and PZ (78.7-52.1%) lesions. Among PK parameters, Ktrans (0.43 vs 0.32) and iAUC (8.99 vs 6.9) for overall PCa, Ktrans (0.43 vs 0.31) and iAUC (9 vs 6.67) for PZ PCa, and iAUC (8.94 vs 7.42) for index PCa were significantly higher for high-grade versus low-grade lesions. Also, Ktrans (0.51-0.34), Kep (1.75-1.29) and iAUC (9.79-7.6) for overall PCa, Ktrans (0.53-0.32), Kep (1.81-1.26) and iAUC (9.83-7.34) for PZ PCa; and Kep (1.79-1.17) and iAUC (11.3-8.45) for index PCa increased significantly with a higher PI-RADSv2 score.ConclusionsThe results of study show the possible utility of qualitative and quantitative DCE-MRI parameters for assessment of PCa GS and PI-RADSv2 categorization.

Background: There is an overlap comparing transition zone prostate cancer (TZ PCa) and benign prostatic hyperplasia (BPH) on T2‐weighted imaging (T2WI) and diffusion‐weighted imaging (DWI), creating additional challenges for assessment of TZ tumors on MRI. Purpose: To evaluate whether amide proton transfer‐weighted (APTw) imaging provides new diagnostic ideas for TZ PCa. Study type: Prospective. Population: A total of 51 TZ PCa patients (age, 49–89), 44 stromal BPH (age, 57–92), and 45 glandular BPH patients (age, 56–92). Field Strength/Sequence: A 3 T; T2WI turbo spin echo (TSE), quantitative T2*‐weighted imaging, DWI echo planar imaging, 3D APTw TSE. Assessment Differences in APTw, apparent diffusion coefficient (ADC), and T2* among three lesions were compared by one‐way analysis of variance (ANOVA). Regions of interest were drawn by two radiologists (X.Q.Z. and X.Y.Q., with 21 and 15 years of experience, respectively). Statistical Tests: Multivariable logistic regression analyses; ANOVA with post hoc testing; receiver operator characteristic curve analysis; Delong test. Significance level: P < 0.05. Results: APTw among TZ PCa, stromal BPH, and glandular BPH (3.48% ± 0.83% vs. 2.76% ± 0.49% vs. 2.72% ± 0.45%, respectively) were significantly different except between stromal BPH and glandular BPH (P > 0.99). Significant differences were found in ADC (TZ PCa 0.76 ± 0.16 × 10−3 mm2/sec vs. stromal BPH 0.91 ± 0.14 × 10−3 mm2/sec vs. glandular BPH 1.08 ± 0.18 × 10−3 mm2/sec) among three lesions. APTw (OR = 12.18, 11.80, respectively) and 1/ADC (OR = 703.87, 181.11, respectively) were independent predictors of TZ PCa from BPH and stromal BPH. The combination of APTw and ADC had better diagnostic performance in the identification of TZ PCa from BPH and stromal BPH. Data Conclusion: APTw imaging has the potential to be of added value to ADC in differentiating TZ PCa from BPH and stromal BPH. Evidence Level 2 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Abstract Background The study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PI-RADS v2.1-B. Results Among TZ lesions (n = 78), 47 (60.0%) had T2WI score of 3, and 16 of the 47 (34.0%) were malignant. The rate of malignancy was 8.8% in PI-RADS category 3A, 100% in PI-RADS category 3B, and 100% in PI-RADS category 4. The apparent diffusion coefficient value of PI-RADS category 3B (0.934 ± 0.158 × 10−3 mm2/s) showed significant difference with that of PI-RADS category 3A (1.098 ± 0.146 × 10−3 mm2/s) but none with PI-RADS category 4 (0.821 ± 0.091 × 10−3 mm2/s). There was no significant difference in the sensitivity and negative predictive value of PI-RADS v2.1 and PI-RADS v2.1-B. Specificity and positive predictive value of modified PI-RADS v2.1-B were much higher than those of PI-RADS v2.1 for both readers (p < .001). The area under the receiver operating characteristic curve tended to be higher with PI-RADS v2.1-B than with PI-RADS v2.1. Conclusion Biopsy for PI-RADS 3B lesion is necessary due to its superior malignancy potential than that of PI-RADS 3A lesion.

Purpose: To determine if pharmacokinetic modeling of DCE-MRI can diagnose CS-PCa in PI-RADS category 3 PZ lesions with subjective negative DCE-MRI. Materials and methods: In the present IRB approved, bi-institutional, retrospective, case–control study, we identified 73 men with 73 PZ PI-RADS version 2.1 category 3 lesions with MRI-directed-TRUS-guided targeted biopsy yielding: 12 PZ CS-PCa (ISUP Grade Group 2; N = 9, ISUP 3; N = 3), 27 ISUP 1 PCa and 34 benign lesions. An expert blinded radiologist segmented lesions on ADC and DCE images; segmentations were overlayed onto pharmacokinetic DCE-MRI maps. Mean values were compared between groups using univariate analysis. Diagnostic accuracy was assessed by ROC. Results: There were no differences in age, PSA, PSAD or clinical stage between groups (p = 0.265–0.645). Mean and 10th percentile ADC did not differ comparing CS-PCa to ISUP 1 PCa and benign lesions (p = 0.376 and 0.598) but was lower comparing ISUP ≥ 1 PCa to benign lesions (p < 0.001). Mean Ktrans (p = 0.003), Ve (p = 0.003) but not Kep (p = 0.387) were higher in CS-PCa compared to ISUP 1 PCa and benign lesions. There were no differences in DCE-MRI metrics comparing ISUP ≥ 1 PCa and benign lesions (p > 0.05). AUC for diagnosis of CS-PCa using Ktrans and Ve were: 0.69 (95% CI 0.52–0.87) and 0.69 (0.49–0.88). Conclusion: Pharmacokinetic modeling of DCE-MRI parameters in PI-RADS category 3 lesions with subjectively negative DCE-MRI show significant differences comparing CS-PCa to ISUP 1 PCa and benign lesions, in this study outperforming ADC. Studies are required to further evaluate these parameters to determine which patients should undergo targeted biopsy for PI-RADS 3 lesions. [ABSTRACT FROM AUTHOR]

Background: The study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PI-RADS v2.1-B. Results: Among TZ lesions (n = 78), 47 (60.0%) had T2WI score of 3, and 16 of the 47 (34.0%) were malignant. The rate of malignancy was 8.8% in PI-RADS category 3A, 100% in PI-RADS category 3B, and 100% in PI-RADS category 4. The apparent diffusion coefficient value of PI-RADS category 3B (0.934 ± 0.158 × 10−3 mm2/s) showed significant difference with that of PI-RADS category 3A (1.098 ± 0.146 × 10−3 mm2/s) but none with PI-RADS category 4 (0.821 ± 0.091 × 10−3 mm2/s). There was no significant difference in the sensitivity and negative predictive value of PI-RADS v2.1 and PI-RADS v2.1-B. Specificity and positive predictive value of modified PI-RADS v2.1-B were much higher than those of PI-RADS v2.1 for both readers (p <.001). The area under the receiver operating characteristic curve tended to be higher with PI-RADS v2.1-B than with PI-RADS v2.1. Conclusion: Biopsy for PI-RADS 3B lesion is necessary due to its superior malignancy potential than that of PI-RADS 3A lesion. [ABSTRACT FROM AUTHOR]

Introduction: The recent literature has focussed predominantly on prostate cancer detection which has been revolutionized by multiparametric magnetic resonance imaging (mpMRI). Due to an overlap of features, prostatitis may mimic prostate cancer on MRI, especially in patients with chronic prostatitis. We retrospectively analysed our in-gantry MRI-guided biopsy (MRGB) results to determine incidental detection rate of prostatitis in Prostate Imaging Reporting and Data System (PIRADS) 3, 4 and 5 foci reported on diagnostic MRI of the prostate.Methods: About 137 patients underwent in-gantry MRGB for lesions with PIRADS score of 3 or above. All the biopsies were performed utilizing the dynaTRIM™ system (Invio Inc, Germany) on a three-tesla MRI scanner (Ingenia 3.0T, Philips, Netherlands) by a Radiologist and a Urologist.Results: We biopsied 228 lesions in 137 patients. There were 55 lesions that returned positive for prostate cancer with a Gleason Score of 3 + 3 = 6 or above. There were 62 lesions that showed inflammation. The distribution of these lesions was 3 (5%) in the central zone, 32 (52%) in the transitional zone and 27 (43%) in the peripheral zone. Inflammation was found in 36 (58%) PIRADS 3 lesions, 24 (39%) PIRADS 4 lesions and 2 (3%) PIRADS 5 lesions on pre biopsy MRI evaluation.Conclusion: In our series, biopsies which showed inflammation had a radiological appearance on mpMRI more likely of a PIRADS 3 or 4 lesions with only 3% of PIRADS 5 biopsies showing inflammation. This would suggest that a higher PIRADS score can more reliably differentiate between prostate cancer and prostatitis. [ABSTRACT FROM AUTHOR]